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Leptospirosis – no longer the rural farmer’s disease

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Making a breakthrough in the study of leptospirosis, a bacterial infection transmitted from animals, a team of Sri Lankan researchers in a collaborative endeavour has discovered six new genotypes of this largely undermined tropical disease. In an exclusive interview with the Sunday Island, they throw light on the findings of their research which are now in international literature enabling new knowledge on the world’s commonest zoonotic disease.

by Randima Attygalle

No longer considered the ‘rural farmer’s disease’, leptospirosis, commonly called rat fever or mee una in Sinhala, is changing its dynamics, urging clinicians, health policy-makers and the public to revisit this common tropical disease of both humans and animals. The bacterium that causes leptospirosis is spread through the urine of infected animals, which can get into water or soil and can survive there for weeks or months. Many different kinds of wild and domestic animals carry the bacterium including cattle, pigs, rodents, dogs, horses and wild animals.

Humans can become infected with the bacterium either through contact with urine of an infected animal or with water or soil contaminated with the urine of infected animals. The bacteria can enter the body through skin, eyes, nose or mouth. Outbreaks of leptospirosis are usually caused by exposure to contaminated water, such as floodwaters. It is a serious occupational hazard for those working outdoors such as farmers, miners etc. and professionals such as veterinarians in close contact with animals. According to global research findings, around one million cases of leptospirosis and 58,900 deaths are estimated to occur worldwide each year. More than 70% of the deaths are reported from the tropical, poorest regions of the world.

A re-merging disease here at home, leptospirosis has gained much attention since the large outbreak in 2008. “The annual incidence of leptospirosis that had required hospitalization from 2008 to 2015 was 52.1 per 100,000 people, with an estimated case fatality rate of 7.0% according to National Health Bulletin data. In 2018 there was another resurgence in numbers. The disease is no more a ‘seasonal’ one as it was conventionally known to be, resulting in multiple outbreaks per year, notably during rainy seasons. Manifestations of the disease have also changed, with a wide array of new clinical entities such as pulmonary haemorrhage (bleeding into the lungs), pancreatitis, and myocarditis coupled with high case fatality. These shifts in the disease call for new strategies, new interventions and the need to reorganize ourselves as the health care sector,” says Dr. Panduka Karunanayake, Senior Lecturer from the Department of Clinical Medicine, University of Colombo.

The purpose of this research project between researchers from several local institutions (Medical Research Institute and Base Hospital Elpitiya under the Ministry of Health, and University of Peradeniya and University of Colombo) and Japan (National Institute of Infectious Diseases in Tokyo, and Graduate School of Infectious Diseases and Institute of Genetic Medicine of Hokkaido University) had been to identify the serogroups and genetic groups of Leptospira organisms that are found here at home. “This knowledge is important to better understand the new clinical manifestations for their early diagnosis and treatment, and to know the carrier animal for specific control measures, as this disease is carried by animals,” explains Dr. Karunanayake.

A laborious process, first, the organisms need to be ‘isolated’ (grown) in artificial culture, and thereafter artificially ‘maintained’ (kept alive) in culture media. This needs specialized laboratories with biosafety measures. The National Reference Laboratory (NRL) for Leptospirosis at the MRI offers this service to hospitals routinely. “Organisms were isolated from blood of patients affected by the 2015-2017 leptospirosis outbreak from the Base Hospital in Elpitiya and animal kidney tissue from Kandy. Once they were successfully grown and maintained in culture, they were sent to Japan for the genetic characterization which was done for us by the Japanese collaborator (Dr. Nobuo Koizumi, National Institute of Infectious Diseases (NIID), Japan),” says Dr Karunanayake.

The genetic characterization and serogroup analyses were done in NIID, Japan which demonstrated that these strains belonged to three genetically-defined species. “When their genotypic strains were analyzed, it was found that the isolates belong to 15 different strains, of which six were not described before in the world literature, hence treated as ‘novel genotypes’. Of these, three were from patients treated at the Base Hospital in Elpitiya. They were causing multiple complications such as kidney, liver, heart and lung involvement and septic shock. However, all of these patients survived,” says Dr. Karunanayake.

