title: Leptospirosis in "Eco-Challenge" athletes, Malaysian Borneo, 2000.
abstract: Adventure travel is becoming more popular, increasing the likelihood of contact with unusual pathogens. We investigated an outbreak of leptospirosis in "Eco-Challenge" multisport race athletes to determine illness etiology and implement public health measures. Of 304 athletes, we contacted 189 (62%) from the United States and 26 other countries. Eighty (42%) athletes met our case definition. Twenty-nine (36%) case-patients were hospitalized; none died. Logistic regression showed swimming in the Segama River (relative risk [RR]=2.0; 95% confidence interval [CI]=1.3 to 3.1) to be an independent risk factor. Twenty-six (68%) of 38 case-patients tested positive for leptospiral antibodies. Taking doxycycline before or during the race was protective (RR=0.4, 95% CI=0.2 to 1.2) for the 20 athletes who reported using it. Increased adventure travel may lead to more frequent exposure to leptospires, and preexposure chemoprophylaxis for leptospirosis (200 mg oral doxycycline/week) may decrease illness risk. Efforts are needed to inform adventure travel participants of unique infections such as leptospirosis.
authors.affiliation: Division of Viral and Rickettsial Diseases, Mailstop A39, NCID, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. zea3@cdc.gov
authors.forename: James
authors.initials: J
authors.lastname: Sejvar
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bancroft
authors.forename: Kevin
authors.initials: K
authors.lastname: Winthrop
authors.forename: Julie
authors.initials: J
authors.lastname: Bettinger
authors.forename: Mary
authors.initials: M
authors.lastname: Bajani
authors.forename: Sandra
authors.initials: S
authors.lastname: Bragg
authors.forename: Kathleen
authors.initials: K
authors.lastname: Shutt
authors.forename: Robyn
authors.initials: R
authors.lastname: Kaiser
authors.forename: Nina
authors.initials: N
authors.lastname: Marano
authors.forename: Tanja
authors.initials: T
authors.lastname: Popovic
authors.forename: Jordan
authors.initials: J
authors.lastname: Tappero
authors.forename: David
authors.initials: D
authors.lastname: Ashford
authors.forename: Laurene
authors.initials: L
authors.lastname: Mascola
authors.forename: Duc
authors.initials: D
authors.lastname: Vugia
authors.forename: Bradley
authors.initials: B
authors.lastname: Perkins
authors.forename: Nancy
authors.initials: N
authors.lastname: Rosenstein
mesh_terms: D000328:Adult; D004269:DNA, Bacterial / Q000032:analysis; D004196:Disease Outbreaks; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000382:microbiology; D005618:Fresh Water / Q000382:microbiology; D006801:Humans; D007919:Leptospira / Q000235:genetics / Q000302:isolation & purification; D007922:Leptospirosis / Q000175:diagnosis / Q000453:epidemiology*; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013177:Sports; D014195:Travel; D014871:Water Microbiology
chemical_list: D004269:DNA, Bacterial