{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T14:03:47Z","timestamp":1792677827072,"version":"4.5.0"},"reference-count":84,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>\n                    Leptospirosis is a globally significant zoonoses that contributes to 1.03 million infections and 58,900 deaths annually. Animal reservoirs carry pathogenic\n                    <jats:italic>Leptospira<\/jats:italic>\n                    in the kidneys and contaminate the environment via urine. Contact of mucous membranes or abrasions with pathogenic\n                    <jats:italic>Leptospira<\/jats:italic>\n                    commonly leads to infection in humans. Leptospirosis has various presentations, ranging from an acute self-limiting infection to a severe infection with multi-organ involvement requiring hospitalization. In 2008, leptospirosis cases in Sri Lanka spiked, marking a potential emergence event. In the current work, cases of reported leptospirosis were analyzed from 2007 to 2024 identifying an overall increase in leptospirosis over the study period and annual seasonality. Increased precipitation seems to be driving the seasonal spikes in leptospirosis case rates across Sri Lanka. District level case rates over the 18-year time frame increased in the southern districts and indicated a dissemination to northern districts. A low-low spatial cluster, signifying an area of lower disease, was identified in the northern districts from 2007 to 2012, but was not observed from 2013 to 2024. A high-high spatial cluster, indicating an area of increased incidence, was identified from 2013 to 2024. District level precipitation and case rates were correlated over the 18-year study period, suggesting that rainfall is a driver of disease in Sri Lanka. While this correlation was identified to be significant, the correlation weakens over time when analyzed per annum with 2011 and 2024 showing no link. No correlation was identified in 2011, however, analysis of precipitation trends and case rates over the year show that major flooding events drove anomalous increases in leptospirosis case rates throughout the country. In 2024, a record year in reported leptospirosis, there was also no correlation over the entire year but the seasonality of disease still aligns with the overall trend. Investigation of renal carriage in five potential animal reservoirs identified that all carried the\n                    <jats:italic>lipL32<\/jats:italic>\n                    gene of pathogenic\n                    <jats:italic>Leptospira<\/jats:italic>\n                    species. Together, this work identified temporal and spatial trends of human leptospirosis in Sri Lanka, identifying a link with precipitation as a potential driver of disease, and further characterized localized renal carriage of animal reservoirs linked to environmental contamination.\n                  <\/jats:p>","DOI":"10.3389\/fpubh.2026.1814638","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T05:43:46Z","timestamp":1779083026000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Spatiotemporal dynamics and environmental trends of reported human leptospirosis in Sri Lanka, 2007\u20132024"],"prefix":"10.3389","volume":"14","author":[{"given":"Ian A.","family":"McMillan","sequence":"first","affiliation":[{"name":"Daniel K. Inouye Center for Microbial Oceanography: Research and Education, School of Ocean and Earth Science and Technology, University of Hawai\u2019i at M\u0101noa","place":["Honolulu, HI, United States"]},{"name":"Pathogen Analysis and Translational Health Group, School of Life Sciences, University of Hawai\u2019i at M\u0101noa","place":["Honolulu, HI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prashant","family":"Dahal","sequence":"additional","affiliation":[{"name":"Pathogen Analysis and Translational Health Group, School of Life Sciences, University of Hawai\u2019i at M\u0101noa","place":["Honolulu, HI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md Samun","family":"Sarker","sequence":"additional","affiliation":[{"name":"Pathogen Analysis and Translational Health Group, School of Life Sciences, University of Hawai\u2019i at M\u0101noa","place":["Honolulu, HI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thi Hai Au","family":"La","sequence":"additional","affiliation":[{"name":"Pathogen Analysis and Translational Health Group, School of Life Sciences, University of Hawai\u2019i at M\u0101noa","place":["Honolulu, HI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jourdan K. P.","family":"McMillan","sequence":"additional","affiliation":[{"name":"Department of