Although leptospirosis had been prevalent in our country since the 1950s, it has been changing its nature in the last decade. “While the number of cases are increasing alarmingly, the clinical picture too is changing, with the identification of new and troublesome complications including pulmonary haemorrhage, pancreatic involvement, heart involvement, community-acquired sepsis, etc.” he said. The disease is also affecting a wider group of people, such as those living in urban areas and people exposed only briefly to stagnant waters or floods.

“After 40 years since Dr. K. Nityananda’s work in the 1960s and 1970s at the NRL, we have been able to introduce new strains for the first time to the world literature on leptospirosis, again from the NRL,” observes Dr. Lilani Karunanayake, Consultant Clinical Microbiologist and Head/National Reference Laboratory for Leptospirosis at the Medical Research Institute. The emergence of new genotypes, as she points out, imply the importance of strict quarantine of imported cattle as well as other imported domestic animals that are potential reservoirs of leptospirosis. “Unintentional introduction of rodent reservoirs through improper garbage disposal and the existence of unidentified reservoir animals in the country also call for attention,” says the senior microbiologist who further says that new knowledge from this study will be valuable in future research for patient management and specifically-targeted control approaches for reservoir hosts in the prevention and control of leptospirosis in Sri Lanka. She extended her thanks to the clinicians from various hospitals who sent in samples, which enabled these discoveries in the best interest of people.

The National Reference Laboratory (NRL) for Leptospirosis at the MRI which serves as the central referral laboratory in the country performs certain specific leptospirosis tests, samples for which are sent from hospitals island-wide. “Although certain tests could be performed at peripheral levels, some of the advanced cases need to be referred to the central lab,” notes Dr. Karunanayake, adding that the Teaching Hospitals at regional level should be strengthened with testing facilities for early detection.

Non-specific features of the patients such as fever, headaches, body aches, diarrhea which could mimic other conditions such as dengue has rendered early detection of leptospirosis very challenging, says Dr. Sajiv De Silva, Consultant Physician, Base Hospital, Balapitiya. “Hence kidney complications and the lung involvement are two specific features we give attention to in our investigations which often require intensive care. We also take serious account of the patient’s exposure to paddy fields and muddy water. In the Elpitiya patient cluster which we took as our research sample, the kidney complications and pulmonary haemorrhage were very severe which enabled us to add the new genotypes from this cluster to the world literature on leptospirosis.” He further remarks that these genotypes are more virulent than those found in the Western Province. Similar to the cluster in Elpitiya, more recent samples from patients in Galle, Balapitiya and Udugama in the Southern Province have reflected more severe complications, particularly lung and kidney complications which trigger rapid deterioration of the patient.

Patient demographic changes are also significant as the research reveals, points out Dr. De Silva. “Apart from farmers and miners who were traditionally identified as the most vulnerable to the disease, today we find a considerable percentage of young patients who had contacted it by merely visiting a paddy field or bathing in a river.” Diagnosing leptospirosis has become a “dilemma” for the physicians at the peripheral level, observes the Consultant who adds that, blurring lines between dengue and leptospirosis makes it more challenging. “In both situations platelets will drop. However in the treatment of dengue, while fluids need to be administered proportionate to the urine output, in the case of leptospirosis, fluids cannot be administered to mitigate pulmonary hemorrhage.”

Reiterating on the urgency of seeking early hospital care, the physician notes, “the earlier they come, faster the laboratory diagnosis would be.” Although clinical diagnosis of leptospirosis was not possible in the first few days of symptoms, today the availability of the PCR test (free in the state health sector) makes this possible, he adds. The toll the disease takes on families and the national health budget cannot be undermined. In a bid to create awareness on prevention of it by promoting safety footwear and early detection among the communities at rural level, a programme is now in place facilitated by the MOHs and PHIs says Dr. De Silva.

The breakthrough research is also a reflection of the validity of the ‘One Health’ concept where collaborative health efforts of multiple disciplines working nationally and globally can attain optimal health for people, animals and the environment, observes Dr. Chandika Gamage, Veterinarian and Senior Lecturer from the Department of Microbiology, Faculty of Medicine, University of Peradeniya. “Pathogens isolated from rats and humans in a molecular study during the research had revealed same genetic strain types which have enabled us to enlarge our knowledge on leptospirosis,” explains Dr. Gamage.

