Outbreak of leptospirosis among triathlon participants in Germany, 2006.
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.
Brockmann
Stefan
S
Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
Piechotowski
Isolde
I
Bock-Hensley
Oswinde
O
Winter
Christian
C
Oehme
Rainer
R
Zimmermann
Stefan
S
Hartelt
Katrin
K
Luge
Enno
E
Nöckler
Karsten
K
Schneider
Thomas
T
Stark
Klaus
K
Jansen
Andreas
A
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
D000907:Antibodies, Bacterial; D007075:Immunoglobulin M