People contract leptospirosis through contact with animal urine and contaminated water. Two-thirds of patients are hospitalised, and many suffer long after infection and the numbers are increasing - 91 cases in the first half of 2017 compared to 33 in 2016. Leptospirosis is a workplace hazard in the agricultural sector, but the use of protective equipment does not necessarily prevent infection. Animal vaccines do not cover all strains and ACC access can be challenging. While animal contact remains important, we have observed that the demography of patients is changing, with more women affected, change in infecting strain and fewer with occupational association. Our pilot work suggests rodent sources and environmental pathways, including flooding, are increasingly important in disease transmission. We will address gaps in leptospirosis knowledge through a case control study which will identify infection risk factors, sources and pathways. Findings will inform development of intervention and control strategies and assessment criteria for ACC.