The federal government recognized the state of public calamity for 336 municipalities in the Rio Grande do Sul last Sunday, 5th, due to strong rains in the region, which left 83 dead and 111 missing to date. Given the scenario, the Brazilian Society of Infectious Diseases, together with the Gaúcha Society of Infectious Diseases and the Health Secretariat of the State of Rio Grande do Sul, released a technical note warning about an increased risk of leptospirosis and the best way to carry out prophylaxis to prevent the disease.
Leptospirosis is an infectious disease caused by bacteria of the genus Leptospira, commonly acquired through contact with water or soil contaminated by the urine of infected animals, mainly rats. Floods, therefore, create an environment conducive to the spread of the disease, increasing the risk for those exposed to contaminated water.
Floods are considered a favorable environment for the spread of leptospirosis
Photograph: Amanda Perobelli/Reuters
Although the use of antimicrobials is not recommended as a routine approach, the note highlights that in high-risk situations, where there is continuous exposure to flooding and contaminated water, with or without skin injuries, this intervention can be considered.
The guidance is based on studies, including a guide to World Health Organization (WHO) 2003, which, despite some limitations, such as low number of participants and randomization failures, indicate a potential benefit in the use of these medications in cases such as that in Rio Grande do Sul.
The main recommendation from the entities responsible for the document is the use of doxycycline, administered in a single dose to adults in high-risk post-exposure. For children, the dose is calculated based on body weight, with a maximum dose established. Alternatively, azithromycin can be used under the same conditions.
Considering these points, the recommendations for identifying people at high risk and eligible for the use of emergency medicines are as follows:
- Rescue responders and volunteers with prolonged exposure to flood water when personal protective equipment is unable to prevent exposure;
- People exposed to flood water for a prolonged period with careful medical assessment of the risk of this exposure.
How to carry out prophylaxis?
If the medicine used is doxycyclinethe instructions for use are as follows:
- Adults: 200 mg orally, in a single dose for people with high-risk post-exposure;
- Adults: 200 mg orally once a week while exposure occurs (rescue/first responders);
- Children: 4 mg/kg orally, in a single dose for children post-high-risk exposure. Maximum dose of 200 mg.
Now, if the medication used is the azithromycinthe recommendations are as follows:
- Adults: 500 mg orally, in a single dose for people with high-risk post-exposure;
- Adults: 500 mg orally once a week while exposure occurs (rescue/first responders);
- Children: 10 mg/kg orally, in a single dose for children post-high-risk exposure. Maximum dose of 500 mg.
It is important to emphasize that prophylaxis should only be carried out with medical guidance. Furthermore, it does not offer absolute protection against leptospirosis, and even those who use the recommended medications can still contract the disease. Furthermore, pregnant women and breastfeeding women should not use doxycycline as a preventive measure.
Tags: Medical entity warns risk leptospirosis suggests ways prevent
