{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T06:42:01Z","timestamp":1783406521358,"version":"3.54.6"},"reference-count":64,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,5]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Leptospirosis is a neglected zoonotic disease caused by pathogenic\n                    <jats:italic>Leptospira<\/jats:italic>\n                    species, and it is one of the leading causes of zoonotic bacterial infections globally. It is routinely underdiagnosed or misdiagnosed as other febrile infections, like dengue or malaria. Hawai\u02bbi has consistently had one of the highest rates of leptospirosis in the United States. Here, we present the trends associated with cases of confirmed leptospirosis that were acquired in the state of Hawai\u02bbi between 2012 and 2024. County-level analysis shows consistency with previously observed spatial trends, identifying higher case rates on the islands of Kaua\u02bbi and Hawai\u02bbi ranging from 17.74 to 30.90 cases per 100,000 population. To increase spatial resolution, cases were analyzed at the Moku level (i.e., district), identifying localized rates up to 244.78 cases per 100,000 population. This analysis identified that the northeastern region of Maui has the highest case rate in Hawai\u02bbi, which has the highest case rate of all states. The northeastern coasts of each island tend to have higher rates of leptospirosis that also correlate with higher annual rainfall. Serological analysis identified that the dominant serogroups in human disease were Australis and Icterohaemorrhagiae. The main infecting\n                    <jats:italic>Leptospira<\/jats:italic>\n                    serovars were Bratislava, Icterohaemorrhagiae, Georgia, Canicola, and Australis. Dominant infecting serovars were associated with infections throughout the state, except in the case of Canicola, which was localized to the islands of Maui and Hawai\u02bbi. Overall, this work identified regions of higher human leptospirosis incidence throughout the Hawaiian Islands, correlating clinical incidence with precipitation and serovar reactivity across the state.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0267","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T17:45:40Z","timestamp":1756230340000},"page":"980-989","source":"Crossref","is-referenced-by-count":3,"title":["Analysis of Confirmed Leptospirosis Cases in Hawai\u02bbi Identifies Spatial and Environmental Patterns of Incidence"],"prefix":"10.4269","volume":"113","author":[{"given":"Ian A.","family":"McMillan","sequence":"first","affiliation":[{"name":"Pathogen Analysis and Translational Health Group, School of Life Sciences, University of Hawai\u02bbi at M\u0101noa, Honolulu, Hawai\u02bbi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grayson N.","family":"Kallas","sequence":"additional","affiliation":[{"name":"Kaua\u02bbi District Health Office, Hawai\u02bbi State Department of Health, L\u012bhu\u02bbe, Hawai\u02bbi;"}],"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\u02bbi at M\u0101noa, Honolulu, Hawai\u02bbi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren T.","family":"Guest","sequence":"additional","affiliation":[{"name":"Kaua\u02bbi District Health Office, Hawai\u02bbi State Department of Health, L\u012bhu\u02bbe, Hawai\u02bbi;"}],"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\u02bbi at M\u0101noa, Honolulu, Hawai\u02bbi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet M.","family":"Berreman","sequence":"additional","affiliation":[{"name":"Kaua\u02bbi District Health Office, Hawai\u02bbi State Department of Health, L\u012bhu\u02bbe, Hawai\u02bbi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah K.","family":"Kemble","sequence":"additional","affiliation":[{"name":"Hawai\u02bbi State Department of Health, Honolulu, Hawai\u02bbi"}],"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\u02bbi at M\u0101noa, Honolulu, Hawai\u02bbi;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"PLoS Negl Trop Dis","first-page":"e0003898","article-title":"Global morbidity and mortality of leptospirosis: A systematic review","volume":"9","author":"Costa","year":"2015"},{"key":"b2","series-title":"Clin Infect Dis","first-page":"1593","article-title":"Outbreak of