{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:20:22Z","timestamp":1790835622776,"version":"4.1.0"},"reference-count":84,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2017,6,3]],"date-time":"2017-06-03T00:00:00Z","timestamp":1496448000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Record-breaking and devastating rainfall events have occurred in the past decade. Rain and floods are considered the main risk factors for leptospirosis and several outbreaks have been reported following extreme weather events. In such situations, one possible intervention to prevent leptospirosis cases in high-risk groups is the use of chemoprophylaxis. However, not enough evidence of its effect is available. The objectives of this study were to review the literature on the current practices of chemoprophylaxis for leptospirosis and to explore, using a mathematical model, how various chemoprophylaxis scenarios may affect the progression of a leptospirosis outbreak. Twenty-six peer-reviewed publications were selected (10 quantitative studies, two systematic reviews and 14 articles of other types). Oral doxycycline was the most used antibiotic for chemoprophylaxis of leptospirosis. Post-exposure prophylaxis was assessed in four studies following a natural disaster. Although evidence of the effectiveness of post-exposure prophylaxis is inconsistent, the direction of association supported a protective effect for morbidity and mortality. The theoretical model showed how the assumed benefit of chemoprophylaxis was influenced by the time and rate of administration. Future models should consider the heterogeneity of affected communities, improved estimates of the effect of chemoprophylaxis on leptospirosis infection and disease, as well as potential detrimental impacts. Additional research is critical to provide clear evidence-based recommendations for leptospirosis control during an outbreak. The results of this study suggest that chemoprophylaxis may provide some protection in reducing the number of leptospirosis cases after a high-risk exposure; however, the effective benefit may depend on a variety of factors such as the timing and coverage of prophylaxis. The information summarized can be used to support decision-making during a high-risk event.<\/jats:p>","DOI":"10.3390\/ijerph14060594","type":"journal-article","created":{"date-parts":[[2017,6,6]],"date-time":"2017-06-06T10:53:09Z","timestamp":1496746389000},"page":"594","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["The Use of Chemoprophylaxis after Floods to Reduce the Occurrence and Impact of Leptospirosis Outbreaks"],"prefix":"10.3390","volume":"14","author":[{"given":"Maria","family":"Schneider","sequence":"first","affiliation":[{"name":"PAHO Health Emergencies Department, Pan American Health Organization, Washington, DC 20037, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Velasco-Hernandez","sequence":"additional","affiliation":[{"name":"Instituto de Matematicas, National Autonomous University of Mexico, Juriquilla 76230, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung-duk","family":"Min","sequence":"additional","affiliation":[{"name":"PAHO Health Emergencies Department, Pan American Health Organization, Washington, DC 20037, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deise","family":"Leonel","sequence":"additional","affiliation":[{"name":"PAHO Health Emergencies Department, Pan American Health Organization, Washington, DC 20037, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Baca-Carrasco","sequence":"additional","affiliation":[{"name":"Instituto de Matematicas, National Autonomous University of Mexico, Juriquilla 76230, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Gompper","sequence":"additional","affiliation":[{"name":"School of Natural Resources, University of Missouri, Columbia, MO 65211, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudy","family":"Hartskeerl","sequence":"additional","affiliation":[{"name":"WHO\/FAO\/OIE and National Leptospirosis Reference Centre, Amsterdam 1105, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Munoz-Zanzi","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2017,6,3]]},"reference":[{"key":"ref_1","unstructured":"Intergovernmental Panel on Climate Change (2014). Climate Change 2014 Synthesis Report: Summary for Policymakers, IPCC."},{"key":"ref_2","unstructured":"Guha-Sapir, D., Below, R., and Hoyois, P. (2017, February 15). EM-DAT: The International Disaster Database. Available online: www.emdat.be."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1038\/nclimate1452","article-title":"A decade of weather extremes","volume":"2","author":"Coumou","year":"2012","journal-title":"Nat. Clim. Chang."