Leptospirosis in the Caribbean Region between 2000 and 2022: A scoping review of morbidity and mortality

BACKGROUND: Leptospirosis remains an important yet underreported public health concern in the Caribbean. Urbanisation, biodiversity loss and human encroachment into natural habitats have contributed to shifts in its epidemiological patterns. However, accurate assessment of disease burden is hindered by limited diagnostic capacity, surveillance challenges, and scarce research. We aim to describe geographical and temporal distribution of leptospirosis epidemiology in Caribbean Island Countries and Territories (CRICTs) and identify patterns and gaps in knowledge. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a systematic search across PubMed, Web of Science, Embase, Scopus, and the Latin America and Caribbean Health Sciences Literature databases, between 2000-2022, without language restrictions. Eligible publications were routine surveillance-based studies or cross-sectional seroprevalence surveys. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) protocol. Of 110 full-text articles reviewed, 16 met inclusion criteria, documenting leptospirosis in 15 of 27 CRICTs (55.6%). Between 2000-2010, we identified an average of 2.6 studies per year, compared to just 1.2 between 2011-2022. Nine studies (60.0%) reported surveillance data, and six (40.0%) were seroprevalence surveys. Two studies reported hospitalisation rate (12.5%), and five studies, case fatality rate (31.3%). There were more than one publication from Guadeloupe, Jamaica, Puerto Rico, St. Lucia and Trinidad and Tobago. Although most studies acknowledged links between leptospirosis and extreme weather, only three were specifically designed to investigate this association. CONCLUSIONS/SIGNIFICANCE: Our findings highlight critical gaps in leptospirosis burden and research across the Caribbean. The scarcity of recent studies investigating epidemiological differences across rural and urban settings, and the impact of environmental changes, contributes to limited characterisation of evolving transmission patterns across the region. Strengthening regional research capacity and surveillance systems is essential to inform targeted public health strategies and reduce the disease's burden locally.