Although traditionally leptospirosis had been considered a disease spread by rats (‘natural reservoirs’), it is now becoming clear that there are other animals, such as cattle, that harbour the bacteria and spread it, points out Dr. Gamage. The research had further thrown light on dairy cattle as a potent reservoir of the disease. They are often grazed on grassland infected with rat urine and can can set off a vicious cycle, says the Veterinarian. “One excretion of cattle urine can be an amplifier pathogen of leptospirosis.”

Concurrent studies in humans, animals and environmental sampling can determine how these interact to bring about disease in humans which validates the One Health approach, says the Veterinarian. Furthermore, diverse sero groups were found in this study to cause both human disease and that present in animals like cattle and buffalo, pointing towards the need for new preventive strategies to control human leptospirosis in Sri Lanka, he says. Research will also be extended to the study of domestic animals such as dogs and cats as potential carriers of the disease.

“It is imperative that we contribute to the control of leptospirosis through One Health perspective through preventive measures such as safe garbage disposal which would otherwise become breeding grounds for rats, vaccination of cats and dogs, use of preventive footwear in agrarian and other outdoor pursuits. While a patient infected with the disease may be treated, unless we adopt a holistic approach towards prevention, the environment around us could still be a catalyst of the disease hindering the control or even elimination of the disease.”



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Features

The Rohingya question and states’ international obligations

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A boat load of Rohingyas rescued off MullaitIvu

The presence of Rohingya refugees in Sri Lanka has prompted sections in the South of the country to raise some concerns in connection with it but The Human Rights Commission of Sri Lanka’s (THRCSL) recent report on the issue, if received and read in a spirit of reconciliation and humanity, should put their minds at ease.

To be sure, there is considerable substance in the objections and worries of the relevant Southern quarters but the majority of the refugees in question need to be seen as victims of complex political circumstances in their countries of origin over which they do not have any control.

Those Rohingyas who are now literally adrift in the seas of South Asia and beyond, are strictly speaking stateless. Most of them are escaping endemic political turmoil and runaway lawlessness in the Rakhine state of Mynamar and the spillover of such tensions into the Myanmar-Bangladesh border and beyond.

There has been playing out in the Rakhine region over the decades a Rohingya armed struggle for autonomy but the majority of the Rohingyas are not in any way supportive of this armed struggle which is an expression of the Rohingyas’ awareness of their separate identity as a community, although they possess a wider Muslim identity as well.

But there has been an influx of Rohingya refugees to several neighbouring countries from this conflict, including very significantly Bangladesh, and this has been triggering concerns among the wider publics in those states which are compelled to manage the Rohingya refugee presence amid economic pressures of their own.

The problems arising from the Rohingya refugee presence have been compounded by the rise of Islamic militancy in South Asia and the tendency among some of these militant groups to exploit this presence for the propagation of their causes.

However, this does not take away from the fact that the majority of Rohingyas are helpless victims of circumstance. They are caught up in the metaphorical ‘exchange of fire’ between mutually suspicious states that are compelled to contend with issues growing out of the rise of Islamic militancy. But for the majority of Rohingyas such endemic conflicts among states translate into displacement, statelessness and growing powerlessness.

For an enlightened understanding of what states need to do in connection with the refugee crisis and connected questions it would be necessary to read the THRCSL report above mentioned. States that are members of the UN family are obliged to ratify and implement a number of conventions related to refugees and the THRCSL mentions some of these. They are: The 1951 Convention on Refugees; 1954 Convention Relating to the Status of Stateless Persons; 1961 Convention on the Reduction of the Stateless and the Rights of Refugees and Stateless Persons within Sri Lanka.

If Sri Lanka and other countries facing a refugee influx have not adopted these laws they would need to do so without further delay if they are opting to remain within the UN fold. In this connection, the Universal Declaration of Human Rights should be seen to be of fundamental importance. The Declaration is the fountainhead, so to speak, of international humanitarian law and UN members states have no choice but to adhere to it.

Contentious issues are likely to grow out of the implementation part of the mentioned conventions but it is best that signatory states take up these matters with the relevant key agencies of the UN rather than grouch over matters that surface from their inalienable obligations towards the stateless and homeless.

