{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:23:57Z","timestamp":1791235437935,"version":"4.1.0"},"reference-count":65,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T00:00:00Z","timestamp":1744848000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Leptospirosis is a well-known disease that frequently occurs after floods. At the beginning of May 2024, a catastrophic flood occurred in the state of Rio Grande do Sul, Brazil, affecting two million people and leading to a state of calamity. Given the State\u2019s high pre-flood leptospirosis rates, the disease became a major concern for decision-makers. This study aimed to estimate the rise in leptospirosis cases after the flood, assess the changes in case patterns before and after the disaster, and document the response of the state health surveillance center to the outbreak. We estimated the increase during the flood period (May to July 2024) by comparing it with the same period in the previous year as baseline. During the first three months of the catastrophic event, 6273 suspected cases of leptospirosis were reported to the surveillance system, and 958 cases were confirmed. The number of confirmed cases during the flood was 10.3-fold higher than the baseline. Spearman\u2019s rank-order correlation coefficient was 0.77 (p-value &lt; 0.0001) for the association of Health Regions regarding the rank in incidence rates of confirmed cases in the flood period and the proportion of the population with households flooded. Thirty deaths (three females) were confirmed, a 6.0-fold rise compared with 2023. The state responders carried out many activities, including epidemiological surveillance and the dissemination of information. Among the challenges faced was the lack of evidence in the literature supporting recommendations for antibiotic chemoprophylaxis for rescue personnel. Another difficulty concerned performing gold-standard laboratory diagnostic tests to confirm the enormous number of suspected cases reported during this catastrophe. Despite implementing many actions to mitigate its impact, leptospirosis remained a major challenge during the event. These findings may provide valuable insights for decision-makers facing similar situations in massive climate disasters.<\/jats:p>","DOI":"10.3390\/pathogens14040393","type":"journal-article","created":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T06:53:46Z","timestamp":1744872826000},"page":"393","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Leptospirosis Cases During the 2024 Catastrophic Flood in Rio Grande Do Sul, Brazil"],"prefix":"10.3390","volume":"14","author":[{"given":"Tani Maria","family":"Ranieri","sequence":"first","affiliation":[{"name":"State Health Surveillance Center, Health Department of the Rio Grande do Sul State, Porto Alegre 90610-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6347-6431","authenticated-orcid":false,"given":"Eduardo","family":"Viegas da Silva","sequence":"additional","affiliation":[{"name":"State Health Surveillance Center, Health Department of the Rio Grande do Sul State, Porto Alegre 90610-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo Jostmeier","family":"Vallandro","sequence":"additional","affiliation":[{"name":"State Health Surveillance Center, Health Department of the Rio Grande do Sul State, Porto Alegre 90610-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2735-9788","authenticated-orcid":false,"given":"Mayara Mota de","family":"Oliveira","sequence":"additional","affiliation":[{"name":"State Health Surveillance Center, Health Department of the Rio Grande do Sul State, Porto Alegre 90610-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0901-2422","authenticated-orcid":false,"given":"Regina Bones","family":"Barcellos","sequence":"additional","affiliation":[{"name":"State Health Surveillance Center, Health Department of the Rio Grande do Sul State, Porto Alegre 90610-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta Vanacor","family":"Lenhardt","sequence":"additional","affiliation":[{"name":"State