title: Investigation of a leptospirosis outbreak in triathlon participants, Réunion Island, 2013.
abstract: We report herein the investigation of a leptospirosis outbreak occurring in triathlon competitors on Réunion Island, Indian Ocean. All participants were contacted by phone or email and answered a questionnaire. Detection and molecular characterization of pathogenic Leptospira was conducted in inpatients and in rodents trapped at the vicinity of the event. Of the 160 athletes competing, 101 (63·1%) agreed to participate in the study. Leptospirosis was biologically confirmed for 9/10 suspected cases either by real-time PCR or serological tests (MAT or ELISA). The total attack rate, children's attack rate, swimmers' attack rate, and the attack rate in adult swimmers were respectively estimated at 8·1% [95% confidence interval (CI) 4·3-14·7], 0%, 12·7% (95% CI 6·8-22·4) and 23·1% (95% CI 12·6-33·8). Leptospirosis cases reported significantly more wounds [risk ratio (RR) 4·5, 95% CI 1·6-13], wore complete neoprene suits less often (RR 4·3, 95% CI 1·3-14·5) and were most frequently unlicensed (RR 6·6, 95% CI 2·9-14·8). The epidemiological investigation supported that some measures such as the use of neoprene suits proved efficient in protecting swimmers against infection. PCR detection in rats revealed high Leptospira infection rates. Partial sequencing of the 16S gene and serology on both human and animal samples strongly suggests that rats were the main contaminators and were likely at the origin of the infection in humans.
authors.affiliation: Regional Office of the French Institute for Public Health Surveillance (Institut de Veille Sanitaire),Saint-Denis,Réunion,France.
authors.forename: F
authors.initials: F
authors.lastname: Pagès
authors.affiliation: Regional Office of the French Institute for Public Health Surveillance (Institut de Veille Sanitaire),Saint-Denis,Réunion,France.
authors.forename: S
authors.initials: S
authors.lastname: Larrieu
authors.affiliation: Health Agency of the Indian Ocean,Saint-Denis,Réunion,France.
authors.forename: J
authors.initials: J
authors.lastname: Simoes
authors.affiliation: Hospital Gabriel Martin,St Paul,Ile de la Réunion,France.
authors.forename: P
authors.initials: P
authors.lastname: Lenabat
authors.affiliation: Health Agency of the Indian Ocean,Saint-Denis,Réunion,France.
authors.forename: B
authors.initials: B
authors.lastname: Kurtkowiak
authors.affiliation: Centre de Recherche et de Veille sur les Maladies Emergentes dans l'océan Indien,Plateforme de recherché CYROI,97490 Ste Clotilde,Réunion,France.
authors.forename: V
authors.initials: V
authors.lastname: Guernier
authors.affiliation: Centre de Recherche et de Veille sur les Maladies Emergentes dans l'océan Indien,Plateforme de recherché CYROI,97490 Ste Clotilde,Réunion,France.
authors.forename: G
authors.initials: G
authors.lastname: Le Minter
authors.affiliation: Centre de Recherche et de Veille sur les Maladies Emergentes dans l'océan Indien,Plateforme de recherché CYROI,97490 Ste Clotilde,Réunion,France.
authors.forename: E
authors.initials: E
authors.lastname: Lagadec
authors.affiliation: Centre de Recherche et de Veille sur les Maladies Emergentes dans l'océan Indien,Plateforme de recherché CYROI,97490 Ste Clotilde,Réunion,France.
authors.forename: Y
authors.initials: Y
authors.lastname: Gomard
authors.affiliation: Laboratory of Biology,Centre Hospitalier Universitaire,Saint-Pierre,Réunion,France.
authors.forename: A
authors.initials: A
authors.lastname: Michault
authors.affiliation: Laboratory of Virology,Centre Hospitalier Universitaire,Saint-Denis,Réunion,France.
authors.forename: M C
authors.initials: MC
authors.lastname: Jaffar-Bandjee
authors.affiliation: Centre de Recherche et de Veille sur les Maladies Emergentes dans l'océan Indien,Plateforme de recherché CYROI,97490 Ste Clotilde,Réunion,France.
authors.forename: K
authors.initials: K
authors.lastname: Dellagi
authors.affiliation: National Reference Center and the WHO Collaborating Center for Leptospirosis,Institut Pasteur,Paris,France.
authors.forename: M
authors.initials: M
authors.lastname: Picardeau
authors.affiliation: Centre de Recherche et de Veille sur les Maladies Emergentes dans l'océan Indien,Plateforme de recherché CYROI,97490 Ste Clotilde,Réunion,France.
authors.forename: P
authors.initials: P
authors.lastname: Tortosa
authors.affiliation: Regional Office of the French Institute for Public Health Surveillance (Institut de Veille Sanitaire),Saint-Denis,Réunion,France.
authors.forename: L
authors.initials: L
authors.lastname: Filleul
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000835:Animals, Wild / Q000382:microbiology; D000907:Antibodies, Bacterial / Q000097:blood; D001642:Bicycling; D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000097:blood; D004196:Disease Outbreaks; D005260:Female; D006306:Health Surveys; D006801:Humans; D007195:Indian Ocean Islands / Q000453:epidemiology; D007919:Leptospira / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D007922:Leptospirosis / Q000097:blood / Q000453:epidemiology* / Q000662:veterinary*; D008297:Male; D008875:Middle Aged; D011481:Protective Clothing; D051381:Rats / Q000382:microbiology; D012376:Rodent Diseases / Q000382:microbiology*; D012420:Running; D012867:Skin / Q000293:injuries; D013177:Sports; D019876:Sports Equipment; D013550:Swimming; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D004269:DNA, Bacterial
keywords: Leptospirosis; Réunion Island; outbreak; triathlon