{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T03:21:11Z","timestamp":1788837671745,"version":"build-2803163510"},"reference-count":81,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Leptospirosis is a zoonotic disease prevalent in tropical regions influenced by climatic factors such as precipitation and soil moisture, which are regulated by the El Ni\u00f1o-Southern Oscillation (ENSO). This study examines the causal relationship between El Ni\u00f1o and La Ni\u00f1a episodes and leptospirosis cases in Colombia at the municipal level from 2007 to 2023. Using an ecological longitudinal design, we analyzed laboratory-confirmed cases from the National Public Health Surveillance System, environmental data from remote sensing, and socioeconomic data, employing a causal machine learning framework with doubly robust estimation and overlap weighting. We estimated the Average Treatment Effect (ATE) and the Conditional Average Treatment Effect (CATE) for three scenarios: Neutral vs. La Ni\u00f1a, Neutral vs. El Ni\u00f1o, and El Ni\u00f1o vs. La Ni\u00f1a. Results showed 10,629 cases, predominantly in males, with the highest incidence in Cali, Barranquilla, San Jos\u00e9 del Guaviare, and Cartagena. La Ni\u00f1a was associated with a 1.2 percentage point reduction in the probability of excess leptospirosis cases (ATE\u2009=\u2009-0.012, 95% CI: -0.015 \u2013 -0.008), while El Ni\u00f1o corresponded with a 7.2 percentage point increase in the probability of excess leptospirosis cases (ATE\u2009=\u20090.072, 95% CI: 0.041 \u2013 0.103) compared to Neutral episodes. The El Ni\u00f1o vs. La Ni\u00f1a comparison showed no significant effect. As sea surface temperatures rose in the Pacific Ocean off the Colombian coast, the impact of both El Ni\u00f1o and La Ni\u00f1a episodes was observed to diminish, according to the CATE analysis. Regional variations, particularly in the Orinoco and Amazon regions, seem to drive these national trends, probably due to inverse hydro-climatic responses to ENSO. Refutation tests indicated the presence of remaining bias for the scenarios Neutral vs. El Ni\u00f1o and El Ni\u00f1o vs. La Ni\u00f1a. These findings highlight the complex interplay between climate and leptospirosis, underscoring the need for region-specific public health strategies to mitigate climate-driven disease risks in Colombia.<\/jats:p>","DOI":"10.1371\/journal.pgph.0005238","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T18:35:51Z","timestamp":1762454151000},"page":"e0005238","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sea surface temperature modulates El Ni\u00f1o and La Ni\u00f1a driven leptospirosis patterns: Evidence from causal machine learning in Colombia"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6120-941X","authenticated-orcid":true,"given":"Juan David","family":"Guti\u00e9rrez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1067-4079","authenticated-orcid":true,"given":"Juan","family":"Wilches-Vega","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0026-4829","authenticated-orcid":true,"given":"Fabi\u00e1n","family":"Galvis-Serrano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holver","family":"Parada-Jurado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5876-165X","authenticated-orcid":true,"given":"Javier","family":"Cortes-Ram\u00edrez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,11,6]]},"reference":[{"issue":"2","key":"pgph.0005238.ref001","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1128\/CMR.14.2.296-326.2001","article-title":"Leptospirosis","volume":"14","author":"PN Levett","year":"2001","journal-title":"Clin Microbiol Rev"},{"issue":"1","key":"pgph.0005238.ref002","doi-asserted-by":"crossref","first-page":"14","DOI":"10.7861\/clinmed.2021-0784","article-title":"Leptospirosis: clinical aspects","volume":"22","author":"S Rajapakse","year":"2022","journal-title":"Clin Med (Lond)"},{"issue":"12","key":"pgph.0005238.ref003","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/S1473-3099(03)00830-2","article-title":"Leptospirosis: a zoonotic disease of global importance","volume":"3","author":"AR Bharti","year":"2003","journal-title":"Lancet Infect Dis"},{"issue":"9","key":"pgph.0005238.ref004","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0003898","article-title":"Global Morbidity and Mortality of Leptospirosis: A Systematic Review","volume":"9","author":"F Costa","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"pgph.0005238.ref005","doi-asserted-by":"crossref","DOI":"10.26633\/RPSP.2023.126","article-title":"Prevalence of human leptospirosis in the Americas: a systematic review and meta-analysis","volume":"47","author":"ES Browne","year":"2023","journal-title":"Rev Panam Salud Publica"},{"issue":"4","key":"pgph.0005238.ref006","first-page":"856","article-title":"Serologically Confirmed Human Leptospirosis in Colombia, 2015-2020","volume":"111","author":"EL Parra-Barrera","year":"2024","journal-title":"Am J Trop Med Hyg"},{"key":"pgph.0005238.ref007","doi-asserted-by":"crossref","first-page":"6473851","DOI":"10.1155\/2018\/6473851","article-title":"Clinical and Epidemiological Status of Leptospirosis in a Tropical Caribbean Area of Colombia","volume":"2018","author":"V Tique","year":"2018","journal-title":"Biomed Res Int"},{"issue":"35","key":"pgph.0005238.ref008","doi-asserted-by":"crossref","first-page":"763","DOI":"10.15585\/mmwr.mm7335a2","article-title":"Leptospirosis Outbreak in Aftermath of Hurricane Fiona - 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