},{"key":"ref_4","unstructured":"National Centers for Environmental Information (2017, February 15). Global Climate Report\u2014Annual 2010, Available online: https:\/\/www.ncdc.noaa.gov\/sotc\/global\/201013."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Mwachui, M.A., Crump, L., Hartskeerl, R., Zinsstag, J., and Hattendorf, J. (2015). Environmental and behavioural determinants of leptospirosis transmission: A systematic review. PLoS Negl. Trop. Dis., 9.","DOI":"10.1371\/journal.pntd.0003843"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"309","DOI":"10.4269\/ajtmh.2012.11-0398","article-title":"Leptospirosis in American Samoa 2010: Epidemiology, environmental drivers, and the management of emergence","volume":"86","author":"Lau","year":"2012","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"91","DOI":"10.3201\/eid1801.101892","article-title":"Outbreak of leptospirosis after flood, the Philippines, 2009","volume":"18","author":"Amilasan","year":"2012","journal-title":"Emerg. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S59","DOI":"10.1590\/S0102-311X2001000700014","article-title":"The place behind the case: Leptospirosis risks and associated environmental conditions in a flood-related outbreak in Rio de Janeiro","volume":"17","author":"Barcellos","year":"2001","journal-title":"Cad. Saude Publica."},{"key":"ref_9","doi-asserted-by":"crossref","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":"ref_10","doi-asserted-by":"crossref","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":"ref_11","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1086\/314424","article-title":"Epidemic leptospirosis associated with pulmonary hemorrhage\u2014Nicaragua, 1995","volume":"178","author":"Trevejo","year":"1998","journal-title":"J. Infect. Dis."},{"key":"ref_12","first-page":"453","article-title":"Leptospirosis following a flood in the Veneto area, North-East Italy","volume":"18","author":"Pellizzer","year":"2006","journal-title":"Ann. Ig."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"882","DOI":"10.4269\/ajtmh.2007.76.882","article-title":"Leptospirosis on Oahu: An outbreak associated with flooding of a university campus","volume":"76","author":"Gaynor","year":"2007","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_14","unstructured":"Solomon, S., Qin, D., Manning, M., Chen, Z., Marquis, M., Averyt, K.B., Tignor, M., and Miller, H.L. (2007). Summary for Policymakers. Climate Change 2007: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change, Cambridge University Press."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Melillo, J.M., Richmond, T., and Yohe, G.W. (2014). Climate Change Impacts in the United States: The Third National Climate Assessment.","DOI":"10.7930\/J0Z31WJ2"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3201\/eid1301.060779","article-title":"Epidemics after natural disasters","volume":"13","author":"Watson","year":"2007","journal-title":"Emerg. Infect. Dis."},{"key":"ref_17","first-page":"193","article-title":"Natural disasters and communicable diseases in the Americas: Contribution of veterinary public health","volume":"48","author":"Schneider","year":"2012","journal-title":"Vet. Ital."},{"key":"ref_18","unstructured":"Pan American Health Organization (2012). Health in the Americas\u2014Regional Outlook and Country Profiles, PAHO. [2012 ed.]."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"7229","DOI":"10.3390\/ijerph10127229","article-title":"Leptospirosis: A silent epidemic disease","volume":"10","author":"Schneider","year":"2013","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_20","unstructured":"World Health Organization (2003). Human Leptospirosis: Guidance for Diagnosis, Surveillance and Control, WHO."},{"key":"ref_21","unstructured":"Acha, P., and Szyfres, B. (2003). Zoonoses and Communicable Diseases Common to Man and Animals: Bacterioses and Mycoses, Pan American Health Organization. [3rd ed.]."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","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":"ref_23","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1128\/CMR.14.2.296-326.2001","article-title":"Leptospirosis","volume":"14","author":"Levett","year":"2001","journal-title":"Clin. Microbial. Rev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/j.trstmh.2010.07.002","article-title":"Climate change, flooding, urbanisation and leptospirosis: Fuelling the fire?","volume":"104","author":"Lau","year":"2010","journal-title":"Transact. Royal Soc. Trop. Med. Hyg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e81","DOI":"10.26633\/RPSP.2017.81","article-title":"Leptospirosis in Latin America: Exploring the first set of regional data","volume":"41","author":"Schneider","year":"2017","journal-title":"Rev. Panam. Salud Publica"},{"key":"ref_26","first-page":"74","article-title":"Leptospirosis anict\u00e9rica: An\u00e1lisis de una epidemia en Costa Rica","volume":"33","author":"Boza","year":"1990","journal-title":"Acta Med. Costarric"},{"key":"ref_27","unstructured":"Pan American Health Organization (1998). Impacto del hurac\u00e1n mitch en Centro Am\u00e9rica. Boletin. Epidemiologico., 19, 1\u201313. (In Spainish)."