Tropical Medicine, Medical Microbiology & Pharmacology, John A. Burns School of Medicine, University of Hawai\u2019i at M\u0101noa","place":["Honolulu, HI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra P.","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Tropical Medicine, Medical Microbiology & Pharmacology, John A. Burns School of Medicine, University of Hawai\u2019i at M\u0101noa","place":["Honolulu, HI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siriwardana Rampalage","family":"Sarathchandra","sequence":"additional","affiliation":[{"name":"Rice Research and Development Institute","place":["Batalagoda, Sri Lanka"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chandika","family":"Gamage","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, University of Peradeniya","place":["Peradeniya, Sri Lanka"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael H.","family":"Norris","sequence":"additional","affiliation":[{"name":"Pathogen Analysis and Translational Health Group, School of Life Sciences, University of Hawai\u2019i at M\u0101noa","place":["Honolulu, HI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1016\/s1473-3099(03)00830-2","article-title":"Leptospirosis: a zoonotic disease of global importance","volume":"3","author":"Bharti","year":"2003","journal-title":"Lancet Infect Dis"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1097\/01.qco.0000178824.05715.2c","article-title":"Leptospirosis","volume":"18","author":"McBride","year":"2005","journal-title":"Curr Opin Infect Dis"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1016\/S0140-6736(96)91167-8","article-title":"Leptospirosis associated with outbreak of acute febrile illness and pulmonary haemorrhage, Nicaragua, 1995","volume":"347","author":"Zaki","year":"1996","journal-title":"Lancet"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1086\/427110","article-title":"Clinical spectrum of pulmonary involvement in leptospirosis in a region of endemicity, with quantification of leptospiral burden","volume":"40","author":"Segura","year":"2005","journal-title":"Clin Infect Dis"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"505","DOI":"10.3201\/eid1403.071064","article-title":"Leptospirosis-associated severe pulmonary hemorrhagic syndrome, Salvador, Brazil","volume":"14","author":"Gouveia","year":"2008","journal-title":"Emerg Infect Dis"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"834","DOI":"10.3201\/eid1505.080270","article-title":"Pulmonary involvement and leptospirosis, Greece","volume":"15","author":"Papa","year":"2009","journal-title":"Emerg Infect Dis"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1016\/s0140-6736(13)60647-9","article-title":"Acute kidney injury: an increasing global concern","volume":"382","author":"Lameire","year":"2013","journal-title":"Lancet"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e0007205","DOI":"10.1371\/journal.pntd.0007205","article-title":"A simple score to predict severe leptospirosis","volume":"13","author":"Smith","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"911","DOI":"10.4269\/ajtmh.2008.79.911","article-title":"Predictors of lethality in severe leptospirosis in urban Brazil","volume":"79","author":"Spichler","year":"2008","journal-title":"Am J Trop Med Hyg"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e2324","DOI":"10.1371\/journal.pntd.0002324","article-title":"Etiology of severe non-malaria febrile illness in northern Tanzania: a prospective cohort study","volume":"7","author":"Crump","year":"2013","journal-title":"PLoS Negl Trop Dis"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.actatropica.2005.07.001","article-title":"Leptospirosis among patients presenting with dengue-like illness in Puerto Rico","volume":"96","author":"Bruce","year":"2005","journal-title":"Acta Trop"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"657","DOI":"10.4269\/ajtmh.2001.65.657","article-title":"Referral pattern of leptospirosis cases during a large urban epidemic of dengue","volume":"65","author":"Flannery","year":"2001","journal-title":"Am J Trop Med Hyg"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"766","DOI":"10.3201\/eid1105.041212","article-title":"Leptospirosis during dengue outbreak, Bangladesh","volume":"11","author":"LaRocque","year":"2005","journal-title":"Emerg Infect Dis"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1089\/vbz.2007.0241","article-title":"Underrecognition of leptospirosis during a dengue fever outbreak in Hawaii, 2001\u20132002","volume":"8","author":"Ellis","year":"2008","journal-title":"Vector Borne Zoonotic