{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T20:15:55Z","timestamp":1790799355792,"version":"4.1.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0010430","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,5,24]],"date-time":"2022-05-24T00:00:00Z","timestamp":1653350400000}}],"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2022,5,12]],"date-time":"2022-05-12T00:00:00Z","timestamp":1652313600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Universidad de las Americas, Quito-Ecuador","award":["Proyecto MED.MCH.19.09"],"award-info":[{"award-number":["Proyecto MED.MCH.19.09"]}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>In Ecuador, leptospirosis surveillance involves a mandatory notification of all cases and a hospitalization for severe illness. Morbidity and mortality are, nevertheless, underestimated and contribute directly to the status of leptospirosis as a neglected disease. <jats:italic>Leptospira<\/jats:italic> spp. is zoonotic in Ecuador with established endemic transmission in the Tropics. Here, we review retrospective national data within the country to aid in control strategies.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methodology\/Principal findings<\/jats:title>\n<jats:p>In a population-based nationwide study, we analysed morbidity, mortality, and spatial distribution on confirmed hospital-discharged leptospirosis cases from 2000\u20132020 from a publicly accesible National Database, including males and females of all ages. We computed data for the 24 provinces across the four-geoclimatic regions of Ecuador based on seasonal and monthly variations and calculated rates according to age and sex. The spatial distribution was estimated at the level of ecoregions, provinces, and cantons. A total of 2,584 hospitalizations were recorded over all three continental regions in 22 provinces, except Carchi province and the Galapagos Islands. The annual incidence varied from 0.27 to 2.45 cases per 100,000 inhabitants with ages ranging from 1 to 98 years-old and an overall male\/female ratio of 1.92:1. Most hospitalizations and deaths occurred in males ages 25\u201334 years. We registered 79 fatalities (3.06%); the highest mortality rate was 0.05 per 100,000 inhabitants. More cases clustered in the tropical cantons of central and north of the Coast and in the southern Amazon when compared to the Andes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions and significance<\/jats:title>\n<jats:p>Our findings evidence leptospirosis endemicity and pinpoint the highest incidence within resource-poor tropical settings. The highest incidence occurred in males of adult age, with those also exhibiting the highest mortality. The national incidence rate was stable, but peaks occurred intermittently during the rainy seasons. Thus, strategies aimed at leptospirosis monitoring and control involving the application of preventive measures should consider this season and the aforementioned high-risk groups.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0010430","type":"journal-article","created":{"date-parts":[[2022,5,12]],"date-time":"2022-05-12T17:51:37Z","timestamp":1652377897000},"page":"e0010430","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":29,"title":["Leptospirosis: Morbidity, mortality, and spatial distribution of hospitalized cases in Ecuador. A nationwide study 2000-2020"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0286-0747","authenticated-orcid":true,"given":"Manuel","family":"Calvopi\u00f1a","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"V\u00e1sconez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Coral-Almeida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Romero-Alvarez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel Angel","family":"Garcia-Bereguiain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Orlando","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,5,12]]},"reference":[{"key":"pntd.0010430.ref001","article-title":"Leptospirosis: A neglected tropical zoonotic infection of public health importance\u2013an updated review","author":"KB Karpagam","year":"2020","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"pntd.0010430.ref002","doi-asserted-by":"crossref","first-page":"e0003898","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":"pntd.0010430.ref003","unstructured":"World Health Organization 2010. Report of the First Meeting of the Leptospirosis Burden Epidemiology Reference Group. ISBN 978 92 4 159989 4 (NLM classification: WC 420). Geneva 2010."},{"key":"pntd.0010430.ref004","article-title":"Leptospira and Leptospirosis","author":"C Goarant","year":"2019","journal-title":"Global Water Pathogen Project"},{"key":"pntd.0010430.ref005","unstructured":"Pan American Health Organization Health (PAHO). 2015. Emergencies Department Analysis Leptospirosis: region of the Americas. https:\/\/www.paho.org\/hq\/dmdocuments\/2016\/2016-PHE-Leptospirosis-Schneider-Surv-Drivers.pdf"},{"key":"pntd.0010430.ref006","first-page":"65","article-title":"Leptospirosis in humans","volume":"387","author":"DA Haake","year":"2015","journal-title":"Current topics in microbiology and immunology"},{"issue":"9","key":"pntd.0010430.ref007","doi-asserted-by":"crossref","first-page":"e300","DOI":"10.1371\/journal.pntd.0000300","article-title":"The neglected tropical diseases of Latin America and the Caribbean: a review of disease burden and distribution and a roadmap for control and elimination","volume":"2","author":"PJ Hotez","year":"2008","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0010430.ref008","article-title":"Programa de Vigilancia Epidemiol\u00f3gica de leptospirosis Quito, Ecuador","author":"L Pati\u00f1o","year":"2010","journal-title":"Universidad central del Ecuador"},{"key":"pntd.0010430.ref009","unstructured":"Meneses-Ca\u00f1izares EA, Coral-Almeida M. 2018. 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Universidad de las Americas, Quito. https:\/\/repositorioslatinoamericanos.uchile.cl\/handle\/2250\/2791867?show=full"},{"issue":"12","key":"pntd.0010430.ref010","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.3201\/eid2112.140659","article-title":"High Prevalence of Intermediate Leptospira spp. DNA in Febrile Humans from Urban and Rural Ecuador","volume":"21","author":"J Chiriboga","year":"2015","journal-title":"Emerg Infect Dis"},{"issue":"1","key":"pntd.0010430.ref011","doi-asserted-by":"crossref","first-page":"146","DOI":"10.4269\/ajtmh.2009.81.146","article-title":"Etiology of Acute Undifferentiated Febrile Illness in the Amazon Basin of Ecuador","volume":"81","author":"SR Manock","year":"2009","journal-title":"Am J Trop Med Hyg"},{"key":"pntd.0010430.ref012","unstructured":"Ministerio de Salud P\u00fablica del Ecuador (MSP). 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