},{"key":"ref_28","unstructured":"Rodr\u00edguez, T., Cruz, L., Rangel, G.S., and Vides, R. (2002). Brote de leptospirosis en el caser\u00edo las guarumas, cant\u00f3n cerco de piedra, municipio de chapeltique, san miguel, el salvador, 15 de febrero de 2002. Encuesta Transversal, 1\u20139. (In Spainish)."},{"key":"ref_29","first-page":"13","article-title":"Estudio de un brote de leptospirosis en Honduras tras el paso del hurac\u00e1n Mitch y potencialidad profil\u00e1ctica de vax-SPIRAL\u00ae","volume":"16","author":"Naranjo","year":"2007","journal-title":"Vaccimonitor"},{"key":"ref_30","first-page":"841","article-title":"Outbreak of acute febrile illness and pulmonary hemorrhage\u2014Nicaragua, 1995","volume":"44","author":"Munoz","year":"1995","journal-title":"MMWR"},{"key":"ref_31","unstructured":"Pan American Health Organization (2016, August 16). Regional Core Health Data Initiative. Available online: http:\/\/www.paho.org\/hq\/index.php?option=com_tabs&view=article&id=2151&Itemid=3632&lang=en."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"8301","DOI":"10.3390\/ijerph110808301","article-title":"Socioeconomic factors and vulnerability to outbreaks of leptospirosis in Nicaragua","volume":"11","author":"Bacallao","year":"2014","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3883","DOI":"10.3390\/ijerph9113883","article-title":"Leptospirosis outbreaks in Nicaragua: Identifying critical areas and exploring drivers for evidence-based planning","volume":"9","author":"Schneider","year":"2012","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_34","unstructured":"World Health Organization (2016, August 16). Disaster Risk Management for Health Overview Fact Sheet. Available online: http:\/\/www.who.int\/hac\/techguidance\/preparedness\/factsheets\/en\/."},{"key":"#cr-split#-ref_35.1","doi-asserted-by":"crossref","unstructured":"Dechet, A.M., Parsons, M., Rambaran, M., Mohamed-Rambaran, P., Florendo-Cumbermack, A., Persaud, S., Baboolal, S., Ari, M.D., Shadomy, S.V., and Zaki, S.R. (2012). Leptospirosis outbreak following severe flooding: A rapid assessment and mass prophylaxis campaign","DOI":"10.1371\/journal.pone.0039672"},{"key":"#cr-split#-ref_35.2","unstructured":"Guyana, January-February 2005. PLoS ONE, 7."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e40","DOI":"10.1086\/339942","article-title":"Leptospirosis, water sports, and chemoprophylaxis","volume":"34","author":"Haake","year":"2002","journal-title":"Clin. Infect. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","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":"ref_38","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/j.jiac.2014.07.016","article-title":"Single dosage of doxycycline for prophylaxis against leptospiral infection and leptospirosis during urban flooding in southern Thailand: A non-randomized controlled trial","volume":"20","author":"Chusri","year":"2014","journal-title":"J. Infect. Chemother."},{"key":"ref_39","first-page":"Cd007342","article-title":"Antibiotic prophylaxis for leptospirosis","volume":"8","author":"Lipnick","year":"2009","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Wohlin, C. (2014, January 13\u201314). Guidelines for Snowballing in Systematic Literature Studies and a Replication in Software Engineering. Proceedings of the 18th International Conference on Evaluation and Assessment in Software Engineering, New York, NY, USA.","DOI":"10.1145\/2601248.2601268"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1007\/s00285-012-0520-2","article-title":"Role of environmental persistence in pathogen transmission: A mathematical modeling approach","volume":"66","author":"Breban","year":"2013","journal-title":"J. Mathem. Boil."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.actatropica.2006.08.003","article-title":"A model of leptospirosis infection in an African rodent to determine risk to humans: Seasonal fluctuations and the impact of rodent control","volume":"99","author":"Holt","year":"2006","journal-title":"Acta. Trop."},{"key":"ref_43","unstructured":"Heymann, D.L. (2008). Control of Communicable Diseases Manual, American Public Health Association."},{"key":"ref_44","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":"Bharti","year":"2003","journal-title":"Lancet Infect. Dis."