Leptospirosis in the Caribbean Region between 2000 and 2022: A scoping review of morbidity and mortality

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Abstract
Leptospirosis remains an important yet underreported public health concern in the Caribbean. Urbanisation, biodiversity loss and human encroachment into natural habitats have contributed to shifts in its epidemiological patterns. However, accurate assessment of disease burden is hindered by limited diagnostic capacity, surveillance challenges, and scarce research. We aim to describe geographical and temporal distribution of leptospirosis epidemiology in Caribbean Island Countries and Territories (CRICTs) and identify patterns and gaps in knowledge. We conducted a systematic search across PubMed, Web of Science, Embase, Scopus, and the Latin America and Caribbean Health Sciences Literature databases, between 2000–2022, without language restrictions. Eligible publications were routine surveillance-based studies or cross-sectional seroprevalence surveys. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) protocol. Of 110 full-text articles reviewed, 16 met inclusion criteria, documenting leptospirosis in 15 of 27 CRICTs (55.6%). Between 2000–2010, we identified an average of 2.6 studies per year, compared to just 1.2 between 2011–2022. Nine studies (60.0%) reported surveillance data, and six (40.0%) were seroprevalence surveys. Two studies reported hospitalisation rate (12.5%), and five studies, case fatality rate (31.3%). There were more than one publication from Guadeloupe, Jamaica, Puerto Rico, St. Lucia and Trinidad and Tobago. Although most studies acknowledged links between leptospirosis and extreme weather, only three were specifically designed to investigate this association. Our findings highlight critical gaps in leptospirosis burden and research across the Caribbean. The scarcity of recent studies investigating epidemiological differences across rural and urban settings, and the impact of environmental changes, contributes to limited characterisation of evolving transmission patterns across the region. Strengthening regional research capacity and surveillance systems is essential to inform targeted public health strategies and reduce the disease’s burden locally. Leptospirosis continues to affect communities across the Caribbean. Growing cities and population, closer contact between people and wildlife, and more frequent heavy rain and flooding can facilitate Leptospira survival and transmission. Despite its importance, the most recent regional estimates were published over a decade ago and relied on information that largely predates the year 2000. This limits the effectiveness of public health responses and disease control strategies. To address this gap, we conducted a scoping review of studies published between 2000–2022 to provide an updated overview of leptospirosis epidemiology across Caribbean Islands Countries and Territories (CRICTs). We identified 16 studies reporting data from 15 of 27 CRICTs, revealing substantial gaps in surveillance, geographic coverage, and research on environmental drivers. Our findings underscore the need for strengthened regional research capacity and improved surveillance systems to better understand evolving transmission patterns and inform targeted interventions to reduce the burden of leptospirosis in the Caribbean.
Funding Information
  • University of Queensland
  • University of Queensland
  • National Health and Medical Research Council (APP1193826)
  • National Health and Medical Research Council (APP2034827)
  • University of Queensland

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