leptospirosis among triathlon participants and community residents in Springfield, Illinois, 1998","volume":"34","author":"Morgan","year":"2002"},{"key":"b3","series-title":"Epidemiol Infect","first-page":"843","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"},{"key":"b4","series-title":"Emerg Infect Dis","first-page":"702","article-title":"Leptospirosis in \u201ceco-challenge\u201d athletes, Malaysian Borneo, 2000","volume":"9","author":"Sejvar","year":"2003"},{"key":"b5","series-title":"Trans R Soc Trop Med Hyg","first-page":"1233","article-title":"Leptospirosis in a subsistence farming community in Brazil","volume":"102","author":"Lacerda","year":"2008"},{"key":"b6","series-title":"PLoS Negl Trop Dis","first-page":"e579","article-title":"Increasing trends of leptospirosis in northern India: A clinico-epidemiological study","volume":"4","author":"Sethi","year":"2010"},{"key":"b7","series-title":"Clin Microbiol Rev","first-page":"296","article-title":"Leptospirosis","volume":"14","author":"Levett","year":"2001"},{"key":"b8","series-title":"Nat Rev Microbiol","first-page":"736","article-title":"Leptospira: The dawn of the molecular genetics era for an emerging zoonotic pathogen","volume":"7","author":"Ko","year":"2009"},{"key":"b9","series-title":"Lancet Infect Dis","first-page":"757","article-title":"Leptospirosis: A zoonotic disease of global importance","volume":"3","author":"Bharti","year":"2003"},{"key":"b10","series-title":"Int. J. Infect. Dis","first-page":"47","article-title":"Leptospirosis in sub-Saharan Africa: A systematic review","volume":"28","author":"de Vries","year":"2014"},{"key":"b11","series-title":"Vet Microbiol","first-page":"287","article-title":"Leptospira and leptospirosis","volume":"140","author":"Adler","year":"2010"},{"key":"b12","series-title":"Trans R Soc Trop Med Hyg","first-page":"631","article-title":"Climate change, flooding, urbanisation and leptospirosis: Fuelling the fire?","volume":"104","author":"Lau","year":"2010"},{"key":"b13","series-title":"Emerg Infect Dis","first-page":"124","article-title":"Clinical diagnosis and geographic distribution of leptospirosis, Thailand","volume":"13","author":"Wuthiekanun","year":"2007"},{"key":"b14","series-title":"Lancet Infect Dis","first-page":"524","article-title":"The potential emergence of leptospirosis in Sri Lanka","volume":"9","author":"Agampodi","year":"2009"},{"key":"b15","series-title":"PLoS Negl Trop Dis","first-page":"e3338","article-title":"Influence of household rat infestation on Leptospira transmission in the urban slum environment","volume":"8","author":"Costa","year":"2014"},{"key":"b16","series-title":"Lancet","first-page":"820","article-title":"Urban epidemic of severe leptospirosis in Brazil. Salvador Leptospirosis Study Group","volume":"354","author":"Ko","year":"1999"},{"key":"b17","series-title":"PLoS Negl Trop Dis","first-page":"e154","article-title":"Household transmission of Leptospira infection in urban slum communities","volume":"2","author":"Maciel","year":"2008"},{"key":"b18","series-title":"PLoS Med","first-page":"e308","article-title":"Determining risk for severe leptospirosis by molecular analysis of environmental surface waters for pathogenic Leptospira.","volume":"3","author":"Ganoza","year":"2006"},{"key":"b19","series-title":"PLoS Negl Trop Dis","first-page":"e2927","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"},{"key":"b20","series-title":"PLoS Negl Trop Dis","first-page":"e228","article-title":"Impact of environment and social gradient on Leptospira infection in urban slums","volume":"2","author":"Reis","year":"2008"},{"key":"b21","series-title":"Int Microbiol","first-page":"35","article-title":"Cell aggregation: A mechanism of pathogenic Leptospira to survive in fresh water","volume":"7","author":"Trueba","year":"2004"},{"key":"b22","series-title":"Microbiology (Reading)","first-page":"1309","article-title":"Biofilm formation by saprophytic and pathogenic leptospires","volume":"154","author":"Ristow","year":"2008"},{"key":"b23","series-title":"Curr Opin Infect Dis","first-page":"376","article-title":"Leptospirosis","volume":"18","author":"McBride","year":"2005"},{"key":"b24","series-title":"PLoS Negl Trop Dis","first-page":"e0007205","article-title":"A simple score to predict severe