https://www.sciencedaily.com/releases/2021/01/210126134026.htm

As Weil's disease kills so few & can be treated with antibiotics it's unlikely to be worth the investment of going to human trials, although presumably the treatment of bovine leptospirosis may prove worthwhile.

mikem said:

As Weil's disease kills so few & can be treated with antibiotics it's unlikely to be worth the investment of going to human trials, although presumably the treatment of bovine leptospirosis may prove worthwhile.

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Over a million cases and 60,000 ish annual deaths - plus probably long term cheaper to avoid antibiotics treatment than to keep using it
(plus the disease is driven by climate change and urbanisation so isn't likely to decrease in prevalence)

There's a giant citadel of rats living under the tower blocks at the bottom of London Road, 200m from me, and the council seem oblivious, even when I stuck a Streets Ahead guy's face down one of the entrances, six months ago. Haha - Light Years Behind, more like.

Plus I'm having to deal with regular occurrences of the 'Junkie Doorstep Challenge' at the moment. So I might take it

I think given that pretty much anyone who has anything to do with inspection / maintenance / construction of drainage, sewage, farming, road or rail infrastructure has a significant risk of contracting the disease there will be a comercial incentive for producing a vaccine which companies can provide employes as a big tick on there H+S policy.

mikem said:

As Weil's disease kills so few & can be treated with antibiotics it's unlikely to be worth the investment of going to human trials, although presumably the treatment of bovine leptospirosis may prove worthwhile.

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Weil's disease killed my father in law.

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Avoidance of death is only one of several reasons why you wouldn't want to contract leptospirosis.

Leptospirosis is a significant problem worldwide, as 2xw points out. It's more common in warm regions and, as well as occupational exposure (which includes caving) there have been several major outbreaks in Central America after floods. With climate change and increasing urbanisation of the countryside, this is likely to get worse, not better. Most cases occur in developing countries with small health budgets, so any vaccination programme would have to be cheap. In wealthy countries, the incidence is low and it would be difficult to justify widespread vaccination on economic grounds. Most of the cases I've seen haven't been in people at very high risk (eg sewage workers) but have been in farmers, gardeners and soldiers who weren't indulging in particularly risky behaviour.

There are numerous species (increasing all the time) and over 300 serovars (which are immunologically distinct, even if they aren't different species). Historically, individual vaccines have tended to be active against only a few serovars, which limited their usefulness. The implication is that one would need to create a large number of separate vaccines to achieve wide coverage, which would be very expensive (as would be the cost for each vaccination).

What is interesting about this new vaccine is that it has the potential to be active against a very wide variety of species. Potentially, one vaccine could be developed which would work in most countries. The economies of scale would allow individual doses of vaccine to be cheap. The fact that it appears to be a single dose vaccine makes the logistics of a vaccination programme much simpler than a multiple vaccine schedule (eg Covid).

Yes, it does very much depend if it can be brought down to a viable price point, but still the market for those who require it will be relatively small.

Having had leptospirosis, I can see the benefit of a vaccine. While it is not usually fatal in this country as antibiotics are administered, it was a thoroughly unpleasant experience. Never before have I felt so cold, but sweated enough that it soaked through to the top of my duvet!

I worked as a mechanical fitter in the waste water industry for over a year, in close proximity to all sorts of horrible stuff and never had an issue, but I managed to contract it after a trip down Stoke Lane. I wonder if this has something to do with the fact that you are more alert to the issues when at work and subconsciously take more care... 

Did you immerse yourself fully in the waste water..?

I think Mikem's got it. Leptospirosis usually gets in through cuts or intact mucous membranes (eg conjunctiva) or via the mouth, and you don't need a particularly big dose to catch it. I would expect you to be far more intimately exposed to infected water for longer in Stoke Lane than at work, and more likely to scratch yourself. My mother (also a doctor) used to dose me with penicillin whenever I went near Stoke Lane....

Fair point, I was diving in Stoke Lane and I did cut myself. At work, we always wore gloves and drained stuff down before working on it. That said, hosing out tanks and other treatment equipment always resulted in a lot of airbourne droplets, which you might imagine posed some risk.

