Fig 1.
Administratively, Ecuador is divided in 24 provinces containing 224 cantons with differing geographic, socioeconomic, and cultural characteristics. Seven provinces lie on the Coast, ten in the Andes, and six in the Amazon. The Galapagos Islands are in the Pacific Ocean at 1,369 km from the Ecuadorian coast and have dry and warm weather. Cantons are second-order administrative divisions, within the provinces. The map was created with QGIS 2.18. (Geographic Information System, Open Source Geospatial. Foundation Project. http://qgis.osgeo.org). The box to the upper left encloses the Galapagos Islands, while the box to the lower right provides a color-coded key to the land-elevation ranges within the map.
Fig 2.
Annual incidence and mortality of leptospirosis (2000–2020).
In the figure, the cases per 100,000 population are plotted on the ordinate as a function of the years on the abscissa for the incidence rate (blue) and the death rate (yellow). The box with the key to the colors at the lower left also marks the respective data for each year in the two rows underneath the abscissa.
Fig 3.
Number of cases of leptospirosis by year and sex (2000–2020).
In the figure, the number of cases is plotted on the ordinate as a function of the years on the abscissa for males (black bars), females (gray bars), and the total (red line). The box with the key to the colors at the lower left also marks the respective data for each year in the two rows underneath the abscissa.
Fig 4.
Distributions of the 2,584 cases over the 21-year period divided by age groups and sex.
Cases were reported over all ages (range, 1 to 98 years; mean/median, 31/27 years), but were least frequent between birth and 4 years of age. Male and females aged 25 to 34 years, were the most frequently hospitalized. A statistically significant association was found between the frequency of cases and the age category (p <0.001), with the age categories of 15–19 and 25–34 years being the ones with the highest rates of infection compared to age categories 1–4 and over 65 years, having the lower infection rates.
Fig 5.
Cumulative incidence of hospitalized cases per 100,000 population by province.
The incidence was calculated with the total population of 2020 as denominator. The color ramp on the lower right comprises the spectrum of quintiles for the total incidence. The numbers in the square brackets in the following indicate leptospirosis case numbers corresponding to the numbered provinces on the map: Esmeraldas [No. 1: 186], Imbabura [No. 2: 11], Carchi [No. 3: 0], Sucumbíos [No. 4: 33], Manabí [No. 5: 1029], Santo Domingo de los Tsáchilas [No. 6: 46], Pichincha [No. 7: 171], Napo [No. 8: 23], Orellana [No. 9: 8], Los Ríos [No. 10: 186], Cotopaxi [No. 11: 15], Bolívar [No. 12: 12], Tungurahua [No. 13: 9], Pastaza [No. 14: 9], Santa Elena [No. 15: 30], Guayas [No. 16: 502], Chimborazo [No. 17: 7], Morona Santiago [No. 18: 91], Cañar [No. 19: 3], Azuay [No. 20: 16], El Oro [No. 21: 90], Loja [No. 22: 23], Zamora Chinchipe [No. 23: 79], and the Galapagos [No. 24: 0]. The map was created by QGIS 2.18.
Fig 6.
Clusters identified at the canton level of Ecuador based on the cumulative incidence.
The color ramp on the lower right comprises the spectrum of spatial clusters for the total incidence. This spatial analysis identified cantons with the highest numbers of hospitalized cases (No. 1, bright red) and those with the lowest number (No. 7, pale orange). Numbers represent the following cantons: No. 1: Junín, Bolívar, Tosagua, Portoviejo, Rocafuerte, Santa Ana, Sucre, Pichincha, Jaramijó, Olmedo, 24 de Mayo, and Empalme; No. 2: El Pangui, Yantzaza, Gualaquiza, Paquisha, Centinela del Cóndor, Zamora, Oña, Sígsig, San Juan Bosco, and Limón Indanza; No. 3: Babahoyo and Montalvo; No. 4: Atacames, Esmeraldas, and Muisne; No. 5: Manta; No. 6: Taisha, Morona, and Logroño; No. 7: Jama and San Vicente; No. 8: Eloy Alfaro.
Fig 7.
Hospitalized leptospirosis by the month in the three continental geoclimatic regions (2000–2020).
In the figure, the cumulative incidence per 100,000 is plotted on the ordinate as a function of the months of the year indicated on the abscissa for the Coast (red circles), Amazon (black squares), and Andes (blue triangles) ecoregions. An increase in cases occurred for the Coast from January to June. Cases throughout the Amazon increased and decreased during the year. In contrast, the number of hospitalizations in the Andes (blue) was relatively constant over time except for a peak of hospitalizations in April. The incidence was calculated from the total estimated population of Ecuador for 2020 as the denominator per 100,000 inhabitants.