Leptospirosis in Malaysia: The Understated Role of Hygiene in Health Security

Malaysian health officials announced last month that the country was experiencing an outbreak of leptospirosis after up to ten people died from the disease between July and August. It is caused by exposure to water contaminated with the leptospirosis bacteria found in the urine of rodents, where the bacterium is absorbed through broken skin or soft tissue on the inside of the mouth, nose or eyes. Symptoms of the disease include severe muscle pain, fever, vomiting and headache, and they may last from a few days to several weeks. The fatality rate of leptospirosis ranges from 5 to 40 percent, depending on individual cases and whether the sufferer has prior immunodeficiency. Health officials also added that the number of leptospirosis deaths in Malaysia had tripled in the past six years.

The Malaysian health ministry’s disease control division director attributed the outbreak to poor enforcement of hygiene standards nationwide, adding that leptospirosis was rare in cities like Tokyo and Singapore where hygiene standards were more vigorously enforced. He stated that rubbish and food waste was often improperly disposed of, attracting rodents and increasing the possibility of the disease spreading – particularly among certain occupational groups like those working in the food and beverage industry, cleaners and sewage workers.

Over half of all human pathogens are animal-borne diseases, also known as vector-borne diseases. The Southeast Asian region is particularly susceptible to these diseases as it is home to a diverse host of animals – both wild as well as within the agricultural context. Vector-borne diseases include those carried by mosquitoes such as the West Nile virus, encephalitis and dengue, those carried by wild animals such as avian influenza, those found in household pets such as rabies, and those found in animal products that we consume (for example, salmonella in eggs and E. coli in beef). Additionally, consistently high temperatures create good conditions for certain types of vector-borne bacteria to thrive in water, invisible to and undetected by the human eye.

The maintenance and enforcement of strict hygiene standards in Southeast Asia is, therefore, an important aspect of health security in a region already considered vulnerable to such diseases. Measures undertaken by certain Southeast Asian countries during past vector-borne disease outbreaks have focused primarily on eliminating the source of the disease (for example, the mass culling of poultry during the avian influenza outbreak) but less attention has been paid to precautionary hygiene practices and educating the public on the health risks posed by low hygiene.

In spite of the disease control division director pointing out that poor hygiene had a major role to play in spreading leptospirosis, Malaysian health authorities responded to the leptospirosis outbreak by addressing the symptoms instead of the root of the problem. Warnings were issued, cautioning the public against swimming in rivers. Public areas where the bacteria were found were cleaned up. It was made mandatory for all new or suspected cases to be reported to the government.

While this reaction may be adequate to address the small-scale nature of the leptospirosis outbreak, the role of hygiene has once again taken a backseat in the immediate reactions to the problem. It will therefore be interesting to observe where hygiene stands as a human security priority in the event of a similar future outbreak, and how health policy can be adapted to account for this evolving context.