The first case reports of leptospirosis and melioidosis in the aftermath of Hurricanes Irma and Maria — Saint Thomas/Saint John District, U.S. Virgin Islands, September-October 2017.

Background: Following Hurricanes Irma and Maria, the first cases of leptospirosis (n=1) and melioidosis (n=2) were identified in the U.S. Virgin Islands (USVI). Leptospirosis and melioidosis are potentially fatal bacterial diseases caused by Leptospira species and Burkholderia pseudomallei, respectively; both are found in contaminated water/soil and outbreaks have been documented following extreme weather events.

Methods: Querying the USVI arbovirus syndromic surveillance system and Emergency Department (ED) records from 2 hospitals, we identified patients in the 2.5 months post-hurricanes demonstrating symptoms consistent with leptospirosis/melioidosis. Available patient blood samples underwent rapid diagnostic testing (RDT) for anti-Leptospira IgM and were sent to the U.S. Centers for Disease Control and Prevention for confirmatory microscopic agglutination testing (MAT). A subset were tested with a B. pseudomallei antigen RDT, and water collected from sites of potential Leptospira-contamination were tested by PCR.

Results: An initial query of the syndromic surveillance database yielded 17 patients warranting testing; 15 available patient samples were tested for leptospirosis and were negative (2 tested for melioidosis—negative). Following efforts to enhance this system to proactively detect leptospirosis/melioidosis, 15 additional patient samples were obtained and tested for leptospirosis; 1 tested positive. We reviewed 5,220 ED charts, identifying 6 patients warranting testing; 5 available patient samples were tested for leptospirosis; 1 tested positive (1 tested for melioidosis—negative). Altogether, as of April 2018, there are 3 leptospirosis and 2 melioidosis confirmed cases in USVI. One of 3 water samples collected from sites associated with patients with leptospirosis tested PCR-positive for Leptospira species.

Conclusion: This investigation documents the first cases of leptospirosis and melioidosis in USVI and demonstrates how USVI’s surveillance system was adapted to establish ongoing leptospirosis/melioidosis surveillance. Collectively, although not confirmed by detection of B. pseudomallei in the environment, both leptospirosis and melioidosis may be endemic in the USVI.