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Open Access Highly Accessed Research article

Outbreak of leptospirosis among triathlon participants in Germany, 2006

Stefan Brockmann1, Isolde Piechotowski1, Oswinde Bock-Hensley2, Christian Winter13, Rainer Oehme1, Stefan Zimmermann4, Katrin Hartelt1, Enno Luge5, Karsten Nöckler5, Thomas Schneider6, Klaus Stark7 and Andreas Jansen7*

Author Affiliations

1 Baden-Württemberg State Health Office, District Government Stuttgart, Germany

2 Gesundheitsamt Rhein-Neckar-Kreis, Heidelberg, Germany

3 Postgraduate Training of Applied Epidemiology (PAE), Berlin, Germany

4 Karl-Ruprecht University Heidelberg, Department of Hygiene, Heidelberg, Germany

5 Federal Institute for Risk Assessment (BfR), Berlin, Germany

6 Medical Clinic I, Campus Benjamin Franklin, Charité, Berlin, Germany

7 Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany

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BMC Infectious Diseases 2010, 10:91  doi:10.1186/1471-2334-10-91

Published: 10 April 2010

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.

Discussion

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.