On October 12, 2012, the Nellis Air Force Base Public Health Flight (Nellis Public Health), near Las Vegas, Nevada, was notified by the Mike O'Callaghan Federal Medical Center (MOFMC) emergency department (ED) of three active-duty military patients who went to the ED during October 10–12 with fever, vomiting, and hemorrhagic diarrhea. Initial interviews by clinical staff members indicated that all three patients had participated October 6–7 in a long-distance obstacle adventure race on a cattle ranch in Beatty, Nevada, in which competitors frequently fell face first into mud or had their heads submerged in surface water. An investigation by Nellis Public Health, coordinated with local and state health officials, identified 22 cases (18 probable and four confirmed) of Campylobacter coli infection among active-duty service members and civilians. A case-control study using data provided by patients and healthy persons who also had participated in the race showed a statistically significant association between inadvertent swallowing of muddy surface water during the race and Campylobacter infection. Public health agencies and adventure race organizers should consider informing race attendees of the hazards of inadvertent ingestion of surface water.
Campylobacter is one of the most common causes of diarrheal illness in the United States. Most persons who become ill with campylobacteriosis get diarrhea, cramping, abdominal pain, and fever within 2–5 days after exposure to the organism. The diarrhea can be bloody and can be accompanied by nausea and vomiting. The illness typically lasts about 1 week. Most cases occur as isolated, sporadic events and are usually associated with eating raw or undercooked poultry or from cross-contamination of other foods by these items.
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Warning participants in outdoor sporting events who might be exposed to fecally contaminated water or slurry that potentially serious diarrheal disease can result if ingested, even inadvertently, could reduce exposures to these pathogens. Event organizers should consider including the risk for waterborne outbreaks in their participant waivers and advise participants to avoid drinking or swallowing unsafe water. Participants also need to be encouraged to seek appropriate medical care for postcompetition diarrhea, especially bloody diarrhea, and to inform medical personnel of their exposure. In addition, health-care providers need to be aware of the association between these adventure races and the risk for exposure to Campylobacter or other pathogens via contaminated water, mud, or slurry so that appropriate diagnostic testing and treatment can be provided to ill participants.
Fantastic.
CDC...Outbreak of Campylobacteriosis Associated with a Long-Distance Obstacle Adventure Race — Nevada, October 2012
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