Speleofish said:

I think Mikem's got it. Leptospirosis usually gets in through cuts or intact mucous membranes (eg conjunctiva) or via the mouth, and you don't need a particularly big dose to catch it. I would expect you to be far more intimately exposed to infected water for longer in Stoke Lane than at work, and more likely to scratch yourself. My mother (also a doctor) used to dose me with penicillin whenever I went near Stoke Lane....

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As a doctor I have never gone to that extreme in Stoke Lane but I have always been careful to not swallow the water!  I know of more cavers than anybody in any other group who have had Weil's Disease so I would certainly consider vaccination. A friend of mine who is a farmer got it about 40 years ago - a different form of leptospirosis. He suggested I must have missed cases but over 30 years despite screening likely suspects I never found a case. The other disease that is not very nice and is rural is Q fever caused by Coxiella burneti - related to sheep.  My father had it and it took months to diagnose.

You really don't want leptospirosis.

I had it in my 20's and was very ill but managed to avoid hospital, but I didn't seem to fully recover for  long time.

Two of my friends ended in hospital with it on separate occasions.

I had Leptospirosis in the first part of 2014. (There is a topic about it somewhere on this forum.)
It's the most ill I've ever felt and, as far as I'm concerned, the bloke that invented Doxycycline should be knighted. (That's despite the nasty side effects caused by  the large dose needed to get me mended.)

Like Pete, my infection was from a caving trip. Please can I reiterate once more; the BCA's information on this disease is excellent and worth being aware of in case you ever think you've got it. Print it off and take it to your doctor, which should speed things up (and raise your medical priority when trying to fight your way past receptionists).

Even if you've never had Weils, read the BCA information anyway, because it's important that cavers have good awareness, as we're at elevated risk compared with Joe Public. (Incidentally you have Bob Mehew to thank for updating / improving the BCA info.)

Indeed, your doctor may well have no memory of having heard about it!

The trouble with leptospirosis is that it has a very non specific start (flu) and by the time the diagnosis is obvious antibiotics probably have little effect (the later part of the illness has a significant immune driven component).
Antibiotics need to be started early to have  any bennefit.
That is why it is important to push a risk history if you have one (and make it clear*). Otherwise the Dr will (should) tell you to take some paracetamol and go away (which is the 'right' thing to do).
(The vaccine directed against a 'common' epitope is really useful, but I'm not sure about the economics of its development / roll out given the sort of risk groups)

* eg. If you are a water bailiff it might be obvious to you what you do. However, if you say you are a bailiff, most hospitals will think of big blokes kicking doors in at 4am.......

Speleofish said:

There are numerous species (increasing all the time) and over 300 serovars

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When I was at medical school I did want to do a testing programme on freshers as we observed that most people seemed to get a bit ill after their first few couple of trips and then would get better. They then seemed to get ill each time they were caving in different regions and we thought it might be due to regional serovars of lepto. Then again it might just be 'exer-stress'

The logistics, ethics and the implication of a health risk associated with caving put paid to that. Some years later I got pleurisy in death's head and ended up getting a very panicked phone call from my GP when they grew a previously unrecorded haemophilus species (I was fine and suffered no long term effects). So who knows what else is in the water.

I'd happily run a trial of the vaccine in cavers if it meant we could go caving again. I'd even swim in the most fetid holes in mendip open mouthed and all.

Anyone know where the BCA Weil's Disease advise is located?  I read it years ago but thought I would remind myself - but seemingly the links to it in other BCA documents are not valid e.g.

This document Training Document https://www.british-caving.org.uk/wiki3/lib/exe/fetch.php?media=training:2020_08_water_safety_for_cave_and_mine_leaders.pdf

contains invalid links - https://tinyurl.com/BCAWeils and https://british-caving.org.uk/?id=publications_information:weils

Google suggests a link that goes to a 'Page Not Found' - https://british-caving.org.uk/wiki3/lib/exe/fetch.php?media=publications_information:bca_weils_disease_leaflet.pdf