Leptospirosis is an acute febrile illness with a wide variety of clinical manifestations and is encountered throughout the world, prominently in tropical areas with high rainfall. In this paper, we review the current status of leptospirosis in two Asian countries, Japan and Philippines, which have quite different situations in terms of economy, environment, infrastructures and prevailing infectious diseases. In Japan, until 1960, more than 200 deaths due to leptospirosis had been reported yearly. After 1960, the number of reported cases had rapidly decreased. Now, leptospirosis cases notified every year were less than 20. After the early 1960s, modernization of agriculture was introduced, at the same time, inactivated vaccine against Leptospira was applied for humans and there was good maintenance of infrastructures such as water works and sewage systems. In Philippines, on the other hand, leptospirosis patients tend to be frequently found in flood-prone areas of urban setting such as Metro Manila, which was found to be the endemic foci of leptospirosis. Morbidity in a rural area (Cabatuan, Iloilo) was 147 cases per 100,000 populations. From 1998 to 2001, about 70% of 1200 suspected leptospirosis patients in Philippines were serologically positive. The average age of patients was 32 years old where 87% of the cases were males and 70% were outdoor workers. Case fatality rate was found to be 12-14%. The estimated major serovars in Metro Manila and neighboring provinces were Manilae, Losbanos, Tarassovi, Poi and an unknown serovar. Outbreaks of leptospirosis in the Philippines are thought to be associated with heavy rainfall, rapid urbanization (dramatic increase in populations), deforestation, increasing number of flood-prone areas, poor infrastructures and many others.