Post-flood leptospirosis outbreak response due to L. interrogans and L. kirschneri in central Greece, 2023: comparison of laboratory and clinical manifestations

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ID: 313393
2026
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Abstract
Abstract Background In September 2023, catastrophic flooding from storms Daniel and Elias struck Thessaly, Greece. We present findings from the post-flood leptospirosis outbreak investigation and key lessons for future preparedness. Methods Ad-hoc active surveillance was set-up to complement national notifications. We used the national case definition for leptospirosis probable and confirmed cases. Diagnostic protocols involved clinical manifestation, PCR, targeted sequencing (blood/urine) and serology. Exposure history was collected via a structured questionnaire. We performed case-series analyses, logistic regression, and Receiver Operating Characteristic curve. Results During the three-month post-flood period, 285 probable and 45 confirmed leptospirosis cases were identified. The post-flood notification rate was 6.5/100,000 population. L. kirschneri and L. interrogans were identified in 33 (87%) and five (13%) of the 38 PCR-confirmed cases, respectively. Two fatalities were attributed to L. interrogans. L. interrogans cases had higher odds of hospitalization (OR:16, 95%CI:1.6-159.2), elevated creatinine (p=0.03), urea (p=0.03), and lower platelets (p=0.02). Urine PCR had the highest diagnostic yield (84%). Leptospirosis cases reported exposure to floodwater (89%), lack of strict adherence to personal protective equipment (100%), and limited awareness of protective measures (25%). Discussion The 2023 Thessaly floods led to a marked rise in leptospirosis incidence, with L. interrogans linked to greater clinical severity. The outbreak highlights the need for public and healthcare workers’ awareness, early diagnosis, species-specific active surveillance, and One Health strategies. Strengthening multisectoral preparedness is critical as climate change increases the risk of similar events in Europe.
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Authors Zacharoula Bogogianidou, Ioanna Voulgaridi, Maria Tseroni, Γεώργιος Δουγάς, Evangelia D. Apostolidi, Evangelia Angelouli, Theologia Sideroglou, Katerina Maria Kontouli, Sotirios Vasileiadis, Christos Kontos, Athanasios G. Lianos, Thalia Panagiotopoulou, Dimitrios Babalis, Dora Konstantoula, Konstantinos Krapis, George Karras, Alexandra Manika, Chrisovalanti Koukouletsou, Ilias Karametos, Meropi Zigra, George Βatziogiorgos, Sotiria Dimou, Nikolaos Papageorgiou, Dimitrios Georgiou, Dimitrios Paraskevis, Dimitrios Hatzigeorgiou, Stamatia Kokkali, Fani Kalala, Varvara Α. Mouchtouri, Matthaios Speletas, Efthymia Petinaki, Christos Hadjichristodoulou
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Journal Open forum infectious diseases
Year 2026
DOI
10.1093/ofid/ofag301
URL
https://doi.org/10.1093/ofid/ofag301
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