Outbreak of diarrhoea among participants of a triathlon and a duathlon on 12 July 2015 in Utrecht, The Netherlands
Open accessAbstract
On 12 July 2015, a triathlon competition with 900 participants took place in Utrecht, the Netherlands. An outbreak investigation was initiated after 56 participants reported health complaints. An online questionnaire was sent to 700 participants. Stool specimens from six participants and four water specimens were collected from the swimming location. A total of 239 participants completed the questionnaire (response rate: 34%), 73 (31%) of them met the case definition for acute gastrointestinal illness (AGI). A total of 67% of the respondents were male and the median age was 38 years. Almost half (42%) of swimmers reported health complaints. Consumption of energy drinks and ingesting ⩾3 mouthfuls of canal water were identified as risk factors for AGI among swimmers only (adjusted relative risks (aRR) 1·6; 95% confidence intervals (CI) 1·0-2·5 and aRR 2·6; 95% CI 1·5-4·8). The collected water specimens tested positive for norovirus genogroup I and rotavirus and stool specimens tested positive for norovirus genogroup II. Our findings indicate that the outbreak could have been caused by exposure to norovirus during swimming. Swimmers should get information about the health risks for making an informed choice about participating. For future events, the organisers decided to change the swimming location from a canal to a recreational lake.
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A high incidence of GI disorders during physical exercise can be observed among long-distance runners, duathletes and triathletes, cyclists, and athletes who participate in other sports modalities of long duration.
“A high incidence of GI disorders during physical exercise can be observed among long-distance runners [30], duathletes and triathletes [24], cyclists [33,37], and athletes who participate in other sports modalities of long duration [5,25].”
From Nutrition-Related Adverse Outcomes in Endurance Sports Competitions: A Review of Incidence and Practical Recommendations (2020) · cites this paper as [24]
Diarrhea is the GI disease that affects the highest number of endurance athletes, representing 16.4-59% of the total number of registered cases of GI problems.
“The results found highlight diarrhea as the GI disease that affects the highest number of endurance athletes, representing 16.4–59% of the total number of registered cases of GI problems [24,25,30,37,57].”
From Nutrition-Related Adverse Outcomes in Endurance Sports Competitions: A Review of Incidence and Practical Recommendations (2020) · cites this paper as [24]
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Cites
Somatic symptom reporting in women and men
Barsky, A. J., Peekna, H. M., & Borus, J. F. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016004266.x · Cited by 816 · see citing works
Review of epidemiological studies on health effects from exposure to recreational water
Prüss, A. (1998) · International Journal of Epidemiology · doi:10.1093/ije/27.1.1 · Cited by 565 · see citing works
Norovirus Infectivity in Humans and Persistence in Water
Seitz, S., León, J. S., Schwab, K. J., Lyon, G. M., Dowd, M., McDaniels, M., Abdulhafid, G., Fernandez, M. L., Lindesmith, L. C., Baric, R. S., et al. (2011) · Applied and Environmental Microbiology · doi:10.1128/aem.05806-11 · Cited by 310 · see citing works
Gender differences of symptom reporting and medical health care utilization in the German population
Ladwig, K., Marten‐Mittag, B., Formanek, B. M., & Dammann, G. (2000) · European Journal of Epidemiology · doi:10.1023/a:1007629920752 · Cited by 301 · see citing works
Surveillance of adenoviruses and noroviruses in European recreational waters
Wyn-Jones, A. P., Carducci, A., Cook, N., D’Agostino, M., Divizia, M., Fleischer, J., Gantzer, C., Gawler, A., Gironés, R., Höller, C., et al. (2010) · Water Research · doi:10.1016/j.watres.2010.10.015 · Cited by 282 · see citing works
MATTHEWS, J. E., DICKEY, B. W., Miller, R. D., Felzer, J., DAWSON, B. P., LEE, A. S., Rocks, J. J., Kiel, J., Montes, J., Moe, C. L., et al. (2012) · Epidemiology and Infection · doi:10.1017/s0950268812000234 · Cited by 277 · see citing works
Energy Drink Consumption : Beneficial and Adverse Health Effects
