The case fatality rate of leptospirosis has been spiralling up in Kerala with the disease claiming 49 lives—30 confirmed and 19 probable leptospirosis deaths—just in the month of July, 2026.

A look at the daily “death list” of the Health department’s Integrated Disease Surveillance Programme shows that at least five or six deaths due to leptospirosis have been reported daily in the past two days.

The State has reported 1,381 confirmed and 922 probable cases of leptospirosis so far in 2026. There have been 115 deaths, including 52 probable leptospirosis deaths.

High-risk groups

It is manual/agricultural labourers, farmers, dairy workers and gardeners—people whose work puts them at risk of regular contact with water/soil that may be contaminated—who are most affected by leptospirosis.

From the public health perspective, there should be renewed focus on disease-prevention activities, specifically amongst the high-risk or vulnerable groups who are at most risk of contracting leptospirosis

The State health system’s age-old strategy has been to put people who are at high risk on doxycycline prophylaxis. Compliance has, however, been poor.

Doxycycline prophylaxis

“Doxycycline prophylaxis is an important strategy to prevent leptospirosis but somehow it is poorly understood and the right communication about the rationale behind the strategy has not reached those who have high-risk occupational exposure,” a senior Health official says.

“Current clinical data show that antibiotics have little to no proven direct effect on reducing overall mortality in leptospirosis. But it has a crucial role as prophylaxis and at the beginning of the disease, to shorten the duration of fever, reduce symptom severity, and clear the bacteria from the body. The key thus is to start antibiotics as early as possible, if a person, who is at risk of occupational exposure, presents at the OP with fever and myalgia,” says R. Aravind, Head of Infectious diseases, Government Medical College Hospital, Thiruvananthapuram.

He points out that it is important that at least during the southwest monsoon season, when leptospirosis surges, high-risk groups are persuaded to comply with the Health department’s directive of consistent doxycycline prophylaxis twice a week.

The clinical manifestation of leptospirosis can vary from mild, nonspecific symptoms to a fatal outcome involving liver and renal failure, pulmonary haemorrhage, meningitis, and septic shock. It is only in 5-10% that the disease worsens and the prognosis becomes unpredictable.

According to literature, the severity of fatal outcomes is likely to be due to virulence factors, host susceptibility, and epidemiological conditions.

Morbidity

The clinical death audit by the Health department into the leptospirosis deaths in 2025 showed that 62% of the deaths were occurring in those in the late 40s to up to 52 years age group. One of the conclusions was that almost all of those in this age group had other co-morbidities like diabetes or hypertension, which made the disease worse.

However, deaths in the lower age groups occurred in 4.5 to 5 days, due to severe leptospirosis triggering a cytokine storm, leaving little or no therapeutic window for clinicians to intervene.

It does not help either that in the initial days of fever and body pain, most people continue to self treat with analgesics. Patients presented late, with pulmonary involvement and multi-organ failure having set in on the third or fourth day itself, require mechanical ventilation and dialysis.

Which is why, leptospirosis prevention is still the best bet to save lives, from the public health perspective. Manual workers and farm labourers should be provided protective gear such as gum boots and thick gloves because pathogenic leptospira in the soil or contaminated water infect humans through skin abrasions or minor cuts on hands or feet.

Doxycycline has been found to be highly efficient even when one has been exposed to leptospira (by reducing the multiplying of the organism), provided it is consumed as per the guidelines. The risk communication from the Health department should thus be clear and consistent so that people do not ignore the health advisories.