Dis"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e0003898","DOI":"10.1371\/journal.pntd.0003898","article-title":"Global morbidity and mortality of leptospirosis: a systematic review","volume":"9","author":"Costa","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e0004122","DOI":"10.1371\/journal.pntd.0004122","article-title":"Global burden of leptospirosis: estimated in terms of disability adjusted life years","volume":"9","author":"Torgerson","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"ofaf035","DOI":"10.1093\/ofid\/ofaf035","article-title":"Leptospirosis\u2014improving healthcare outcomes for a neglected tropical disease","volume":"12","author":"Mu\u00f1oz-Zanzi","year":"2025","journal-title":"Open Forum Infect Dis"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1038\/nrmicro2208","article-title":"Leptospira: the dawn of the molecular genetics era for an emerging zoonotic pathogen","volume":"7","author":"Ko","year":"2009","journal-title":"Nat Rev Microbiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1111\/j.1749-6632.1958.tb35398.x","article-title":"Animal reservoirs of leptospires","volume":"70","author":"Babudieri","year":"1958","journal-title":"Ann N Y Acad Sci"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"4280","DOI":"10.1111\/1462-2920.12766","article-title":"Leptospira and paramyxovirus infection dynamics in a bat maternity enlightens pathogen maintenance in wildlife","volume":"17","author":"Dietrich","year":"2015","journal-title":"Environ Microbiol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"2783","DOI":"10.1111\/mec.12777","article-title":"Diversification of an emerging pathogen in a biodiversity hotspot: Leptospira in endemic small mammals of Madagascar","volume":"23","author":"Dietrich","year":"2014","journal-title":"Mol Ecol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e0004933","DOI":"10.1371\/journal.pntd.0004933","article-title":"Identification of Tenrec ecaudatus, a wild mammal introduced to Mayotte Island, as a reservoir of the newly identified human pathogenic Leptospira mayottensis","volume":"10","author":"Lagadec","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e2902","DOI":"10.1371\/journal.pntd.0002902","article-title":"Epidemiology of Leptospira transmitted by rodents in Southeast Asia","volume":"8","author":"Cosson","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e0003819","DOI":"10.1371\/journal.pntd.0003819","article-title":"Patterns in Leptospira shedding in Norway rats (Rattus norvegicus) from Brazilian slum communities at high risk of disease transmission","volume":"9","author":"Costa","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e0004990","DOI":"10.1371\/journal.pntd.0004990","article-title":"High Leptospira diversity in animals and humans complicates the search for common reservoirs of human disease in rural Ecuador","volume":"10","author":"Barragan","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"337","DOI":"10.4269\/ajtmh.2012.12-0187","article-title":"Leptospira infection prevalence in small mammal host populations on three Hawaiian islands","volume":"87","author":"Wong","year":"2012","journal-title":"Am Soc Trop Med Hyg"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"e0004733","DOI":"10.1371\/journal.pntd.0004733","article-title":"Human leptospirosis on Reunion Island, Indian Ocean: are rodents the (only) ones to blame?","volume":"10","author":"Guernier","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1111\/zph.12266","article-title":"Feral swine Leptospira seroprevalence survey in Hawaii, USA, 2007\u20132009","volume":"63","author":"Buchholz","year":"2016","journal-title":"Zoonoses Public Health"},{"key":"ref29","first-page":"35","article-title":"Cell aggregation: a mechanism of pathogenic Leptospira to survive in fresh water","volume":"7","author":"Trueba","year":"2004","journal-title":"Int Microbiol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1099\/mic.0.2007\/014746-0","article-title":"Biofilm formation by saprophytic and pathogenic leptospires","volume":"154","author":"Ristow","year":"2008","journal-title":"Microbiology"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1593","DOI":"10.1086\/340615","article-title":"Outbreak of leptospirosis among triathlon participants and community residents in Springfield, Illinois, 1998","volume":"34","author":"Morgan","year":"2002","journal-title":"Clin Infect Dis"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1017\/S0950268813001465","article-title":"Outbreak of leptospirosis after white-water rafting: sign of a shift from rural to recreational leptospirosis in Sri Lanka?","volume":"142","author":"Agampodi","year":"2014","journal-title":"Epidemiol