Leptospirosis in Campinas, Brazil: The interplay between drainage, impermeable areas, and social vulnerability.

Leptospirosis is an epidemic disease caused by bacteria of the Leptospira genus. Its risk is closely associated with inadequate sanitation and flooding, a common public health challenge in large urban centers together with urban environmental modifications, and socio-economic factors. This retrospective observational research investigated the association between the distribution of leptospirosis cases and three contextual factors, drainage, soil impermeability and social vulnerability in Campinas city, São Paulo, Brazil. We hypothesized that the number of cases will increase in areas that are impermeable and in proximity to drainage systems as well as where social vulnerability is high. We investigated the associations based on 86 autochthonous cases, comparing cases where infection risk was linked to contact with floodwater or mud (n = 54) to cases associated with other exposures (n = 32). Spatial statistics were used to map disease distribution and investigate the relationship between leptospirosis cases and contextual factors. Our results indicate that leptospirosis cases density rises near drainage systems, peaking at 200 m. Risk is elevated in socially vulnerable areas, particularly where floodwater or mud exposure is high, and in highly impermeable areas. This study demonstrated that leptospirosis risk remains highly determined by living and working conditions. These findings support targeted strategies to deliver effective prevention, treatment and control interventions in highly populated urban areas of the Global South and similar contexts. Furthermore, combining local contextual environmental information with spatial analysis produces relevant evidence for guiding health public policy and spatial planning and provides precise parameters for future epidemiological models and prevention actions.