Health Surveillance Center, Health Department of the Rio Grande do Sul State, Porto Alegre 90610-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loeci Natalina","family":"Timm","sequence":"additional","affiliation":[{"name":"State Health Surveillance Center, Health Department of the Rio Grande do Sul State, Porto Alegre 90610-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1731-3527","authenticated-orcid":false,"given":"Aline Scarpellini","family":"Campos","sequence":"additional","affiliation":[{"name":"State Health Surveillance Center, Health Department of the Rio Grande do Sul State, Porto Alegre 90610-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cintia","family":"Simoni","sequence":"additional","affiliation":[{"name":"State Health Surveillance Center, Health Department of the Rio Grande do Sul State, Porto Alegre 90610-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo Renato da Silva","family":"Abbad","sequence":"additional","affiliation":[{"name":"State Health Surveillance Center, Health Department of the Rio Grande do Sul State, Porto Alegre 90610-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4622-7667","authenticated-orcid":false,"given":"Doris Bercht","family":"Brack","sequence":"additional","affiliation":[{"name":"State Health Surveillance Center, Health Department of the Rio Grande do Sul State, Porto Alegre 90610-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T\u00e1ssia Flores","family":"Rech","sequence":"additional","affiliation":[{"name":"State Health Surveillance Center, Health Department of the Rio Grande do Sul State, Porto Alegre 90610-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliano de Oliveira","family":"Silveira","sequence":"additional","affiliation":[{"name":"State Health Surveillance Center, Health Department of the Rio Grande do Sul State, Porto Alegre 90610-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian Oliveira","family":"Estevam","sequence":"additional","affiliation":[{"name":"State Health Surveillance Center, Health Department of the Rio Grande do Sul State, Porto Alegre 90610-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidsy Ximenes","family":"Fonseca","sequence":"additional","affiliation":[{"name":"National Health Surveillance and Environmental Secretary, Ministry of Health of Brazil, Brasilia 70723-040, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deise I.","family":"Galan","sequence":"additional","affiliation":[{"name":"Department of Global Health, School of Health, Georgetown University, 3700 Reservoir Rd NW, Washington, DC 20007, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8575-8002","authenticated-orcid":false,"given":"Maria Cristina","family":"Schneider","sequence":"additional","affiliation":[{"name":"Department of Global Health, School of Health, Georgetown University, 3700 Reservoir Rd NW, Washington, DC 20007, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Costa, F., Hagan, J.E., Calcagno, J., Kane, M., Torgerson, P., Martinez-Silveira, M.S., Stein, C., Abela-Ridder, B., and Ko, A.I. (2015). Global Morbidity and Mortality of Leptospirosis: A Systematic Review. PLoS Negl. Trop. Dis., 9.","DOI":"10.1371\/journal.pntd.0003898"},{"key":"ref_2","first-page":"e78","article-title":"A systematic literature review of leptospirosis outbreaks worldwide, 1970\u20132012","volume":"44","author":"Groene","year":"2020","journal-title":"Rev. Panam. Salud Publica"},{"key":"ref_3","unstructured":"World Health Organization (WHO) (2003). Human Leptospirosis: Guidance for Diagnosis, Surveillance and Control."