Infect"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"702","DOI":"10.3201\/eid0906.020751","article-title":"Leptospirosis in \u201ceco-challenge\u201d athletes, Malaysian Borneo, 2000","volume":"9","author":"Sejvar","year":"2003","journal-title":"Emerg Infect Dis"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1016\/j.trstmh.2008.05.010","article-title":"Leptospirosis in a subsistence farming community in Brazil","volume":"102","author":"Lacerda","year":"2008","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e579","DOI":"10.1371\/journal.pntd.0000579","article-title":"Increasing trends of leptospirosis in northern India: a clinico-epidemiological study","volume":"4","author":"Sethi","year":"2010","journal-title":"PLoS Negl Trop Dis"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1128\/CMR.14.2.296-326.2001","article-title":"Leptospirosis","volume":"14","author":"Levett","year":"2001","journal-title":"Clin Microbiol Rev"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"763","DOI":"10.15585\/mmwr.mm7335a2","article-title":"Leptospirosis outbreak in aftermath of hurricane Fiona \u2014 Puerto Rico, 2022","volume":"73","author":"Jones","year":"2024","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"399","DOI":"10.4269\/ajtmh.1999.61.399","article-title":"Increase of leptospirosis in dengue-negative patients after a hurricane in Puerto Rico in 1996 [correction of 1966]","volume":"61","author":"Sanders","year":"1999","journal-title":"Am J Trop Med Hyg"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"424","DOI":"10.3390\/pollutants4030028","article-title":"Extreme weather events and pathogen pollution fuel infectious diseases: the 2024 flood-related leptospirosis outbreak in southern Brazil and other red lights","volume":"4","author":"Ziliotto","year":"2024","journal-title":"Pollutants"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"e3338","DOI":"10.1371\/journal.pntd.0003338","article-title":"Influence of household rat infestation on Leptospira transmission in the urban slum environment","volume":"8","author":"Costa","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"820","DOI":"10.1016\/S0140-6736(99)80012-9","article-title":"Urban epidemic of severe leptospirosis in Brazil","volume":"354","author":"Ko","year":"1999","journal-title":"Lancet"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"e154","DOI":"10.1371\/journal.pntd.0000154","article-title":"Household transmission of Leptospira infection in urban slum communities","volume":"2","author":"Maciel","year":"2008","journal-title":"PLoS Negl Trop Dis"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"e308","DOI":"10.1371\/journal.pmed.0030308","article-title":"Determining risk for severe leptospirosis by molecular analysis of environmental surface waters for pathogenic Leptospira","volume":"3","author":"Ganoza","year":"2006","journal-title":"PLoS Med"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"e2927","DOI":"10.1371\/journal.pntd.0002927","article-title":"Prospective study of leptospirosis transmission in an urban slum community: role of poor environment in repeated exposures to the Leptospira agent","volume":"8","author":"Felzemburgh","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"e228","DOI":"10.1371\/journal.pntd.0000228","article-title":"Impact of environment and social gradient on Leptospira infection in urban slums","volume":"2","author":"Reis","year":"2008","journal-title":"PLoS Negl Trop Dis"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"337","DOI":"10.4103\/0255-0857.29413","article-title":"Leptospirosis in Mumbai: post-deluge outbreak 2005","volume":"24","author":"Maskey","year":"2006","journal-title":"Indian J Med Microbiol"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"1054","DOI":"10.1136\/jech.2003.018556","article-title":"Relation of rainfall pattern and epidemic leptospirosis in the Indian state of Kerala","volume":"58","author":"Pappachan","year":"2004","journal-title":"J Epidemiol Community Health"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"957","DOI":"10.4269\/ajtmh.2008.78.957","article-title":"Seroprevalence of leptospirosis and risk factor analysis in flood-prone rural areas in Lao PDR","volume":"78","author":"Kawaguchi","year":"2008","journal-title":"Am J Trop Med Hyg"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1186\/1471-2334-9-147","article-title":"Leptospirosis in the Asia Pacific region","volume":"9","author":"Victoriano","year":"2009","journal-title":"BMC Infect Dis"},{"key":"ref50","article-title":"Leptospirosis following a flood in the Veneto area, North-east