Int. J. Environ. Res. Public Health 2012, 9, 3883-3910; doi:10.3390/ijerph9113883 OPEN ACCESS International Journal of Environmental Research and Public Health ISSN 1660-4601 www.mdpi.com/journal/ijerph Article Leptospirosis Outbreaks in Nicaragua: Identifying Critical Areas and Exploring Drivers for Evidence-Based Planning Maria Cristina Schneider 1,*, Patricia Nájera 1, Sylvain Aldighieri 1, Jorge Bacallao 2, Aida Soto 3, Wilmer Marquiño 3, Lesbia Altamirano 3, Carlos Saenz 4, Jesus Marin 4, Eduardo Jimenez 4, Matthew Moynihan 1 and Marcos Espinal 1 1 Pan American Health Organization, Health Surveillance and Disease Prevention and Control, 525 23rd. St. NW, Washington, DC 20037, USA; E-Mails:
[email protected] (P.N.);
[email protected] (S.A.);
[email protected] (M.M.);
[email protected] (M.E.) 2 University of Medical Sciences ofHabana, Research and Reference Center of Atherosclerosis of Havana, Universidad de Ciencias Médicas de La Habana, Tulipán y Panorama, Plaza, La Habana, Cuba; E-Mail:
[email protected] 3 Pan American Health Organization Nicaragua, PO Box 1309, Managua, Nicaragua; E-Mails:
[email protected] (A.S.);
[email protected] (W.M.);
[email protected] (L.A.) 4 Ministry of Health of Nicaragua, Costado Oeste Colonia Primero de Mayo, PO Box 107, Managua, Nicaragua; E-Mails:
[email protected] (C.S.);
[email protected] (J.M.);
[email protected] (E.J.) * Author to whom correspondence should be addressed; E-Mail:
[email protected]; Tel.: +1-202-974-3190; Fax: +1-202-974-3632. Received: 13 July 2012; in revised form: 21 September 2012 / Accepted: 24 September 2012 / Published: 26 October 2012 Abstract: Leptospirosis is an epidemic-prone zoonotic disease that occurs worldwide.