The first cases of leptospirosis in the Comoros archipelago and Mayotte were reported in the early 1980s. From 1998 to 2008, an average of about 20 cases per year were reported for Mayotte by the National Reference Center for Leptospirosis (Institut Pasteur, Paris). Specific surveillance of the disease was established in 2008, initially through a simple collection of cases reported by the Mayotte Hospital Center and their administrative characteristics, and then, starting in 2010, through epidemiological investigation of the cases. From 2008 to 2015, 808 cases of leptospirosis (an average of 100 cases per year, representing an average annual incidence of 47 cases per 100,000 inhabitants) were reported, including 203 hospitalizations. Between 2012 and 2015, 13 people were admitted to intensive care, representing 10% of hospitalized cases. Cases are reported throughout the year, but predominantly during the rainy season, from January to May. The incidence varies by year but also by municipality, depending on rainfall and human activities. Leptospirosis in Mayotte is a disease with high morbidity, affecting men twice as often as women, with 20% of cases occurring in those under 15 years of age. However, severe cases and deaths are rare (average case-fatality rate 0.9%). The vast majority of cases recorded on the island are linked to agricultural or gardening practices and backyard livestock farming, or to freshwater recreational activities (fishing, swimming in rivers or ponds), as well as walking barefoot or without closed-toe shoes. There is likely intra- or peridomestic exposure linked to degraded housing (RR=1.5 [1.4-1.8]). Occupational exposure is found in 4 out of 10 cases, and 1 out of 10 cases is solely of occupational origin. The high-risk occupations identified are those classically described: farmers, construction workers, garbage collectors, and military personnel. Most cases are isolated, with no link between them. In Mayotte, the awareness and vigilance of healthcare workers regarding this disease are partly responsible for its low case-fatality rate. While improvements in housing, wastewater and stormwater management, waste management, and access to water are all key factors for controlling leptospirosis in the future, it is necessary to better inform the public about modes of transmission to reduce exposure, as well as about the need to seek prompt medical attention in the event of fever in order to reduce the severity of the disease. Prevention efforts must also be directed toward at-risk professions, particularly farmers and livestock breeders.