There is limited information on disease burden, and it is most pronounced
in rural regions of developing countries, among
subsistence farmers and livestock herders (Everard et al.,
1992; Kuriakose et al., 1997; Martinez et al., 1993). In China,
there are more than 500 000 cases annually, the majority
of which are reported from rural areas of the country. The
example of the emergence of leptospirosis in rural Thailand
during the 1990s demonstrated the potential magnitude of
this problem: a nationwide outbreak occurred in the late
1990s and in 2000 and was responsible for more than 10 000
reported cases (Phraisuwan et al., 2002)