},{"key":"ref_4","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":"10","author":"Lau","year":"2010","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Agampodi, S.B., Dahanayaka, N.J., Bandaranayaka, A.K., Perera, M., Priyankara, S., Weerawansa, P., Matthias, M.A., and Vinetz, J.M. (2014). Regional differences of leptospirosis in Sri Lanka: Observations from a flood-associated outbreak in 2011. PLoS Negl. Trop. Dis., 8.","DOI":"10.1371\/journal.pntd.0002626"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.4269\/ajtmh.16-0922","article-title":"Leptospirosis Outbreak After the 2014 Major Flooding Event in Kelantan, Malaysia: A Spatial-Temporal Analysis","volume":"98","author":"Hashim","year":"2018","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/S0255-0857(21)02315-X","article-title":"Leptospirosis in Mumbai: Post-deluge outbreak 2005","volume":"24","author":"Maskey","year":"2006","journal-title":"Indian J. Med. Microbiol."},{"key":"ref_8","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_9","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1007\/s11069-016-2493-8","article-title":"Flood-related leptospirosis outbreaks in Brazil: Perspectives for a joint monitoring by health services and disaster monitoring centers","volume":"84","author":"Londe","year":"2016","journal-title":"Nat. Hazards"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1016\/S0140-6736(99)80012-9","article-title":"Urban epidemic of severe leptospirosis in Brazil. Salvador Leptospirosis Study Group","volume":"354","author":"Ko","year":"1999","journal-title":"Lancet"},{"key":"ref_11","unstructured":"Rio Grande do Sul Government (2025, January 10). Declares a State of Public Calamity in the Territory of the State of Rio Grande do Sul 2024, Available online: https:\/\/www.diariooficial.rs.gov.br\/materia?id=1175633."},{"key":"ref_12","unstructured":"Federal Government of Brazil (2025, January 10). Declares a State of Public Calamity in the Territory of the State of Rio Grande do Sul 2024, Available online: https:\/\/www.gov.br\/receitafederal\/pt-br\/acesso-a-informacao\/acoes-e-programas\/calamidade-no-rio-grande-do-sul\/atos-relacionados."},{"key":"ref_13","first-page":"e00114424","article-title":"Disaster in Rio Grande do Sul, Brazil: Climate crisis, Brazilian Unified National Health System response, and challenges of the new times","volume":"40","author":"Freitas","year":"2025","journal-title":"Cad. Saude Publica"},{"key":"ref_14","unstructured":"Brazil. Ministry of Health (2025, February 03). Health Indicators. Available online: https:\/\/www.pns.icict.fiocruz.br\/painel-de-indicadores-mobile-desktop."},{"key":"ref_15","unstructured":"Brazil. Ministry of Health (2025, February 03). Notifiable Diseases Information System (SINAN), Available online: https:\/\/portalsinan.saude.gov.br."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"5964","DOI":"10.34119\/bjhrv5n2-173","article-title":"Leptospirosis: An epidemiological study of notified cases in Brazil between the years 2015 and 2019","volume":"5","author":"Oliveira","year":"2022","journal-title":"Braz. J. Health Rev."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Galan, D.I., Roess, A.A., Pereira, S.V.C., and Schneider, M.C. (2021). Epidemiology of human leptospirosis in urban and rural areas of Brazil, 2000\u20132015. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0247763"},{"key":"ref_18","unstructured":"Brazil. Ministry of Health (2025, February 03). Leptospirosis, Available online: https:\/\/www.gov.br\/saude\/pt-br\/assuntos\/saude-de-a-a-z\/l\/leptospirose."},{"key":"ref_19","first-page":"2","article-title":"Spatio-temporal analysis of leptospirosis in Brazil and its relationship with flooding","volume":"17","author":"Guasselli","year":"2022","journal-title":"Geospat. Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1590\/S0102-311X2003000500007","article-title":"Distribui\u00e7\u00e3o espacial da leptospirose no Rio Grande do Sul, Brasil: Recuperando a ecologia dos estudos ecol\u00f3gicos","volume":"19","author":"Barcellos","year":"2003","journal-title":"Cad Sa\u00fade P\u00fablica"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Schneider, M.C., Najera, P., Pereira, M.M., Machado, G., dos Anjos, C.B., Rodrigues, R.O., Cavagni, G.M., Mu\u00f1oz-Zanzi, C., Corbellini, L.G., and Leone, M. (2015). Leptospirosis in Rio Grande do Sul, Brazil: An Ecosystem Approach in the Animal-Human Interface. PLoS Negl. Trop. Dis., 