Leptospirosis strikes Bronx, all too familiar with rats

Leptospirosis goes by many names. Mud fever, sewerman’s flu, and swamp fever are just a few of the monikers for the illness caused by Leptospira.

As the names indicate, the disease is associated with filth, and in the developed world, it is rare. But in the Grand Concourse neighborhood of the Bronx, where the conditions in some of the buildings have long been called “unlivable” by residents, the disease found its way into the vast rat population and has been linked to a cluster of infections that have left one resident dead and two others severely ill.

This is the first cluster of leptospirosis cases ever identified in New York City. Human leptospirosis cases are generally very rare in New York City and are associated with exposure to rats.

New York City authorities ordered people living in eight “illegal” apartments in a subcellar at 750 Grand Concourse, several blocks from Yankee Stadium, to vacate the premises, and have stepped up efforts to combat the rat population through extermination and better garbage management. Read more in the New York Times.

Questions and answers

Where is leptospirosis maintained?

Leptospirosis is maintained in nature by chronic renal infection of carrier animals, particularly rodents.

How could I get infected?

Infections typically occur following exposure to water or soil contaminated with rodent urine.

Where do outbreaks occur?

In countries with poor housing standards, leptospirosis outbreaks occur in urban settings after heavy rainfall and flooding.

What about leptospirosis and dogs?

Among dogs, an average of 20 cases are reported in NYC each year and are associated with rats and small mammals.

How can it be prevented?

The most effective preventive strategy is to reduce direct contact with animals and indirect contact with urine-contaminated soil and water.

Consistent application of rodent control measures is important in limiting the extent of contamination. Appropriate protective measures depend on the activity but include wearing boots, goggles, overalls, and rubber gloves.

What about the social determinants of health?

The bigger issue is poverty. Why, in 2017, are people in New York City, one of the richest cities in the wealthiest country on earth, living in such dreadful housing conditions?

In 1848, Rudolph Virchow published his Report on the Typhus Epidemic in Upper Silesia. This document was one of the classics of ‘social medicine,’ and Virchow did not recommend more doctors, hospitals, or medical technology. Instead, he focused on full employment, higher wages, the establishment of agricultural cooperatives, and universal education.

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