Epidemiological, temporal, and geographic trends of leptospirosis in the United States, 2014–2020

Background Leptospirosis, caused by pathogenic Leptospira spp., is one of the most widespread zoonotic diseases globally. In 2014, leptospirosis was reinstated as a nationally notifiable condition due to evidence of increasing incidence and public health importance. We describe the epidemiological, temporal, and geographic trends of leptospirosis in the United States since reinstatement. Methodology Analysis included confirmed and probable leptospirosis cases from jurisdictions reporting ≥ 1 case between 2014–2020. Analyzed data included reportable case surveillance and voluntarily submitted supplemental data. Principal findings Between 2014–2020, CDC received 1,053 case reports from 34 jurisdictions. The national incidence rate was 0.48 cases per 100,000 population. Since 2014, leptospirosis cases have been increasing, with an average annual gain of 13 cases (R 2 = 0.69). Cases increased in summer, peaking in early fall, corresponding with warmer weather and hurricane season. Among cases with outcome data, 85% (n = 606/709) were hospitalized and 10% (n = 74) died. Seventy-seven percent of cases (n = 623) reported contact with animals or their bodily fluids while 71% (n = 578) of cases reported contact with freshwater or mud. More cases reported avocational activities (n = 413, 52%) as the source of their animal or environmental exposure(s) than recreational or occupational activities (n = 203, 25% vs n = 163, 20%, respectively). Only 13% of cases reported any international travel in the 30 days prior to symptom onset. Conclusions An increasing number of leptospirosis cases in the U.S. are being reported, mostly from domestic sources of infection. Changing epidemiological trends away from occupational exposures to avocational or recreational activities highlights the need for interventions mitigating these exposure risks. A high percentage of cases were hospitalized and died emphasizing the need to educate healthcare providers, public health professionals, and the public about early identification and treatment for leptospirosis to improve patient outcomes.