The risks of exposure to infection from wild animals, especially rodents, is rarely taught in schools. This is a situation that needs to change, as often those most at risk are the 5-16 age group, as they are:

• More likely to play in or near contaminated water, especially in urban areas
• Less likely to associate risk with their actions
• Less likely to associate the presence of rats with any danger of infection

More likely to have symptoms ignored or mis-diagnosed by parents or doctors

The education of school-age children in developing countries where leptospiral contamination is endemic is a specific and different task, which is addressed elsewhere. This guide is aimed at education in developed countries, where risks are presented from isolated actions such as playing near contaminated water.
There are two separate aspects to this education scheme:

1. Parents and guardians should be aware of the risks, but also the symptoms of infection.
2. Children should be aware of the risks and how to associate what they see with what dangers are presented.
   

Education for parents:
Parents, and to some extent local general practitioners, should be made aware of the fact that leptospirosis exists in the first instance. In recent surveys, less than 20% of adults knew of the infection. Many people in the UK associate rats with historical infections such as bubonic plague, but only consider the current threat to be that of general uncleanliness, leading to risks of food poisoning, infection from bites, etc.
Over the last few years UK television has increasingly introduced leptospirosis into medical drama, possibly as a simple 'plot line' as the infection can be misdiagnosed by staff and therefore create a good 'story'. Inadvertantly however, the appearance of the infection on TV does cause the general public association of the symptoms to increase. There is however no general education programme structure for 'rare' infections such as leptospirosis in the UK.
Education presented via children to parents must be by nature of logistics a target-oriented system in the UK. Children at increased risk can be targeted, however it is impractical to promote education to the entire population. Those groups at higher risk include families:

1. based in farming areas
2. based in areas of inland waterways
3. engaged in high-risk pastimes or sports such as watersports (canoeing, sailing, fishing, etc)
4. based in urban areas with known histories of rodent infestation (housing estates, etc)

Education of target parents should make them aware of the following points:

• Rats carry a bacterial infection that they leave behind in their urine. This can contaminate water, food or other wet areas they travel through.
• Contact with this infected material, if eaten or applied to broken skin, can cause an infection
• The general initial symptoms of the infection should be included
• If any member of the family shows these signs, a doctor should be called immediately

The risks are specifically from water or damp materials and this must enter the body via some means. There are minimal risks from the general acts of living in areas with rat populations provided sensible hygiene is observed. The infection rarely passes from person to person. It can occasionally be caught from cats or dogs which have in turn been infected from rats.
Care must be taken to avoid creating a climate of fear. Educational material should emphasise that the infection is rare, and with sensible precautions the risks are very small. However, if the family lives in a rat-occupied area or some members have high-risk pastimes, they should be aware of the symptoms of infection so that they can check with their doctor, rather than simply assuming they have a common cold or influenza infection.

Education for children
There are two main points to emphasise to children in target groups, the methods of achieving this are both age- and group-dependent. Education of children in a sporting group, such as a canoe club, can be specific and more advanced than for a general population in a rodent-infested urban area. Those with a specific connection to risk, such as a sporting club, can be educated as part of their sporting training and as such will take more interest in the subject. As is the case in general for education, a non-specific target group will show very poor uptake and retention of information which they think is not important to them.

To most UK school-age children, rats are a source of fear and excitement. Many of them will never see a rat, however are exposed to them on TV, in books and films, often as an object of fear. When presented with one in reality, they tend to contrast fear and wariness with fascination. Very few children would consider handling a rat, but correspondingly many would spend time watching one, throwing stones it it, prodding it with a stick, chasing it, etc. The risks arise from the fact that during this time the child may be exposed to area contamination, about which they know nothing.

Children should be told that rats carry infection, though most inately know this from media exposure. The emphasis should be placed on the fact that areas where rate live are also sources of infection even when the rats are not at home. They should be told the urine from rats can infect water, soil, food or anything else damp they walk over, and that drinking, eating or handling these items can cause a serious illness that could kill. The initial effects come on about a week later and seem like a very bad cold, but can get a lot worse, ending with hospital treatment and sometimes death. The golden rule is to avoid any places where rats may live or visit, and never to drink or eat anything that a rat may have been near to.

Children are exposed to contaminated water usually via local lakes, rivers etc. during play. There is a separate issue of exposure caused by specific recreational use of water, such as for canoeing. For the general exposure risks, emphasis must be placed on the idea that both urban and rural lakes, rivers, canals, even small ponds, can present a risk of infection through swimming, drinking the water or contact with broken skin. Children should be taught to treat such locations, however clean they may look initially, as dangerous until proven otherwise. This can be connected to general water safety and anti-drowning messages. It is not simply leptospira that present a risk from bodies of water, there are also numerous bacterial and microcellular pathogens commonly present that can cause skin irritation, digestive disorders, vomiting, fever and worse.