RAIN and puddles now carry a different, heavy meaning for one family who lost a loved one to leptospirosis.
Reign Lirasan vividly recalls the questions that flooded her mind as she watched her brother, Roy Lirasan, fight for his life in the hospital. Roy, aged 36, tragically died from leptospirosis on June 26, 2024.
“I don’t have any idea where he contracted lepto; there was no flood in our area or even at his workplace,” Reign said.
Reign suspects her brother might have contracted it from stepping in small puddles left by floodwaters. All she knew was that Roy had a cut on his foot, a common entry point for the bacteria.
According to the World Health Organization, leptospirosis is a zoonotic disease caused by pathogenic organisms from the genus Leptospira. These are transmitted directly or indirectly from animals to humans.
Roy began feeling unwell and developed a high fever on June 21. The following day, he visited a clinic for a check-up and was advised for hospital admittance. His initial symptoms included high fever and joint pains.
Reign said Roy underwent a leptospirosis test, but the initial result was negative. Another test was conducted later, which came back positive. “Initial test, it doesn’t come up with lepto. They conduct tests again. They said it comes up by stages,” Reign explained, referring to how antibodies can take time to develop after exposure.
Roy’s condition worsened, and Reign recounted how her brother’s organs began to fail one by one. “They conducted dialysis and inserted a breathing tube through his lungs for him to breathe easily,” Reign recalled. “He was already throwing up blood,” she added.
Though almost a year has passed since Roy’s death, questions remain about how a simple action — stepping into remnants of flooding — could lead to such a devastating loss.
The disease
According to the Centers for Disease Control and Prevention (CDC), the US national public health agency, the bacterium Leptospira can be found in contaminated water or soil. The CDC states that the bacteria causing leptospirosis are spread through the urine of infected animals and can survive in contaminated water or soil for weeks to months. The risk often increases after a hurricane or flood when people have contact with contaminated water or soil.
Besides contracting the disease from contaminated water after heavy rainfall or flooding, the CDC also notes that it can be contracted by directly touching body fluids from an infected animal, or by eating food or drinking water contaminated by an infected animal’s urine.
Activities that increase the risk of infection include water recreation like swimming, kayaking, canoeing, or rafting in rivers, swamps, or creeks; hiking or hunting; gardening, yard work and outdoor cleaning and maintenance; and jobs like working at a veterinary clinic, dairy farming, or butchering.
In people, leptospirosis can cause a wide range of symptoms, including fever, headache, chills, body or muscle aches, vomiting or nausea, yellowed skin and eyes (jaundice), red eyes, stomach pain, diarrhea and rashes. The CDC indicates that symptoms generally start to manifest two to 30 days after contact with the bacteria.
Leptospirosis typically occurs in two phases: an initial flu-like illness, followed by a temporary recovery before a more severe second phase, which can potentially cause kidney or liver failure, or inflammation of the membrane around the brain and spinal cord (meningitis).
A CDC report published in April estimates about one million leptospirosis cases in humans globally each year, resulting in nearly 60,000 deaths.
Cebu City’s struggle
Data from the Philippine Statistics Authority in 2023 shows a concerning increase in leptospirosis cases in Central Visayas from 2019 to 2022:
2019: 60 cases
2020: 62 cases
2021: 140 cases
2022: 252 cases
In Cebu City, 35 leptospirosis cases were logged in 2024 — two confirmed and 33 suspected, with eight fatalities. This year, there has been one confirmed case and 14 suspected cases, four of which resulted in death.
Cebu City Health Department (CHD) head Daisy Villa confirmed that the one confirmed case this year was from Barangay Kalunasan, and the patient has recovered. The 14 suspected cases were spread across several barangays, including Cogon Pardo and Mambaling (two cases each) and Basak San Nicolas, Binaliw, Duljo Fatima, Guadalupe, Inayawan, Labangon, Luz, Pahina San Nicolas, Pasil, and Talamban (one case each).
The CHD categorizes cases as follows: suspected (fever history in the past two weeks), probable (at least one clinical or presumptive test) and confirmed (laboratory-verified).
Villa noted that most reported cases in the city were contracted from flooding, particularly from the south of the city. “Cebu City is really prone to flooding. One of the challenges is really to stop the flooding,” said Villa.
Leptospirosis doesn’t only affect humans; animals can also get sick if exposed. Cebu City Veterinarian Alice Utlang urges pet owners to ensure their pets are vaccinated and to properly dispose of pet waste. The Department of Veterinary Medicine and Fisheries currently has no records of leptospirosis in animals, though Utlang believes private clinics may have data from admitted pets.
Flooding has been a persistent issue in Cebu City. Villa attributes this largely to a lack of discipline. “The cause of the flooding is obstruction; the water cannot flow or penetrate because there were obstructions, which are plastics. Plastics which were thrown everywhere,” Villa stated. “When it floods, rat contamination naturally spreads everywhere.” Villa also cited buildings lacking proper facilities like septic tanks as contributing factors to flooding and contamination.
A “One Health” approach
To reduce leptospirosis cases, Villa advocates for a “One Health” approach, emphasizing the need to address the environmental concerns that cause the disease. One key solution is ensuring all city structures comply with sanitary requirements. Villa has been pushing for the Office of the Building Official to be strict on requirements, especially sanitary permits.
The CHD has a multi-agency inspection team, composed of barangay officials, the Department of Health 7, CHD’s environment and sanitary unit and the City Epidemiology Surveillance Unit, which monitors city structures. Villa also mentioned their efforts in health education, particularly for families of infected individuals, and promoting prevention measures like avoiding wading in floodwaters with open wounds and practicing good hygiene.
Cebu City Mayor Nestor Archival, in an earlier statement, pledged to revisit and upgrade the city’s master drainage plan, acknowledging the need to adapt it to an evolving landscape plagued by persistent flooding. Archival said that changes are necessary as the current drainage plan is outdated and new structures and developments have been built over the years.
Earlier reports indicated that some sections of the current drainage plan date back as far as the 1990s, with only about 20 percent of a 2004 Comprehensive Drainage Master Plan completed, leaving many areas vulnerable. The City has allocated between P10 million and P15 million for a feasibility study in 2025, which will serve as the foundation for the new system. Full implementation of a citywide drainage system is estimated to cost P8.2 billion. (JJL)