Primary prevention
Prevention of leptospirosis focuses on rodent control and avoidance of high-risk exposure, particularly after flooding. High-risk exposures include fresh-water immersion, contact with stagnant water, and contact with animals. Personal hygiene and protective equipment and clothing are used to prevent or minimize exposure to contaminated water and soil. Any open wounds should be covered with a waterproof dressing.
Doxycycline chemoprophylaxis has been used in military personnel without known previous exposure. Hikers, bikers, and adventurous travelers may consider doxycycline prophylaxis due to high risk of leptospirosis present in developing countries.[46] Doxycycline prophylaxis is recommended for people at risk of unavoidable exposure. Data suggest that azithromycin is a viable alternative for prophylaxis, as head-to-head studies have shown similar reductions in seropositivity.[47] An observational study concluded that oral penicillin may be an effective chemoprophylaxis against leptospirosis; however, further research is needed.[48]
Antibiotics prophylaxis should be started before exposure, and continued during and after exposure. However, there are limited data to support the duration of therapy. One randomized controlled trial started treatment 1 week prior to exposure and continued for 4 weeks after exposure.[47]
Immunization offers another effective preventive measure. Livestock and dogs are frequently immunized with killed vaccines.[1][49] Human immunization with polyvalent vaccines is a common practice in countries such as China, where the number of individuals at risk of occupational exposure is significant, as is the case with rice-field workers. Human immunization with a monovalent vaccine is frequent practice in France. Human immunization is not practiced in the US.
Secondary prevention
Most countries require reporting of leptospirosis so that epidemiologic data can be collected. In the US, healthcare providers should report all cases of laboratory-confirmed leptospirosis occurring in the US and its territories to their local or state health department.
Prophylaxis of close contacts is unnecessary as human-to-human transmission is rare. It should be borne in mind, however, that people traveling with the patient may have had the same exposures and therefore may be at risk of developing leptospirosis. These people should be given postexposure prophylaxis if required, and advised to seek medical attention if they develop symptoms.
Appropriate advice regarding avoidance of exposure and situations requiring medical prophylaxis should be given to the patient to prevent further episodes. Patients' attitudes about prophylaxis may vary depending on their prior experiences and duration of stay in endemic regions.
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