9.","DOI":"10.1371\/journal.pntd.0004095"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Teles, A.J., Bohm, B.C., Silva, S.C.M., and Bruhn, F.R.P. (2023). Socio-geographical factors and vulnerability to leptospirosis in South Brazil. BMC Public Health, 23.","DOI":"10.1186\/s12889-023-16094-9"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Schneider, M.C., Munoz-Zanzi, C., Min, K.D., and Aldighieri, S. (2019). \u201cOne Health\u201d from Concept to Application in the Global World. Oxford Research Encyclopedia of Global Public Health, Oxford University Press.","DOI":"10.1093\/acrefore\/9780190632366.013.29"},{"key":"ref_24","first-page":"34","article-title":"Sa\u00fade \u00danica: Onde a medicina humana, a medicina veterin\u00e1ria e as ci\u00eancias ambientais se encontram","volume":"194","author":"Schneider","year":"2023","journal-title":"An. Acad. Bras. Medicina"},{"key":"ref_25","unstructured":"Brazil. Ministry of Health (2025, February 03). Epidemiological Situation of Leptospirosis Cases in Brazil, 2010 to 2024, Available online: https:\/\/www.gov.br\/saude\/pt-br\/centrais-de-conteudo\/apresentacoes\/2024\/situacao-epidemiologica-dos-casos-de-leptospirose-no-brasil-2010-a-2024."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Niloofa, R., Fernando, N., de Silva, N.L., Karunanayake, L., Wickramasinghe, H., Dikmadugoda, N., Premawansa, G., Wickramasinghe, R., de Silva, H.J., and Premawansa, S. (2015). Diagnosis of Leptospirosis: Comparison between Microscopic Agglutination Test, IgM-ELISA and IgM Rapid Immunochromatography Test. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0129236"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Neris, R.L.S., da Silva, M.C., da Silva Batista, M., de Almeida Silva, K.C.F., Balassiano, I.T., and Avelar, K.E.S. (2023). Effect of Demographics and Time to Sample Processing on the qPCR Detection of Pathogenic Leptospira spp. from Human Samples in the National Reference Laboratory for Leptospirosis, Brazil. Trop. Med. Infect. Dis., 8.","DOI":"10.3390\/tropicalmed8030151"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Dellagostin, O.A., Grassmann, A.A., Rizzi, C., Schuch, R.A., Jorge, S., Oliveira, T.L., McBride, A.J., and Hartwig, D.D. (2017). Reverse Vaccinology: An Approach for Identifying Leptospiral Vaccine Candidates. Int. J. Mol. Sci., 18.","DOI":"10.3390\/ijms18010158"},{"key":"ref_29","first-page":"e131","article-title":"A road map for leptospirosis research and health policies based on country needs in Latin America","volume":"41","author":"Pereira","year":"2018","journal-title":"Rev. Panam. Salud Publica"},{"key":"ref_30","unstructured":"Brazil. National Institute of Statistics of Brazil (IBGE) (2025, January 30). Cities and States, Available online: https:\/\/www.ibge.gov.br\/cidades-e-estados."},{"key":"ref_31","unstructured":"Rio Grande do Sul Government (2025, January 30). Socioeconomic Atlas of Rio Grande do Sul, Available online: https:\/\/atlassocioeconomico.rs.gov.br."},{"key":"ref_32","unstructured":"Brazil. National Institute of Statistics of Brazil (IBGE) (2025, February 03). Population with Household Flooded, in Municipalities that Were in a Situation of Public Calamity, Available online: https:\/\/www.ibge.gov.br\/singedlab\/dados-apoio-rs_populacao-residente.php."},{"key":"ref_33","unstructured":"Rio Grande do Sul Government (2025, February 05). Civil Defense: Report on the Impact of Floods, Available online: https:\/\/estado.rs.gov.br\/defesa-civil-atualiza-balanco-das-enchentes-no-rs-28-5-18h."},{"key":"ref_34","unstructured":"Pereira, R.H.M., Herszenhut, D., Ferreira, P.C.G., Mation, L., Stivali, M., and Cunha, A. (2024). Estimate of the Population Affected by the Floods in Rio Grande do Sul in 2024, Institute of Applied Economic Research (IPEA)."