It was encouraging to note a Southern group in Sri Lanka mentioning that the Lankan government should draw the attention of the UNHRC to the fact that the state is not a signatory to some of the mentioned refugee conventions. This is the way to go. A dialogue process with the UNHRC, which does not happen to be very popular in Sri Lanka, on such issues would perhaps throw up fresh insights on Sri Lanka’s obligations on refugee issues that may then convince the state to sign and ratify the conventions concerned.

There needs to be a flourishing of such positive approaches to meeting Sri Lanka’s obligations as a UN member state. The present most unhappy existence of being a UN member state and not implementing attendant obligations needs to end if Sri Lanka is not to be accused of ‘double speak’ and ‘double think’.

Meanwhile, identity politics and connected problems are bound to remain in South Asia and bedevil all efforts by states of the region to see eye-to-eye on issues such as the stateless. The yawning ‘democratic deficit’ in South Asia continues to be a formidable challenge.

But all efforts should be made to reduce this deficit through collaborative efforts among the concerned states. This is so because increasing democratization of states remains the most effective means of making identity politics irrelevant and the latter is a primary cause for the break-up of states, which process throws-up troubling consequences, such as statelessness and refugees.

Fresh initiatives need to be undertaken by the ‘South Asian Eight’ to end the continuing ‘Cold War’-type situation between India and Pakistan, since they hold the key to re-activating SAARC and making it workable once again. It ought to be plain to see that it is only the SAARC spirit that could help in ushering a degree of solidarity in South Asia which could go some distance in resolving issues growing out of nation-breaking.

Once again, South-South cooperation should be seen as a compelling necessity. If vital sections of the South come to this realization and recognize the need for such intra-regional cooperation, the coming back to power of Donald Trump could be considered as having yielded some good, though in a highly negative way. Because Trump has made it all too plain that he would not be considering it obligatory on the part of the US to help ease the lot of the South any more.

The South would have no choice but to fall back on strategies of self-reliance. No doubt, this situation would accrue to the benefit of the world’s powerless. Self-reliance is the best option and the only key to unravelling external shackles that bind the South to the North.

Meanwhile, those sections of Southern Sri Lanka that are tending to cheer Trump on need to put the brakes on any such idle distractions. The message that Trump has for the world is one of division and strife. By rolling back almost all the progressive ventures that have come out of Washington over the years, Trump is plunging the world into further ‘disorder’. The international community needs to brace for stepped-up nation-breaking.

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Effective and non-effective methods for mitigating human-elephant conflict

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Villagers living in fear of wild elephants. (File photo)

by Tharindu Muthukumarana
tharinduele@gmail.com

(Author of the award-winning book “The Life of Last Proboscideans: Elephants”)

“We cannot solve our problems with the same thinking we used when we created them”.

-Albert Einstein

When we examine the records of funds spent in the years beforehand to mitigate human-elephant conflict (HEC), it is evident that the expenditure has been growing. For example, in 2010, USD $505,001 was spent, but in 2018, USD $1,068,021 was spent. So, this shows that expenditure had been over double within a period of less than one decade. But in the same way, the HEC had always been rising throughout the years. So, what went wrong? The answer is that the funds were expended mostly on ineffective mitigating strategies rather than effective mitigating approaches. Henceforth, let’s look at a glimpse of what are the non-effective methods and effective methods.

Non-effective methods Translocation

Elephant translocation involves capturing elephants from one place and moving them to a safer environment. Sri Lanka had done this for many decades. One of the earliest translocations occurred in 1979, when 10 elephants were relocated from Deduru Oya to Wilpattu National Park (NP). So, it was a new experience for the Department of Wildlife Conservation (DWC), and they even had to get a foreign veterinary surgeon named Dr. Ian Hoffmeyr from Etosha NP in Namibia to sedate the elephants.

Unfortunately, radio tracking collars were not put on those elephants to monitor updates of those elephants. So, ultimately what happened was that those translocated elephants’ status never got documented. However, in recent translocations, the GPS tracking collars were fixed on them and have given accurate updates on their whereabouts. According to those data, 3 conclusions are probable: (i) The translocated elephant got killed in the new home. (ii) Left the new home and returned to the initial home. (iii) created conflict with neighbouring villagers in the new home.

