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

Abstract 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 83 autochthonous cases, comparing cases where infection risk was linked to contact with floodwater or mud (n=54) to cases associated with other exposures (n=29). Spatial statistics were used to map disease distribution and investigate the relationship between leptospirosis cases and contextual factors. Our results indicate that the density of leptospirosis increases near drainage systems with risk peaking at 200 m, in areas of greater social vulnerability with increased risk due to floodwater or mud exposure in highly vulnerable regions, and in highly waterproofed urban 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. Author summary This study explores the links between environmental and contextual factors that influence the risk of leptospirosis transmission to humans in Campinas, São Paulo, Brazil. Leptospirosis is an infectious disease caused by the Leptospira bacteria. We investigated how drainage systems, impermeable soil area, and social vulnerability contribute to disease distribution, using spatial statistics to map spatial conditions for 83 cases associated with water and mud contact and other risks. Our findings highlight how environmental and socio-economic factors intersect to influence public health, shedding light on the role of urban planning and drainage infrastructure in the transmission risk of infectious diseases. This interdisciplinary approach underscores the importance of considering social and environmental contexts when developing public health strategies, aligning with broader global efforts to address diseases linked to urbanization and environmental changes. Our study advances the understanding of how spatial data and environmental factors can guide more precise parameters for epidemiological models, offering insights into disease control interventions. We discuss the role of prevention, flood management, and equitable infrastructure in safeguarding public health, emphasizing how the environment shapes health risks. This research provides practical recommendations for helping decision-makers prioritize areas for intervention to reduce the burden of leptospirosis, particularly in vulnerable communities. Competing Interest Statement The authors have declared no competing interest. Footnotes Revision after peer review with improved writing around results and figures.