Leptospirosis

Leptospirosis 

Leptospirosis is a notifiable disease, with three cases reported to the duty room in 2011. Of these three cases, two are believed to have been acquired in Northern Ireland.

Leptospirosis is relatively rare in the UK, with around 50–60 cases reported each year. It is important to identify and treat cases, and leptospirosis should be considered a differential diagnosis in patients with abrupt onset of fever who have a history of contact with animal-urine-contaminated water or animals known to carry leptospirosis.

Leptospirosis is caused by spiral shaped bacteria of the genus Leptospira . The bacteria infect a variety of wild and domestic animals, often asymptomatically, and are excreted in their urine. Common sources of infection in the UK include rats and cattle. Person-to-person spread is rare. Infection occurs when infected animal urine or secretions come into contact with broken skin or mucosal membranes, directly or via water, soil or vegetation. The risk is therefore higher in farmers, vets and people taking part in water sports.

Infection may cause a range of illnesses, from asymptomatic or mild, flu-like illness to severe disease with hepatic and renal failure (known as Weil’s disease). Symptoms include fever, headache, chills, muscle aches, vomiting, jaundice, red eyes, abdominal pain, diarrhoea and rash. The incubation period is usually 7–13 days. There are often two phases to the disease: an initial bacteraemic phase from which there may be complete recovery, followed by an immune phase, during which there may be complications such as hepatic and renal failure, meningism, vasculitic manifestations and clotting abnormalities.

Diagnosis is based on clinical suspicion and can be confirmed by laboratory testing. Treatment involves antibiotic therapy, which should be given early in the course of the disease. Patients usually make a complete recovery; however, leptospirosis can be fatal, usually as a result of renal failure.

The public health role includes advising on prevention and responding to potential or confirmed cases of leptospirosis. Prevention strategies include control of the rodent population, immunisation and treatment of infected animals, and the avoidance of swimming or wading in potentially contaminated water. Education and advice for those at risk due to their occupation or leisure activities is also important. There is no vaccine available for humans in the UK, but pre-exposure prophylaxis can be considered in those known to be at high risk for limited periods.

When a potential or confirmed case is reported, the initial public health action is to gather information about the patient, risk factors and possible exposures. Exclusion is not recommended; however, others with similar exposure who may be at risk should be identified to enable the provision of education and advice. Screening of contacts and pets may be indicated in some situations.

The HPA recommends the following advice to reduce the risk of leptospirosis in those who are in contact with fresh, surface water – eg canals, ponds or rivers – or with rats.

•  Cover cuts, scratches or sores with a waterproof plaster and thoroughly clean cuts or abrasions received during activities. 
•  Wear appropriate protective clothing, gloves or footwear. 
•  Wash or shower promptly after water sports, especially if immersed. 
•  Avoid capsize drills or rolling in stagnant or slow moving water. 
•  Wear thick gloves when handling rats. 
•  Wash hands after handling any animal, and before eating. 

Useful resources
HPA website: 
National Travel Health Network and Centre:
Leptospira Reference Unit:

Judith Ewing FY2 Public Health

churches are full of people

I've seen some discussion recently about emotional/spiritual abuse in churches. like this one from Jonathan Hollingsworth in Relevant Magazine, and this one by Thom Rainer on ChurchLeaders.com

Don't allow the edges to get blurred.  There is a clear separation between loving biblical discipline and  abusive bullying, and oversensitivity to well-intended criticism is a different issue altogether.

I was brought up around churches. I grew up understanding the wring of emotions a pastor goes through while preparing sermons, trying to guide his flock through their problems both from the pulpit on a Sunday, and individual counselling - and receiving sustained verbal abuse in return. I've seen several good people give up everything to go and serve on missions, only to return within months because of internal politics or a personality clash with leaders and other missionaries. 

 It's heart-wrenching. 

I've been in the middle, between pastors and irate parishoners who want the church to suspend basic biblical principles, and where selfish and power hungry elders and deacons conduct full-on, red-faced, finger-jabbing shouting matches because they aren't getting their own way.

I used to think churches were a unique case. "If you want to be offended" I'd say "you should join a church!" 

Now I've spent several years working with sports clubs and non-church charities, and I've realised that whenever certain people get a sniff of power in any setting they turn into monsters. I've worked with serial club-and-charity destroyers who move from one organisation to the next, dividing the members and destroying the club from the inside. I've seen groups with potential to thrive becoming utterly stagnant because one or two members have moved into positions of authority and imposed their self-serving agenda. And yes. I've seen full-on red-faced, finger-jabbing shouting matches at Annual General Meetings because some people didn't get their own way.

 So am I saying that churches and missions are just clubs or charities like any other?

Well, no.  I'm not. 

Churches are full of people.
People who come for the right reasons, the wrong reasons, and for no reason at all.
People who treat church like a club.  Their club.  Their own personal multi-faceted charitable club where they can meet with their friends, do their activities and separate themselves from 'the world' - which means anybody who doesn't come to 'Their church'.

Those of us who are believers shouldn't need reminding.  Church isn't about us.  Church is us.  We exist because, even though we're self-centred self-seeking sinners, Jesus sacrificed himself so that we can return to a proper relationship with our maker and his creation.

That makes the abuse all the more demoralising.  

Emotional and spiritual abuse within churches is a natural and predictable consequence of us twisting the church away from the Christ and turning it into our own introverted social club.  Instead of spreading the word about what he's done, we've built barricades, driven needy people away and begun the process of tearing ourselves apart.  It's wrong, unbiblical, self-defeating and will have eternal consequences.

We can never tear his Church apart, but then what we're presiding over is no longer a church.  It's our club.