Rare Infectious Disease Spreading in Puerto Rico: Public Health Watch Report

October 18, 2017
Brian P. Dunleavy

According to reports in multiple media outlets, clinicians on the hurricane-ravaged island have already identified at least 10 cases of a rare water-borne bacterial infection, and they warn of the potential for more.

Federal assistance for Puerto Rico in the aftermath of Hurricane Maria may not be around “forever,” but an infectious component of the storm's impact on the US territory may linger.

According to reports in multiple media outlets, including the Washington Post, clinicians on the storm-ravaged island have already identified at least 10 cases of leptospirosis, a water-borne infection. Given that as many as one-third of Puerto Rico's residents still do not have running water—some 4 weeks after Maria touched down—it is expected that more cases of the bacterial disease will emerge as residents have been forced to stand in line for access to communal water supplies. Leptospirosis is also spread via dogs and cats, livestock, and rodents—relevant considering a report by the SunshineStateNews.com, which suggests that garbage collection has not resumed on much of the island and that there have been sightings of dead animals in the streets in some areas.

All of which makes Puerto Rico a potential ground zero for a major outbreak of an infectious disease, experts say.

Notably, leptospirosis is relatively rare, which makes its appearance on the island all the more striking. The Centers for Disease Control and Prevention (CDC) estimates that there are fewer than 200 cases of leptospirosis annually in the country and its territories, with roughly 50% of those occurring in Hawaii. The largest reported outbreak in the United States occurred in 1998 when 775 people were exposed and 110 ultimately became infected.

It’s been less than a week since the first confirmed case in Puerto Rico. Meanwhile, at least 1 case of the bacterial disease has been reported in the US Virgin Islands.

The fact that Puerto Rico has also only recently emerged from another public health crisis, that of the Zika virus, arguably makes the effects of Maria all the more pronounced. Although both Florida and Texas identified locally-transmitted cases, the island territory reported nearly 35,000 such cases in 2016 alone, according to CDC figures. Officials in San Juan only declared the Zika outbreak over in June.

In a commentary published on October 12, 2017 in the New England Journal of Medicine, Contagion® Editorial Advisory Board member, Carmen D. Zorrilla, MD, Department of Obstetrics and Gynecology and the Maternal-Infant Studies Center, University of Puerto Rico School of Medicine-San Juan, noted, “The potential development of infectious disease outbreaks and reactivation of dengue, Zika, and chikungunya epidemics is one major concern… This hurricane might well increase the mosquito population, and people may not pay attention to prevention messages or be willing to modify behaviors that affect their seeking of food, water, and gasoline or repairing of their homes.”

Last week, Contagion® reported that both the Infectious Disease Society of America (IDSA) and HIV Medicine Association (HIVMA) issued a joint statement calling for dedicated aid in Puerto Rico to “minimize the health effects of the hurricanes.” Specifically, they cited the hazards posed by water-borne pathogens, food-borne illnesses, and mosquito-borne infections.

Political leaders seem to be listening to these calls for action. Earlier this month, for example, President Trump asked Congress to approve $29 million in federal funding for aid to Puerto Rico. It would be part of a much larger, $36.5 billion package for hurricane relief that would also cover damage in Florida, Texas, and the Virgin Islands; however, as of this writing, the request has not yet been approved. According to Politico.com, the House of Representatives recently approved a $4.9 billion aid package, although total recovery costs for Puerto Rico alone have been estimated at $90 billion. And, according to SunshineStateNews.com, Senator Marco Rubio (R-Florida) has written a letter to the US Department of Health and Human Services advocating for urgent action in Puerto Rico to address ongoing “public health concerns.”

Will it be enough, and will it happen before an infectious disease reaches epidemic proportions on the island? Only time will tell.

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.