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Beyond Disciplinary Boundaries: Leptospirosis as a Model of Incorporating Transdisciplinary Approaches to Understand Infectious Disease Emergence

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Abstract

Leptospirosis is a zoonotic infectious disease of global significance. Political, economic, demographic, ecologic, and other anthropogenically driven environmental changes have fueled the reemergence of this disease in industrialized and developing countries, and in both urban and rural settings. We argue that conventional disciplinary, even interdisciplinary, research methods are not sufficient to elucidate the complex mechanisms and causal relationships among the myriad factors responsible for infectious disease emergence. To address the significant gaps in the field of leptospirosis, an integrated research agenda is needed to guide successful public health remediation of the disease. Based on both working group analysis of literature and newly obtained information, we describe cross-disciplinary collaborative approaches that allow a novel approach to understand leptospirosis emergence with regard to mountain-to-sea ecosystems in Hawai‘i and other region-specific ecosystems. Leptospirosis research is a model for how complementary disciplines in the social, cultural, ecological, and biomedical sciences can optimally interact towards a higher understanding of emerging infectious diseases.

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Acknowledgments

This work was supported by a conference grant from the U.S. Public Health Service, R13TW007300—NIH Roadmap initiative “Research Teams of the Future” (Principal Investigator, B.A.W.) and, in part, by U.S. Public Health Service grants R01TW005860, “Leptospirosis Transmission in the Peruvian Amazon,” and D43TW007120, “Endemic Infectious Diseases of the Peruvian Amazon” (Principal Investigator, J.M.V.). We thank Dr. Christian Ganoza for the photographs in Figures 1 and 2; and Kenneth Kaneshiro and Mike Kido for the photographs in Figure 3. We also are grateful to Kenneth Kaneshiro for his support of our field work in Hawai‘i through the University of Hawai‘i EPSCoR grant (NSF EPS-0237065). We thank Shannon Bennett, Yuko Chiba, Kristin Duin, Andrew Hood, Alan Tice, George Watt, Mayee Wong, and many other people participating in the Honolulu meeting for assistance with developing many of the ideas expressed in the article. Finally, we express Mahalo to the staff at Papa Lo‘i Kānewai at Kamakakuokalani, Center for Hawaiian Studies, University of Hawai’i for providing a tour of the lo‘i and sharing their knowledge of taro farming and cultivation with our group.

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Medicine, University of California, San Diego School of Medicine, 9500 Gilman Drive, 0640, La Jolla, CA, 92093-0640

    Joseph M. Vinetz

  2. Division of Ecology and Health, Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI

    Bruce A. Wilcox, Lisa X. Gollin, Kepa Maly & Healani Chang

  3. Wildlife Trust, New York, NY

    Alonso Aguirre

  4. Department of Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI

    Alan R. Katz

  5. Water Resources Research Center, University of Hawaii at Manoa, Honolulu, HI

    Roger S. Fujioka

  6. Consortium for Health and Ecology Program, Edith Cowan University, Joondaloop, Australia

    Pierre Horwitz

  7. Pacific Biosciences Research Center, University of Hawaii, Honolulu, HI

    Healani Chang

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  1. Joseph M. Vinetz
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Corresponding author

Correspondence to Joseph M. Vinetz.

APPENDIX 1: HAWAIIAN TARO FARMERS’ PERCEPTIONS RELATED TO LEPTOSPIROSIS TRANSMISSION

APPENDIX 1: HAWAIIAN TARO FARMERS’ PERCEPTIONS RELATED TO LEPTOSPIROSIS TRANSMISSION

Taro farmers responded to questions about the environmental and exposure risk factors associated with leptospirosis [L. Gollin, unpublished data]. Responses are part of a larger questionnaire and preliminary study and participatory research project on leptospirosis with wetland taro farmer communities on the island of Kaua‘i. Twenty-nine people either completed surveys (14), were interviewed at home or in their taro patches (15), or both (1). Length of interviews ranged from ½ to 2 hours.

I. Major Environmental Causes of Leptospirosis

Questions Asked

What are the main reasons for leptospirosis? Explain anything you know about what causes it and where it comes from, i.e., tell us what you know about the land, water, soil, animals, insects/bugs, plants, or anything else you can think of related to leptospirosis.

Response

Most farmers said that stagnant (low or no flow) water and runoff after a heavy rain, water contamination from animals, from cattle, rats, and pigs urinating in the water are the main causes of leptospirosis. Specific factors responsible for pathogen transmission mentioned (frequency factor was mentioned): stagnant/dirty water (28%); cattle (20%); rats and mice (19%); pigs (18%); cats and dogs (9%); other (4%); plants (2%).

Quotes

“When the river is dry and low, stay away.” “Stagnant water leads to lepto. Doctors say you get it from rats.” “Baloney. Nobody got it growing up! It’s from the cattle upriver.”

II. Relationship to Ecological Health of Wetland Taro Patches

Questions Asked

Describe a “healthy” lo‘i/taro pond (i.e., the water, ditches, soil, plants/weeds, animals, birds, insects, or anything else that you can think of) and, is a healthy lo‘i/taro pond more or less likely to have leptospirosis? Why or why not?

Response

Most said that cool, flowing water is most important for a healthy taro pond and that a healthy lo‘i is less likely to have leptospirosis. Only two people said a healthy lo‘i is not necessarily going to have less lepto; five were not sure.

Quotes

“Weeds keep the taro water cool.” “Fish, frogs, toads, ducks ...if you have a lot living in it, it’s not toxic. Smell the soil. Bad soil smells like methane gas and sulfur.” “If you keep your banks clean, free of weeds (there’s no place for the rats to live). It’s good for the lo‘i and there is less lepto.”

III. Preventive Measures

Question Asked

Do you do anything to keep from getting lepto or to help your family avoid leptospirosis? How do you help children to keep them from getting sick with lepto?

Response

The main preventive measures from most to least favored were to not go in the taro pond or swimming with an open cut, wear protective gear such as boots, gloves, or eye protection; avoid drinking the water from the taro pond, especially from the irrigation ditches; staying out of the water after a hard rain or flood; and washing immediately with soap after exposure to water in the taro patch. Five farmers said they do nothing to avoid getting leptospirosis. A few farmers noted that cuts from apple snails on the taro and handling certain weeds such a rice grass (Paspalum orbiculare) lead to leptospirosis. Children, in particular, should not drink from, or wade in, the irrigation ditch. However, a few farmers said that children should swim often to build up resistance to lepto.

Quotes

“We were born and raised in this valley. We built up a resistance drinking water from the stream. When we go hunting we don’t bring water...just drink from the fresh flowing streams.” “I now know not to wash my face in the ditch. I don’t thinks it’s in the lo‘i, it’s in the ditch from the cattle.” “When we were kids, if we had a cut we’d go to the ocean to dry the cut. Ocean water has iodine. Maybe that also protects people from lepto...we used to swim every day after work [and we didn’t get it]...Also, you’re less likely to get it if your immune system is strong.”

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Vinetz, J.M., Wilcox, B.A., Aguirre, A. et al. Beyond Disciplinary Boundaries: Leptospirosis as a Model of Incorporating Transdisciplinary Approaches to Understand Infectious Disease Emergence. EcoHealth 2, 291–306 (2005). https://doi.org/10.1007/s10393-005-8638-y

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