Health officials underreporting disease epidemic in Puerto Rico after Hurricane Maria

More than two dozen Puerto Ricans have died from the bacterial disease leptospirosis in Puerto Rico, but officials have yet to declare this disease outbreak an epidemic after Hurricane Maria, according to CNN.

Here are seven things to know: 

1. To obtain the records of the disease outbreak, CNN and Centro de Preiodismo Investigativo sued the island's Demographic Registry, according to a seperate CNN report. The records show 26 people died from leptospirosis during the first six months after Hurricane Maria — double the amount of deaths reported in 2017.

"Twenty-six deaths attributed to leptospirosis — that's extraordinary," Joseph Vinetz, MD, professor of medicine at the UC San Diego, told CNN. "There's no other way of putting it … The numbers are huge."

2. Leptospirosis is a bacterial illness spread through infected animals' urine, which can get into water and soil. Outbreaks usually stem from human contact with contaminated water, including floodwaters caused by storms, according to the CDC.

3. Puerto Rico's Health Department initially linked only four of the leptospirosis deaths from leptospirosis to Hurricane Maria. The department added two more deaths to the hurricane's death count June 22 after CNN and CPI question the 26 leptospirosis cases. Health officials said the timing was not related to reporters' inquiries, but rather the availability of laboratory test results. However, these tests should only take a few weeks, not months, experts told CNN.

4. On June 29, the CDC released its own statistics on leptospirosis deaths under the U.S. Freedom of Information Act, confirming 17 deaths after the hurricane where leptospirosis was a leading cause of death. The agency also listed 25 additional suspected leptospirosis deaths linked to the hurricanes.

5. Puerto Rican health officials cited conflicting disease thresholds required to declare a leptospirosis epidemic. The Puerto Rican government said it would need to see a "twofold" increase in cases to declare an epidemic. This past November,  Dr. Rafael Rodríguez Mercado, Puerto Rico's secretary of health, told a local radio reporter "200 cases per week" were needed to make that declaration, according to CNN.

6. Experts review the disease data for CNN and CPI stated the territory had already met, if not exceeded, this threshold, since  lab-confirmed leptospirosis cases doubled after Hurricane Maria.

7. Puerto Rico's state epidemiologist, Dr. Carmen Deseda, told CNN and CPI on June 25 the territory's health department could not access its own lab tests in the storm's aftermath and, therefore, did not have the baseline data needed to declare an epidemic.

"Leptospirosis is one of those diseases where it's very hard to declare an epidemic," she told CNN. "There was no way our laboratory was ready to put samples together. How could we declare an epidemic if we didn't have that number [of confirmed cases] at that time?"

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