As for example, in 2007, a tusker named Ravana that was crop raiding in Anuradhapura got translocated to Udawalawe NP. He then got into conflict with neighbouring villages of Handapanagala, Aluthwewa, and Buttala. Due to this, Ravana got shot in the leg, and as a result, Ravana got re-translocated to Lunugamvehera NP. Again, Ravana raided crops on leased land in the park, and a few months later, Ravana got shot in the jaw and had an agonising death after suffering for a few days.

Another tragic event happened when a young bull elephant named Homey that frequently foraged at a garbage dump in Hambantota got translocated to Yala NP Block II, which took a journey of 75 km. Within a few days, Homey was back at the garbage dump. Astonishingly, when data from the collar was downloaded, it was shown that the route Homey took to return contrasted with the route Homey was taken. For the second time, Homey was translocated to Udawalawe NP, but as time passed by, he created conflict with neighbouring villages. Subsequently, Homey left the park and again returned to the garbage dump. For the third time, Homey got translocated to Maduruoya NP, almost 300 km away from Hambantota. At times, Homey tried to come back to the garbage dump but was unsuccessful due to compact human settlements. So, he continued to stay at Maduruoya but started to create conflict with neighbouring villages. This resulted in him getting shot frequently. One day he got shot in the head and died in a paddy field.

Elephant Drives

Elephant drives involve chasing elephants from one area to another area, and for this, firecrackers or thunder flashes would be used. This procedure can take days to get completed. These drives had happened as early as the 1970s, and the latest to be 2024. From a scientific perspective, the decades of elephant drives that have been done are one of the key reasons for Sri Lanka having the highest level of HEC in the world. Records have clearly shown that after an elephant drive, some or all driven elephants returned. Also, in every location where elephant drives took place, HEC still persists. In many cases, the problem-causing males don’t get driven because those males usually avoid it. Instead, non-problem-causing female elephants get driven. In such incidents, after those driven elephants got enclosed in a restricted home range, those elephants did face starvation and malnourishment that eventually made them die. For this, there are examples coming from Lunugamvehera NP and Yala NP.

Removing the problem elephants

Removing problem elephants could be done in two ways: one is domestication and the other is culling. Such acts can enhance the risk for elephants’ extinction. Problem elephants are usually male elephants, and elephants that raid crops are risk takers. Emerging research shows that risk-taking behaviour contributes highly to their reproductive success. So, if such elephants are removed from the gene pool, it weakens the elephant population.

In modern days, there is a popular misconception that the elephant population has risen, and it is immoderate. In fact, scientifically, there is no way to explain whether the elephant population has risen or plummeted. Because the first legitimate elephant census was done in 2011. Before 2011, elephant population numbers were given as guesses or estimations. After 2011, last year an elephant census was done, but still the results haven’t been published. There are many who think that the elephant population has increased because, around the country, there are places where locals are newly experiencing HEC. This happened because of habitat loss and the blocking of elephant corridors that occurred due to poor development planning done by various governments. So, as a result of it, new places experience HEC.

Still, the Sri Lankan elephant is classified as “Endangered” by the IUCN Red List due to its high risk of extinction and declining population. Also, we must remember that though culling or capturing of elephants is not done, yet annually, in the last few years, over 350 elephants have died due to HEC. This is only the documented data, and the undocumented figure can give a higher value. A mother elephant usually gives birth to a single calf with a two-year gestation period. They have 4-5 years of interval until the next calf is born. Females become less fertile after 40 years. In Sri Lanka only 6,000 elephants are left. So, such a high mortality rate due to HEC is critical.

Biofencing and Geological Barriers

A victim of the human-elephant conflict

Palmyra Palm fencing: This involves planting palmyra trees (Borassus) as a fence to restrict elephants’ movements. Though it has some positive effects, practically there are problems to call it a solution. This project is expected to take a longer time to achieve its anticipated outcomes and could take even a decade. Even so, the germination rate is lower, and by any chance, if at least one tree fails to grow, the fence becomes ineffective.

