title: Outbreak of leptospirosis among triathlon participants in Germany, 2006.
abstract: BACKGROUND
  In August 2006, a case of leptospirosis occurred in an athlete after a triathlon held around Heidelberg and in the Neckar river. In order to study a possible outbreak and to determine risk factors for infection an epidemiological investigation was performed.
  
  
  METHODS
  Participants of the triathlon were contacted by e-mail and were asked to fill out a standardized questionnaire. In addition, they were asked to supply a serum sample for laboratory diagnosis of leptospirosis. A confirmed case patient was defined as a clinical case (i.e. fever and at least one additional symptom suggestive for leptospirosis) with at least two of the following tests positive: ELISA IgM, latex agglutination testing, or microscopic agglutination testing. Rainfall and temperature records were obtained.
  
  
  RESULTS
  A total of 142 of 507 triathletes were contacted; among these, five confirmed leptospirosis cases were found. Open wounds were identified as the only significant risk factor for illness (p = 0.02). Heavy rains that preceded the swimming event likely increased leptospiral contamination of the Neckar River.
  
  
  CONCLUSIONS
  This is the first outbreak of leptospirosis related to a competitive sports event in Germany. Among people with contact to freshwater, the risk of contracting leptospirosis should be considered by health care providers also in temperate countries, particularly in the summer after heavy rains.
authors.affiliation: Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Brockmann
authors.forename: Isolde
authors.initials: I
authors.lastname: Piechotowski
authors.forename: Oswinde
authors.initials: O
authors.lastname: Bock-Hensley
authors.forename: Christian
authors.initials: C
authors.lastname: Winter
authors.forename: Rainer
authors.initials: R
authors.lastname: Oehme
authors.forename: Stefan
authors.initials: S
authors.lastname: Zimmermann
authors.forename: Katrin
authors.initials: K
authors.lastname: Hartelt
authors.forename: Enno
authors.initials: E
authors.lastname: Luge
authors.forename: Karsten
authors.initials: K
authors.lastname: Nöckler
authors.forename: Thomas
authors.initials: T
authors.lastname: Schneider
authors.forename: Klaus
authors.initials: K
authors.lastname: Stark
authors.forename: Andreas
authors.initials: A
authors.lastname: Jansen
mesh_terms: D000372:Agglutination Tests; D000907:Antibodies, Bacterial / Q000097:blood; D056352:Athletes; D004196:Disease Outbreaks; D034742:Electronic Mail; D004797:Enzyme-Linked Immunosorbent Assay; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007922:Leptospirosis / Q000453:epidemiology*; D011795:Surveys and Questionnaires
chemical_list: D000907:Antibodies, Bacterial; D007075:Immunoglobulin M