Italy","volume":"18","author":"Pellizzer","year":"2006","journal-title":"Ann Ig"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1179\/136485908X278784","article-title":"Leptospirosis: case reports of an outbreak in Guyana","volume":"102","author":"Liverpool","year":"2008","journal-title":"Ann Trop Med Parasitol"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.1086\/314424","article-title":"Epidemic leptospirosis associated with pulmonary hemorrhage-Nicaragua, 1995","volume":"178","author":"Trevejo","year":"1998","journal-title":"J Infect Dis"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"926","DOI":"10.1111\/j.1365-3156.2009.02310.x","article-title":"Outbreak of leptospirosis in New Caledonia: diagnosis issues and burden of disease","volume":"14","author":"Goarant","year":"2009","journal-title":"Trop Med Int Health"},{"key":"ref54","first-page":"22","article-title":"Outbreak of leptospirosis after the cyclone in Orissa","volume":"15","author":"Sehgal","year":"2002","journal-title":"Natl Med J India"},{"key":"ref55","first-page":"131","article-title":"The relationship between rainfall and human leptospirosis in Florian\u00f3polis, Brazil, 1991-1996","volume":"4","author":"Kupek","year":"2000","journal-title":"Braz J Infect Dis"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"e0011717","DOI":"10.1371\/journal.pntd.0011717","article-title":"Climate-driven models of leptospirosis dynamics in tropical islands from three oceanic basins","volume":"18","author":"Douchet","year":"2024","journal-title":"PLoS Negl Trop Dis"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"980","DOI":"10.4269\/ajtmh.25-0267","article-title":"Analysis of confirmed leptospirosis cases in Hawai\u2019i identifies spatial and environmental patterns of incidence","volume":"113","author":"McMillan","year":"2025","journal-title":"Am J Trop Med Hyg"},{"key":"ref58","first-page":"51","article-title":"Epidemiologic and clinical study of leptospirosis in Bourail (New Caledonia)","volume":"92","author":"Bour\u00e9e","year":"1999","journal-title":"Bull Soc Pathol Exot"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"933","DOI":"10.4269\/ajtmh.1998.59.933","article-title":"Human leptospirosis in the Seychelles (Indian Ocean): a population-based study","volume":"59","author":"Yersin","year":"1998","journal-title":"Am J Trop Med Hyg"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1016\/S1473-3099(09)70211-7","article-title":"The potential emergence of leptospirosis in Sri Lanka","volume":"9","author":"Agampodi","year":"2009","journal-title":"Lancet Infect Dis"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"124","DOI":"10.3201\/eid1301.060718","article-title":"Clinical diagnosis and geographic distribution of leptospirosis, Thailand","volume":"13","author":"Wuthiekanun","year":"2007","journal-title":"Emerg Infect Dis"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"2106","DOI":"10.1017\/s0950268815000205","article-title":"Spatio-temporal patterns of leptospirosis in Thailand: is flooding a risk factor?","volume":"143","author":"Suwanpakdee","year":"2015","journal-title":"Epidemiol Infect"},{"key":"ref63","year":""},{"key":"ref64","volume-title":"CHIRPS: Rainfall Estimates from Rain Gauge and Satellite Observations","year":"2025"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1111\/j.1538-4632.1995.tb00338.x","article-title":"Local indicators of spatial association\u2014LISA","volume":"27","author":"Anselin","year":"1995","journal-title":"Geogr Anal"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"1363","DOI":"10.3390\/pathogens11111363","article-title":"An investigation of Burkholderia pseudomallei Seroprevalence in market pigs slaughtered at selected pig abattoirs in Uganda","volume":"11","author":"Ekakoro","year":"2022","journal-title":"Pathogens"},{"key":"ref67","doi-asserted-by":"publisher","first-page":"e00780-24","DOI":"10.1128\/jcm.00780-24","article-title":"Serosurveillance of Coxiella burnetii in feral swine populations of Hawai\u02bbi and Texas identifies overlap with human Q fever incidence","volume":"62","author":"McMillan","year":"2024","journal-title":"J Clin Microbiol"},{"key":"ref68","doi-asserted-by":"publisher","first-page":"1692664","DOI":"10.3389\/fepid.2025.1692664","article-title":"Exposure of feral swine to Coxiella burnetii overlaps with human Q fever incidence in California","volume":"5","author":"McMillan","year":"2026","journal-title":"Front Epidemiol"},{"key":"ref69","doi-asserted-by":"publisher","first-page":"1440933","DOI":"10.3389\/fpubh.2024.1440933","article-title":"Tracking sero-molecular trends of swine brucellosis