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Introduction {#sec001}


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Infectious diseases represent one of the major public health concerns, which imposes many medical challenges in tropical countries. The term "diseases caused by infectious microbes", is much broader than a single infectious agent \[[@pntd.0005098.ref001]\]. It includes a variety of infectious diseases that are characterized by the presence of specific microbial agents or parasitic infections. The role of leptospirosis in Haiti is well known, as an important cause of mortality and morbidity among Haitians from several different geographic areas. From a public health standpoint, the report of leptospirosis in Haiti in 1975 was a devastating incident. There was panic throughout the country's southern regions and the entire country was in the grip of a severe epidemic of leptospirosis. Hundreds of people were reported to have died, and the entire scientific community gave their attention to the biological and epidemiological aspects of the disease \[[@pntd.0005098.ref002]\].


The initial outbreak in Saint Martin presented a situation quite similar to that observed in the 2010--2012 Haitian epidemics, which was all over the TV news, with the concern for leptospirosis as a major health problem, affecting mainly children between months 2 and 6 years old \[[@pntd.0005098.ref003]\]. This dramatic increase in mortality and case numbers correlated with drastic changes in the socioeconomic, infrastructural, political, economic and social sectors, together with an accumulation of cases, complicating the epidemiological picture \[[@pntd.0005098.ref004],[@pntd.0005098.ref005]\]. The exact number of cases remained uncertain due to discrepancies in the official reporting of cases, but this was roughly estimated to range between 400 000 and 650 000 based on a compilation of unpublished literature. The crisis started in the villages around Port au Prince, a place considered sacred by the population, and affected a significant number of households, including those of lower socioeconomic level \[[@pntd.0005098.ref006]\].


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