Molecular detection and genetic characterisation of a large flood-borne outbreak of human leptospirosis in Jakarta, Indonesia: a retrospective analysis of surveillance data

Recurring outbreaks of leptospirosis in flood-prone areas caused by heavy rainfall pose a major public health concern, particularly in megacities such as Indonesias capital city, Jakarta. From December 2019 through February 2020, Jakarta experienced a large leptospirosis outbreak due to extensive flooding following extreme monsoonal rainfall. We conducted a comprehensive retrospective analysis of the outbreak based on complete surveillance data from all five districts and 42 of 44 subdistricts in Jakarta. A total of 282 cases (97 suspected, 153 probable, and 32 confirmed) were reported in West (n=162), South (n=64), East (n=30), North (n=14) and Central (n=12) Jakarta. Cases were predominantly adult males exposed to floodwaters. Of 241 cases tested, 164 (68.0%) had a positive IgM-based rapid diagnostic test (RDT). Of 118 cases tested with TaqMan RT-PCR lipL32, 32 (27.1%) were positive; RT-PCR detected an additional 5 cases who were RDT-negative (case detection increased by 4.2% [5/118]), all of whom had fever <7 days. Of 95 cases tested with both assays, the combined detection rate was 74.7% (71/95). We sequenced 42 archived blood samples using Multi Locus Sequence Typing (MLST) and identified Leptospira interrogans and L. borgpeterseni as the predominant species. The findings emphasise the importance of rapid and early laboratory-based diagnosis during leptospirosis outbreaks in flood-prone urban areas, to better target public health interventions. Climate-resilient urban planning is critical for vulnerable megacities in low-resource settings, where complex environmental and infrastructural challenges are compounded by the effects of a changing climate. Author SummaryRecurring leptospirosis outbreaks in flood-prone areas caused by heavy rainfall pose a major public health concern in vulnerable urban areas in low- and middle-income countries. This study investigated a large leptospirosis outbreak following extreme seasonal rainfall from December 2019 through February 2020 in Jakarta, Indonesias capital city. A total of 282 cases were identified, mostly adult males exposed to floodwaters. Combining point-of-care rapid diagnostic tests with RT-PCR laboratory-based tests improved early case detection. The Leptospira species identified were L. interrogans and L. borgpetersenii. This comprehensive analysis highlights the urgent need for improved diagnostic tests and surveillance systems, and enhanced disease control strategies. Climate-resilient urban planning is critical for vulnerable megacities where complex environmental and infrastructural challenges are compounded by the effects of a changing climate, including increased rainfall intensity.