in Hawai\u2018i and the Central Pacific","volume":"12","author":"La","year":"2024","journal-title":"Front Public Health"},{"key":"ref70","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1099\/jmm.0.45860-0","article-title":"Detection of pathogenic leptospires by real-time quantitative PCR","volume":"54","author":"Levett","year":"2005","journal-title":"J Med Microbiol"},{"key":"ref71","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/j.diagmicrobio.2009.03.014","article-title":"Detection of pathogenic Leptospira spp. through TaqMan polymerase chain reaction targeting the LipL32 gene","volume":"64","author":"Stoddard","year":"2009","journal-title":"Diagn Microbiol Infect Dis"},{"key":"ref72","doi-asserted-by":"publisher","first-page":"102286","DOI":"10.1016\/j.cimid.2024.102286","article-title":"Molecular detection and phylogenetic analysis of Leptospira interrogans and Leptospira borgpetersenii in cats from central region of Rio Grande do Sul state, Brazil","volume":"116","author":"Ulsenheimer","year":"2025","journal-title":"Comp Immunol Microbiol Infect Dis"},{"key":"ref73","doi-asserted-by":"publisher","first-page":"e0009959","DOI":"10.1371\/journal.pntd.0009959","article-title":"Diverse lineages of pathogenic Leptospira species are widespread in the environment in Puerto Rico, USA","volume":"16","author":"Stone","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"key":"ref74","doi-asserted-by":"publisher","first-page":"124","DOI":"10.12688\/wellcomeopenres.14826.1","article-title":"Open-access bacterial population genomics: BIGSdb software, the PubMLST.org website and their applications","volume":"3","author":"Jolley","year":"2018","journal-title":"Wellcome Open Res"},{"key":"ref75","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1016\/j.meegid.2013.08.002","article-title":"Reassessment of MLST schemes for Leptospira spp. typing worldwide","volume":"22","author":"Varni","year":"2014","journal-title":"Infect Genet Evol"},{"key":"ref76","doi-asserted-by":"publisher","first-page":"e2022015","DOI":"10.4178\/epih.e2022015","article-title":"Neglecting the neglected during the COVID-19 pandemic: the case of leptospirosis in Sri Lanka","volume":"44","author":"Warnasekara","year":"2022","journal-title":"Epidemiol Health"},{"key":"ref77","doi-asserted-by":"publisher","first-page":"e2626","DOI":"10.1371\/journal.pntd.0002626","article-title":"Regional differences of leptospirosis in Sri Lanka: observations from a flood-associated outbreak in 2011","volume":"8","author":"Agampodi","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"key":"ref78","doi-asserted-by":"publisher","first-page":"73","DOI":"10.4038\/josuk.v17i2.8109","article-title":"A model for predicting confirmed leptospirosis cases in Sri Lanka","volume":"17","author":"Ekanayake","year":"2024","journal-title":"J Sci Univ Kelaniya"},{"key":"ref79","year":"2011"},{"key":"ref80","year":"2011"},{"key":"ref81","doi-asserted-by":"publisher","first-page":"002133","DOI":"10.1099\/jmm.0.002133","article-title":"Molecular epidemiology of rodent-borne Leptospira spp. in Sri Lanka: identification of novel sequence types and previously unrecognized reservoir animals","volume":"75","author":"Rathnayake","year":"2026","journal-title":"J Med Microbiol"},{"key":"ref82","doi-asserted-by":"publisher","first-page":"1154","DOI":"10.1017\/S0950268812002075","article-title":"Endemicity of leptospirosis in domestic and wild animal species from Reunion Island (Indian Ocean)","volume":"141","author":"Desvars","year":"2013","journal-title":"Epidemiol Infect"},{"key":"ref83","doi-asserted-by":"publisher","first-page":"e0007236","DOI":"10.1371\/journal.pntd.0007236","article-title":"The prevalence of Leptospira among invasive small mammals on Puerto Rican cattle farms","volume":"13","author":"Benavidez","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"key":"ref84","doi-asserted-by":"publisher","first-page":"311","DOI":"10.3201\/eid2602.190102","article-title":"Influence of rainfall on Leptospira infection and disease in a tropical urban setting, Brazil","volume":"26","author":"Hacker","year":"2020","journal-title":"Emerg Infect Dis"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1814638\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T05:43:48Z","timestamp":1779083028000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1814638\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,18]]},"references-count":84,"alternative-id":["10.3389\/fpubh.2026.1814638"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1814638","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,18]]},"article-number":"1814638"}}