Box 11
An Outbreak of Leptopirosis Affecting Athletes from 26 Countries Reported by the GeoSentinel Disease Surveillance System

In September 2000, several athletes returning home from the EcoChallenge-Sabah 2000 multisport expedition race in Malaysian Borneo fell ill with leptospirosis, apparently contracted while swimming in a contaminated river. Leptospirosis causes severe fever, headache, chills, muscle pain, and cramps. Left untreated, it can lead to kidney and liver failure, meningitis, and death.

Three clinics that participate in GeoSentinel, the global surveillance network of the International Society of Travel Medicine ( Appendix E), reported a cluster of acute febrile illness among Eco-Challenge racers and helped identity its cause. A clinic in London, England, reported four instances of suspected leptospirosis and queried other GeoSentinel sites for similar cases. Clinics in New York City and Toronto responded with reports of five more cases among the same group of athletes, and all communicated their findings to CDC. Further evaluation indicated that all cases were clinically compatible with leptospirosis.

Leptospirosis is contracted by coming into contact with or swallowing water contaminated with animal urine. During the 12-day Eco-Challenge race, approximately 300 athletes from 26 countries sailed on open ocean and then bicycled and hiked through torrential jungle rain and mud. After that, the racers swam and canoed in a storm-swollen river and waded through caves filled with bat guano. Analysis by CDC suggested that participating in the river swim was significantly associated with illness. At least 44% of the 155 U.S. participants were affected. Additional cases of leptospirosis were identified in athletes from several other countries as well.

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National Center for Infectious Diseases
Centers for Disease Control and Prevention
Atlanta, GA