Thorny plant fencing: Plants such as agave, cacti, and bougainvillaea had been used to deter elephants, but those had been unsuccessful because of elephants’ thick skin. Besides, elephants even feed on thorny plants such as Acacia eburnean that have sharp thorns that can grow up to 1 inch.

Beehive fencing: The fence is erected at chest height with beehives fixed to it and spaced every ten meters. This method had high success in deterring crop-raiding elephants in Africa. In addition, the produce from hives provided economic benefits to farmers. This project was introduced by Save the Elephants Organisation (SEO). From 2014-2019 SEO collaborated with the Sri Lanka Wildlife Conservation Society (SLWCS) to do a pilot project in Wasgamuwa. Unfortunately, results showed it was ineffective due to the reason that African honey bees (Apes mellifera scutellata) and Asian honey bees (Apes cerana indica) behaviour contrasts. Asian bees cannot scare away elephants, and those bees are not active at nighttime.

Trenches: Soil erosion had made trenches ineffective, and also the construction and maintenance cost is very expensive. According to past experiences, it had impeded wildlife movement, and a lot of other smaller animals had died after falling to them. Also, there is a potential of hydrological impacts that would have a negative effect on villages.

Effective methods

Before touching this topic, it is important to mention that the strategies put forward here are science-based projects, and these projects had been put into experiment as pilot projects with successful results. The villagers state that after the implementation of the project, HEC had been solved or mitigated. These projects had been done by the Centre for Conservation and Research and SLWCS.

According to research, it has been proved that the electric fence is the most effective to deter elephants. But it depends where the electric fence is erected. If it is erected in the boundary of a protected area, it can be ineffective, but instead, if it is erected at the border between elephant habitat and human-use areas, it can be successful. This is what is called community-based electric fencing and proved to be successful in mitigating HEC.

Another method is the paddy-field electric fences. These fences are installed seasonally. During cultivation the fences are installed, and during harvest the fence is removed and stored in their houses until the following crop season. So, during the fallow periods, elephants would forage the leftover harvest and other vegetation. By 2020, approximately 50 village electric fences and 25 paddy-field electric fences were active in the Kurunegala, Hambantota, Trincomalee, and Anuradhapura districts for up to 12 years. Feedback from the villagers is positive.

It needs to be mentioned that in 2020 a National Action Plan for the Mitigation of HEC was made by a committee of wildlife experts. Strategies included in the National Action Plan were chosen based on their demonstrated effectiveness, capacity to be executed on a suitable geographic and temporal scale, and cost-effectiveness. Stakeholder discussions were performed with the public and relevant agencies, and their feedback was integrated into the Action Plan as needed. So, if that action plan gets implemented, HEC could be mitigated!

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Congratulations…and celebrations

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Twenty-one years in the news, in Toronto, Canada, and that certainly calls for big time celebrations!

Dirk Tissera, Editor-in-Chief and Publisher of The Sri Lanka Anchorman, is working on making it a big scene.

He says the 21st Anniversary celebrations will take the form of a gala dinner dance, scheduled for Friday, 30th May, 2025, in Toronto, Canada, adding that there would be plenty of surprises!

In fact, The Sri Lankan Anchorman’s 20th Anniversary, ‘A Night To Remember,’ held on 31 May, 2024, at the J&J Convention Centre, in Toronto, turned out to a resounding success.

Dirk mentioned that last year’s event was sold out long before the scheduled date.

“We generally work on our anniversary celebrations months in advance to ensure that the audience got their monies worth, and there was plenty of variety in the music we provided last year, led by veteran singer, the legendary Fahmy Nazick, along with the band Déjà Vu, guest singer Cherry Deluna, and DJ Chami.

What is special about The Sri Lanka Anchorman, a tabloid newspaper, is its wide and varied content which Sri Lankan-Canadians eagerly look forward to reading.

In fact, Dirk Tissera received a top Toronto press award from the National Ethnic Press & Media Council of Canada (NEPMCC) for excellence in editorial content and visual presentation.

An old boy of St. Mary’s College, Dehiwela, he had his early grooming, in journalism, right here, in Colombo, and then moved to Canada, and is now based in Toronto.

Dirk Tissera is efficiently supported by his wife Michelle in the publication of The Sri Lanka Anchorman.

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