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1517\/14656566.5.4.819","article-title":"The management of leptospirosis","volume":"5","author":"Faucher","year":"2004","journal-title":"Expert Opin. Pharmacother."},{"key":"ref_46","first-page":"24","article-title":"Risk of transmission of leptospirosis from infected cattle to dairy workers in southern Israel","volume":"6","author":"Belmaker","year":"2004","journal-title":"Isr. Med. Assoc. J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S0924-8579(99)00134-X","article-title":"Randomized controlled trial of doxycycline prophylaxis against leptospirosis in an endemic area","volume":"13","author":"Sehgal","year":"2000","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e462","DOI":"10.1016\/j.ijid.2012.05.667","article-title":"A study on prophylactic doxycycline to reduce the incidence of leptospirosis among paddy field farmers in a coastal district of India","volume":"16","author":"Shivaraj","year":"2012","journal-title":"Int. J. Infect. Dis."},{"key":"ref_49","first-page":"199","article-title":"Chemoprophylaxis with doxycycline in suspected epidemic of leptospirosis during floods: Does this really work?","volume":"10","author":"Bhardwaj","year":"2010","journal-title":"Afr. Health sci."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1017\/S0950268808001751","article-title":"Assessing cost effectiveness of empirical and prophylactic therapy for managing leptospirosis outbreaks","volume":"137","author":"Galloway","year":"2009","journal-title":"Epidemiol. Infect."},{"key":"ref_51","first-page":"882","article-title":"Is oral penicillin an effective chemoprophylaxis against leptospirosis? A placebo controlled field study in the Kandy district, Sri Lanka","volume":"39","author":"Illangasekera","year":"2008","journal-title":"South. Asian J. Trop. Med. Public Health"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1590\/S0036-46651998000100012","article-title":"Use of doxycycline for leptospirosis after high-risk exposure in Sao Paulo, Brazil","volume":"40","author":"Gonsalez","year":"1998","journal-title":"Rev. Inst. Med. Trop. Sao Paulo"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1056\/NEJM198402233100805","article-title":"An efficacy trial of doxycycline chemoprophylaxis against leptospirosis","volume":"310","author":"Takafuji","year":"1984","journal-title":"N Engl. J. Med."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Guidugli, F., Castro, A.A., and Atallah, A.N. (2000). Antibiotics for preventing leptospirosis. Cochrane Database Syst. Rev., Cd001305.","DOI":"10.1002\/14651858.CD001305"},{"key":"ref_55","first-page":"759","article-title":"Management of leptospirosis: A short review","volume":"7","author":"Devishree","year":"2015","journal-title":"J. Pharmaceut. Sci. Res."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"78","DOI":"10.5455\/njppp.2012.2.78-83","article-title":"Prophylaxis and treatment for leptospirosis: Where are the evidences?","volume":"2","author":"Charan","year":"2012","journal-title":"Nat. J. Physiol. Pharm. Pharmacol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.3390\/ph3051561","article-title":"Chemoprophylaxis of tropical infectious diseases","volume":"3","author":"McBride","year":"2010","journal-title":"Pharmaceuticals"},{"key":"ref_58","first-page":"S137","article-title":"Leptospirosis: A worldwide resurgent zoonosis and important cause of acute renal failure and death in developing nations","volume":"19","author":"Cruz","year":"2009","journal-title":"Ethn. Dis."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1111\/j.1708-8305.2008.00257.x","article-title":"Travel-acquired leptospirosis","volume":"15","author":"Pavli","year":"2008","journal-title":"J. Travel Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"39","DOI":"10.7205\/MILMED.170.4S.39","article-title":"History of U.S. Military contributions to the study of bacterial zoonoses","volume":"170","author":"Christopher","year":"2005","journal-title":"Military Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1586\/14787210.2.2.293","article-title":"Prevention and treatment of leptospirosis","volume":"2","author":"Edwards","year":"2004","journal-title":"Expert Rev. Anti. Infect. Ther."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.cair.2004.08.001","article-title":"Leptospirosis: A forgotten zoonosis?","volume":"4","author":"Levett","year":"2004","journal-title":"Clin. Appl. Immunol. Rev."},{"key":"ref_63","first-page":"1343","article-title":"Fever in the returned traveler","volume":"68","author":"Re","year":"2003","journal-title":"Am. Fam. Physic."