leptospirosis","volume":"13","author":"Smith","year":"2019"},{"key":"b25","series-title":"Am J Trop Med Hyg","first-page":"911","article-title":"Predictors of lethality in severe leptospirosis in urban Brazil","volume":"79","author":"Spichler","year":"2008"},{"key":"b26","series-title":"Lancet","first-page":"535","article-title":"Leptospirosis associated with outbreak of acute febrile illness and pulmonary haemorrhage, Nicaragua, 1995","volume":"347","author":"Zaki","year":"1996"},{"key":"b27","series-title":"Clin Infect Dis","first-page":"343","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"},{"key":"b28","series-title":"Emerg Infect Dis","first-page":"505","article-title":"Leptospirosis-associated severe pulmonary hemorrhagic syndrome, Salvador, Brazil","volume":"14","author":"Gouveia","year":"2008"},{"key":"b29","series-title":"Emerg Infect Dis","first-page":"834","article-title":"Pulmonary involvement and leptospirosis, Greece","volume":"15","author":"Papa","year":"2009"},{"key":"b30","series-title":"Lancet","first-page":"170","article-title":"Acute kidney injury: An increasing global concern","volume":"382","author":"Lameire","year":"2013"},{"key":"b31","series-title":"PLoS Negl Trop Dis","first-page":"e2324","article-title":"Etiology of severe non-malaria febrile illness in northern Tanzania: A prospective cohort study","volume":"7","author":"Crump","year":"2013"},{"key":"b32","series-title":"Acta Trop","first-page":"36","article-title":"Leptospirosis among patients presenting with dengue-like illness in Puerto Rico","volume":"96","author":"Bruce","year":"2005"},{"key":"b33","series-title":"Am J Trop Med Hyg","first-page":"657","article-title":"Referral pattern of leptospirosis cases during a large urban epidemic of dengue","volume":"65","author":"Flannery","year":"2001"},{"key":"b34","series-title":"Emerg Infect Dis","first-page":"766","article-title":"Leptospirosis during dengue outbreak, Bangladesh","volume":"11","author":"LaRocque","year":"2005"},{"key":"b35","series-title":"Vector Borne Zoonotic Dis","first-page":"541","article-title":"Underrecognition of leptospirosis during a dengue fever outbreak in Hawaii, 2001\u20132002","volume":"8","author":"Ellis","year":"2008"},{"key":"b36","series-title":"Emerg Infect Dis","first-page":"221","article-title":"Leptospirosis in Hawaii, USA, 1999\u20132008","volume":"17","author":"Katz","year":"2011"},{"key":"b37","series-title":"Am J Trop Med Hyg","first-page":"61","article-title":"Leptospirosis in Hawaii, 1974\u20131998: Epidemiologic analysis of 353 laboratory-confirmed cases","volume":"66","author":"Katz","year":"2002"},{"key":"b38","series-title":"Jpn J Infect Dis","first-page":"187","article-title":"Re-emerging, under-recognized zoonotic, and neglected tropical diseases in Hawai\u2019i","volume":"77","author":"Zorilla","year":"2024"},{"key":"b39","series-title":"Am J Trop Med Hyg","first-page":"882","article-title":"Leptospirosis on Oahu: An outbreak associated with flooding of a university campus","volume":"76","author":"Gaynor","year":"2007"},{"key":"b40","series-title":"Am J Trop Med Hyg","first-page":"337","article-title":"Leptospira infection prevalence in small mammal host populations on three Hawaiian islands","volume":"87","author":"Wong","year":"2012"},{"key":"b41","series-title":"Zoonoses Public Health","first-page":"584","article-title":"Feral swine Leptospira seroprevalence survey in Hawaii, USA, 2007\u20132009","volume":"63","author":"Buchholz","year":"2016"},{"key":"b42","series-title":"Haw JL Pol","first-page":"175","article-title":"A brief history of land titles in the Hawaiian Kingdom","volume":"2","author":"Alexander","year":"2006"},{"key":"b43","series-title":"Sustainability","first-page":"3554","article-title":"The Moku system: Managing biocultural resources for abundance within social-ecological regions in Hawai\u2019i","volume":"10","author":"Winter","year":"2018"},{"key":"b44","series-title":"Curr Protoc Microbiol","first-page":"Unit 12E.5","article-title":"Leptospirosis serodiagnosis by the microscopic agglutination test","volume":"32","author":"Goris","year":"2014"},{"key":"b45","series-title":"Census\/Projection-Disaggregated Gridded Population Datasets for 189 Countries in 2020 Using Built-Settlement Growth Model (BSGM) Outputs","author":"Bondarenko","year":"2020"},{"key":"b46","series-title":"Sci Data","first-page":"170004","article-title":"WorldPop, open data for spatial demography","volume":"4","author":"Tatem","year":"2017"},{"key":"b47","series-title":"J Clin Microbiol","first-page":"e0078024","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"},{"key":"b48","series-title":"Front Public Health","first-page":"1440933","article-title":"Tracking sero-molecular trends of swine brucellosis in Hawai\u02bbi and the central Pacific","volume":"12","author":"La","year":"2024"},{"key":"b49","series-title":"Am J Trop Med Hyg","first-page":"35","article-title":"Active surveillance and risk factors for leptospirosis in Hawaii","volume":"48","author":"Sasaki","year":"1993"},{"key":"b50","series-title":"BMC Infect Dis","first-page":"147","article-title":"Leptospirosis in the Asia Pacific region","volume":"9","author":"Victoriano","year":"2009"},{"key":"b51","article-title":"State Land Use Districts.","year":"2020"},{"key":"b52","series-title":"Indian J Med Microbiol","first-page":"337","article-title":"Leptospirosis in Mumbai: Post-deluge outbreak 2005","volume":"24","author":"Maskey","year":"2006"},{"key":"b53","series-title":"J Epidemiol Community Health","first-page":"1054","article-title":"Relation of rainfall pattern and epidemic leptospirosis in the Indian state of Kerala","volume":"58","author":"Pappachan","year":"2004"},{"key":"b54","series-title":"Am J Trop Med Hyg","first-page":"957","article-title":"Seroprevalence of leptospirosis and risk factor analysis in flood-prone rural areas in Lao PDR","volume":"78","author":"Leo","year":"2008"},{"key":"b55","series-title":"Ann Ig","first-page":"453","article-title":"Leptospirosis following a flood in the Veneto area, north-east Italy","volume":"18","author":"Pellizzer","year":"2006"},{"key":"b56","series-title":"Ann Trop Med Parasitol","first-page":"239","article-title":"Leptospirosis: Case reports of an outbreak in Guyana","volume":"102","author":"Liverpool","year":"2008"},{"key":"b57","series-title":"J Infect Dis","first-page":"1457","article-title":"Epidemic leptospirosis associated with pulmonary hemorrhage-Nicaragua, 1995","volume":"178","author":"Trevejo","year":"1998"},{"key":"b58","series-title":"Am J Trop Med Hyg","first-page":"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"},{"key":"b59","series-title":"Trop Med Int Health","first-page":"926","article-title":"Outbreak of leptospirosis in New Caledonia: Diagnosis issues and burden of disease","volume":"14","author":"Goarant","year":"2009"},{"key":"b60","series-title":"Natl Med J India","first-page":"22","article-title":"Outbreak of leptospirosis after the cyclone in Orissa","volume":"15","author":"Sehgal","year":"2002"},{"key":"b61","series-title":"MMWR Morb Mortal Wkly Rep","first-page":"763","article-title":"Leptospirosis outbreak in aftermath of Hurricane Fiona\u2014Puerto Rico, 2022","volume":"73","author":"Jones","year":"2024"},{"key":"b62","series-title":"Braz J Infect Dis","first-page":"131","article-title":"The relationship between rainfall and human leptospirosis in Florian\u00f3polis, Brazil, 1991\u20131996","volume":"4","author":"Kupek","year":"2000"},{"key":"b63","series-title":"PLoS Negl Trop Dis","first-page":"e0012042","article-title":"Navigating cross-reactivity and host species effects in a serological assay: A case study of the microscopic agglutination test for Leptospira serology","volume":"18","author":"Mummah","year":"2024"},{"key":"b64","series-title":"Clin Infect Dis","first-page":"447","article-title":"Usefulness of serologic analysis as a predictor of the infecting serovar in patients with severe leptospirosis","volume":"36","author":"Levett","year":"2003"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/5\/article-p980.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/5\/article-p980.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/5\/article-p980.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T14:23:08Z","timestamp":1762352588000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/5\/article-p980.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,5]]},"references-count":64,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.25-0267","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,5]]}}}