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1590\/s0103-4014.202438112.012","article-title":"O maior desastre clim\u00e1tico do Brasil: Chuvas e inunda\u00e7\u00f5es no estado do Rio Grande do Sul em abril-maio 2024","volume":"38","author":"Marengo","year":"2024","journal-title":"Estud. Avan\u00e7ados"},{"key":"ref_36","unstructured":"Rio Grande do Sul Government (2025, February 03). Civil Defense, Available online: https:\/\/www.estado.rs.gov.br\/estado-passa-a-emitir-relatorios-periodicos-sobre-situacao-de-municipios-atingidos-pelas-chuvas."},{"key":"ref_37","unstructured":"Rio Grande do Sul Government (2025, February 10). State Health Surveillance Center, Health Department of the Rio Grande do Sul State, Available online: https:\/\/cevs.rs.gov.br\/inicial."},{"key":"ref_38","unstructured":"Brazil. Ministry of Health (2025, February 10). Health Surveillance Guide, Available online: https:\/\/www.gov.br\/saude\/pt-br\/centrais-de-conteudo\/publicacoes\/svsa\/vigilancia\/guia-de-vigilancia-em-saude-volume-1-6a-edicao\/view."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"376","DOI":"10.4269\/ajtmh.21-0181","article-title":"Leptospirosis Risk among Occupational Groups in Brazil, 2010\u20132015","volume":"109","author":"Galan","year":"2023","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_40","unstructured":"Rio Grande do Sul Government (2025, February 10). State Health Surveillance Center, Health Department of the Rio Grande do Sul State. Guide to Health Risks and Precautions After Floods, Available online: https:\/\/saude.rs.gov.br\/upload\/arquivos\/202406\/10141303-guia-basico-10-06-24.pdf."},{"key":"ref_41","unstructured":"Rio Grande do Sul Government (2025, February 10). State Health Surveillance Center, Health Department of the Rio Grande do Sul State. Guidelines for Epidemiological Surveillance of Diseases and Injuries in the Context of Public Calamity Caused by Floods, Available online: https:\/\/saude.rs.gov.br\/upload\/arquivos\/202405\/21133609-guia-rapido-ve-vigilancia-e-atuacao-em-agravos-e-doencas.pdf."},{"key":"ref_42","unstructured":"Rio Grande do Sul Government (2025, February 10). State Health Surveillance Center, Health Department of the Rio Grande do Sul State. Risk Communication, Available online: https:\/\/saude.rs.gov.br\/upload\/arquivos\/202405\/03115836-comunicado-de-risco-lepto-e-peconhentos-rs-02-05-2024.pdf."},{"key":"ref_43","first-page":"CD014960","article-title":"Antibiotics for treatment of leptospirosis","volume":"3","author":"Win","year":"2024","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Lam, J.Y., Low, G.K., and Chee, H.Y. (2020). Diagnostic accuracy of genetic markers and nucleic acid techniques for the detection of Leptospira in clinical samples: A meta-analysis. PLoS Negl. Trop. Dis., 14.","DOI":"10.1371\/journal.pntd.0008074"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e006032024","DOI":"10.1590\/0037-8682-0162-2024","article-title":"Catastrophic Floods in Rio Grande do Sul, Brazil: The Need for Public Health Responses to Potential Infectious Disease Outbreaks","volume":"57","author":"Croda","year":"2024","journal-title":"Rev. Soc. Bras. Med. Trop."},{"key":"ref_46","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_47","doi-asserted-by":"crossref","first-page":"471","DOI":"10.4269\/ajtmh.2011.11-0276","article-title":"Leptospirosis outbreak in Sri Lanka in 2008: Lessons for assessing the global burden of disease","volume":"85","author":"Agampodi","year":"2011","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"849","DOI":"10.4269\/ajtmh.18-0335","article-title":"A Large Leptospirosis Outbreak following Successive Severe Floods in Fiji, 2012","volume":"99","author":"Togami","year":"2018","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_49","doi-asserted-by":"crossref","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."},{"key":"ref_50","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_51","doi-asserted-by":"crossref","unstructured":"Cunha, M., Costa, F., Ribeiro, G.S., Carvalho, M.S., Reis, R.B., Nery, N., Pischel, L., Gouveia, E.L., Santos, A.C., and Queiroz, A. (2022). Rainfall and other meteorological factors as drivers of urban transmission of leptospirosis. PLoS Negl. Trop. Dis., 16.","DOI":"10.1371\/journal.pntd.0007507"},{"key":"ref_52","unstructured":"Rio Grande do Sul Government (2025, February 03). Plano Rio Grande for Reconstruction, Adaptation, and Climate Resilience, Available online: https:\/\/leisestaduais.com.br\/rs\/lei-ordinaria-n-16134-2024-rio-grande-do-sul-institui-o-plano-rio-grande-programa-de-reconstrucao-adaptacao-e-resiliencia-climatica-do-estado-do-rio-grande-do-sul-cria-o-fundo-do-plano-rio-grande-funrigs-e-da-outras-providencias."