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1136\/pgmj.64.749.236","article-title":"Failure of penicillin prophylaxis in laboratory acquired leptospirosis","volume":"64","author":"Gilks","year":"1988","journal-title":"Postgr. Med. J."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"431","DOI":"10.4103\/0019-5359.48454","article-title":"A case control study to explore the risk factors for acquisition of leptospirosis in Surat city, after flood","volume":"62","author":"Bhardwaj","year":"2008","journal-title":"Indian J. Med. Sci."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Allan, K.J., Biggs, H.M., Halliday, J.E.B., Kazwala, R.R., Maro, V.P., Cleaveland, S., and Crump, J.A. (2015). Epidemiology of leptospirosis in Africa: A systematic review of a neglected zoonosis and a paradigm for \u201cone health\u201d in Africa. PLoS Negl. Trop. Dis., 9.","DOI":"10.1371\/journal.pntd.0003899"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.ijid.2014.06.013","article-title":"Leptospirosis in Sub-Saharan Africa: A systematic review","volume":"28","author":"Visser","year":"2014","journal-title":"Int. J. Infect. Dis."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"6666","DOI":"10.3390\/ijerph110706666","article-title":"Leptospira contamination in household and environmental water in rural communities in Southern Chile","volume":"11","author":"Mason","year":"2014","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"7953","DOI":"10.3390\/ijerph110807953","article-title":"Molecular detection of leptospiral DNA in environmental water on St. Kitts","volume":"11","author":"Rawlins","year":"2014","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.3201\/eid1707.101050","article-title":"Typhoon-related leptospirosis and melioidosis, Taiwan, 2009","volume":"17","author":"Su","year":"2011","journal-title":"Emerg. Infect. Dis. J."},{"key":"ref_71","unstructured":"Moreno, G. (2012). Experience in Controlling Outbreaks of Leptospirosis in Leon."},{"key":"ref_72","unstructured":"Chavez, O. (2012). Experience in Controlling Outbreaks of Leptospirosis in Chinandega."},{"key":"ref_73","unstructured":"Pena, E. (2012). Experience in Human Leptospirosis in the Dominican Republic."},{"key":"ref_74","first-page":"49","article-title":"Measurement issues in environmental epidemiology","volume":"101","author":"Hatch","year":"1993","journal-title":"Environ. Health Perspect."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1590\/S0036-46652002000200005","article-title":"Leptospirosis severity may be associated with the intensity of humoral immune response","volume":"44","author":"Abdulkader","year":"2002","journal-title":"Rev. Inst. Med. Trop. Sao Paulo"},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Guerrier, G., Hie, P., Gourinat, A.-C., Huguon, E., Polfrit, Y., Goarant, C., D\u2019Ortenzio, E., and Missotte, I. (2013). Association between age and severity to leptospirosis in children. PLoS Negl. Trop. Dis., 7.","DOI":"10.1371\/journal.pntd.0002436"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1093\/bmb\/ldp038","article-title":"Mathematical modelling of infectious diseases","volume":"92","author":"Keeling","year":"2009","journal-title":"Br. Med. Bull."},{"key":"ref_78","unstructured":"National Institute for Mathematical and Biological Synthesis (2017, March 29). Nimbios Working Group: Leptospirosis Modeling. Available online: http:\/\/www.nimbios.org\/workinggroups\/WG_leptospira."},{"key":"ref_79","unstructured":"Minist\u00e9rio da Sa\u00fade do Brasil (2005). Plano de Conting\u00eancia de Vigil\u00e2ncia em Sa\u00fade Frente a Inunda\u00e7\u00f5es, (In Portuguese)."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"6000","DOI":"10.3390\/ijerph110606000","article-title":"A global, multi-disciplinary, multi-sectorial initiative to combat leptospirosis: Global leptospirosis environmental action network (GLEAN)","volume":"11","author":"Durski","year":"2014","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_81","unstructured":"Global Leptospirosis Environmental Action Network (2017, March 29). 3rd Glean Meeting Report. Annex 3: Recommendations for Outbreak Control. Available online: https:\/\/docs.google.com\/viewer?a=v&pid=sites&srcid=ZGVmYXVsdGRvbWFpbnxnbGVhbmxlcHRvfGd4OjY0ZTQxZWIzMTc3NGIyNmE."},{"key":"ref_82","first-page":"204","article-title":"Towards a \u201cone health\u201d strategy against leptospirosis","volume":"2","author":"Jancloes","year":"2014","journal-title":"Planet. Risk"},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Pereira, M.M., Schneider, M.C., Munoz-Zanzi, C., Costa, F., Benshop, J., Hartskeerl, R., Martinez, J., Jancloes, M., and Bertherat, E. (2017). Rio report\u2014A roadmap for leptospirosis research and health policies based on country needs. Rev. Panam. Salud. 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