},{"key":"ref_53","unstructured":"Schafer, I., Galloway, R., and Stoddard, R. (2023). Leptospirosis. CDC Yellow Book 2024: Health Information for International Travel, Oxford University Press. [1st ed.]."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Naing, C., Reid, S.A., Aye, S.N., Htet, N.H., and Ambu, S. (2019). Risk factors for human leptospirosis following flooding: A meta-analysis of observational studies. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0217643"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Parra-Barrera, E.L., Bello Piruccini, S., Rodr\u00edguez, K., Duarte, C., Torres, M., and Undurraga, E.A. (2023). Demographic and clinical risk factors associated with severity of lab-confirmed human leptospirosis in Colombia, 2015\u20132020. PLoS Negl. Trop. Dis., 17.","DOI":"10.1371\/journal.pntd.0011454"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Petersen, K., and Maranich, A. (2024). Antibiotic Chemoprophylaxis for Leptospirosis: Previous Shortcomings and Future Needs. Trop. Med. Infect. Dis., 9.","DOI":"10.3390\/tropicalmed9070148"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Schneider, M.C., Velasco-Hernandez, J., Min, K.D., Leonel, D.G., Baca-Carrasco, D., Gompper, M.E., Hartskeerl, R., and Munoz-Zanzi, C. (2017). The Use of Chemoprophylaxis after Floods to Reduce the Occurrence and Impact of Leptospirosis Outbreaks. Int. J. Environ. Res. Public Health., 14.","DOI":"10.3390\/ijerph14060594"},{"key":"ref_58","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_59","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_60","doi-asserted-by":"crossref","unstructured":"Polo, N., Machado, G., Rodrigues, R., N\u00e1jera Hamrick, P., Munoz-Zanzi, C., Pereira, M.M., Bercini, M., Timm, L.N., and Schneider, M.C. (2019). A One Health Approach to Investigating Leptospira Serogroups and Their Spatial Distributions among Humans and Animals in Rio Grande do Sul, Brazil, 2013\u20132015. Trop. Med. Infect. Dis., 4.","DOI":"10.3390\/tropicalmed4010042"},{"key":"ref_61","doi-asserted-by":"crossref","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":"ref_62","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1080\/17460441.2020.1694508","article-title":"An overview of human leptospirosis vaccine design and future perspectives","volume":"15","author":"Felix","year":"2020","journal-title":"Expert. Opin. Drug Discov."},{"key":"ref_63","unstructured":"World Health Organization (WHO) (2025, February 10). Ending the Neglect to Attain the Sustainable Development Goals: A Road Map for Neglected Tropical Diseases, Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240010352."},{"key":"ref_64","unstructured":"Pan American Health Organization (PAHO) (2025, February 10). Diseases Elimination Initiative. Available online: https:\/\/www.paho.org\/en\/elimination-initiative."},{"key":"ref_65","unstructured":"Brazil. Ministry of Health (2025, February 03). Program of Elimination of 14 Diseases Social Determinate, Available online: https:\/\/www.gov.br\/saude\/pt-br\/centrais-de-conteudo\/apresentacoes\/2024\/lancamento-do-programa-brasil-saudavel-02\/view."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/14\/4\/393\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:16:17Z","timestamp":1760030177000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/14\/4\/393"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,17]]},"references-count":65,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["pathogens14040393"],"URL":"https:\/\/doi.org\/10.3390\/pathogens14040393","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,17]]}}}