Alsunni, A. A. (2015) · International Journal of Health Sciences · doi:10.12816/0031237 · Cited by 174 · see citing works
Schets, F. M., Wijnen, J. H. V., Schijven, J. F., Schoon, H., & Husman, A. D. R. (2008) · Applied and Environmental Microbiology · doi:10.1128/aem.01609-07 · Cited by 125 · see citing works
Norovirus outbreaks: a systematic review of commonly implicated transmission routes and vehicles
Bitler, E. J., MATTHEWS, J. E., DICKEY, B. W., Eisenberg, J. N. S., & León, J. S. (2013) · Epidemiology and Infection · doi:10.1017/s095026881300006x · Cited by 105 · see citing works
Risk of gastroenteritis among triathletes in relation to faecal pollution of fresh waters
van Asperen, I. (1998) · International Journal of Epidemiology · doi:10.1093/ije/27.2.309 · Cited by 73 · see citing works
Grøndahl-Rosado, R. C., Yarovitsyna, E., Trettenes, E., Myrmel, M., & Robertson, L. J. (2014) · Food and Environmental Virology · doi:10.1007/s12560-014-9161-5 · Cited by 66 · see citing works
Swimmer Illness Associated with Marine Water Exposure and Water Quality Indicators
Arnold, B. F., Schiff, K., Griffith, J. F., et al. (2013) · Epidemiology · doi:10.1097/01.ede.0000434431.06765.4a · Cited by 65 · see citing works
Disease outbreaks associated with untreated recreational water use
Schets, F. M., Husman, A. D. R., & Havelaar, A. H. (2010) · Epidemiology and Infection · doi:10.1017/s0950268810002347 · Cited by 58 · see citing works
Harder-Lauridsen, N. M., Kuhn, K. G., Erichsen, A. C., et al. (2013) · PLoS ONE · doi:10.1371/journal.pone.0078371 · Cited by 56 · see citing works
Persistence of Human Noroviruses on Food Preparation Surfaces and Human Hands
Liu, P., Chien, Y., Papafragkou, E., Hsiao, H., Jaykus, L., & Moe, C. L. (2009) · Food and Environmental Virology · doi:10.1007/s12560-009-9019-4 · Cited by 55 · see citing works
Schijven, J. F., & Husman, A. M. D. R. (2006) · Environmental Health Perspectives · doi:10.1289/ehp.8523 · Cited by 55 · see citing works
Sartorius, B. K. D., Andersson, Y., Veličko, I., et al. (2007) · Scandinavian Journal of Infectious Diseases · doi:10.1080/00365540601053006 · Cited by 49 · see citing works
Norovirus Outbreak Associated With a Natural Lake Used for Recreation—Oregon, 2014
Zlot, A. I., Simckes, M. S., Vines, J., Reynolds, L. E., Sullivan, A. D., Scott, M. K., McLuckie, J., Kromer, D., Hill, V. R., Yoder, J. S., et al. (2015) · American Journal of Transplantation · doi:10.1111/ajt.13404 · Cited by 18 · see citing works
Norovirus outbreak associated with a natural lake used for recreation - Oregon, 2014.
Zlot, A. I., Simckes, M. S., Vines, J., Reynolds, L. E., Sullivan, A. D., Scott, A. K., McLuckie, J., Kromer, D., Hill, V. R., Yoder, J. S., et al. (2015) · PubMed Central · Cited by 16 · see citing works
Schets, F. M., & Husman, A. M. D. R. (2014) · PubMed · Cited by 2 · see citing works
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Research works printed but not linked: 1
- Anonymous. Directive 2006/7/EC of the European Parliament and of the Council of 15 February 2006 con- cerning the management of bathing water quality and repealing directive 76/160EEC. Official Journal of European Union 2006; L64: 37-51.
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Martínez-Sanz, J. M., Fernández Nuñez, A., Sospedra, I., Martínez-Rodríguez, A., Domínguez, R., González-Jurado, J. A., & Sánchez-Oliver, A. J. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17114082 · Cited by 25 · see citing works
- Authors
- PARKKALI, S., JOOSTEN, R., FANOY, E., PIJNACKER, R., VAN BEEK, J., BRANDWAGT, D., & VAN PELT, W.
- Affiliations
- National Institute for Public Health and the Environment (NL)
- Corresponding author
- PARKKALI, S.
- Venue
- Epidemiology and Infection
- Publisher
- Cambridge University Press (CUP)
- Published
- 2017-05-17
- Volume
- 145
- Issue
- 10
- Pages
- 2176-2184
- ISSN
- 0950-2688 (ISSN-L)
- 1469-4409
- PMC
- PMC9203431
- OpenAlex
- W2616368723
- Cited by
- 14
- References
- 20
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 3 · 2020: 4 · 2019: 2 · 2018: 2
- FWCI
- 1.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Epidemiology and Infection (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Rivm Repository (Netherlands National Institute for Public Health and the Environment) (submittedVersion)
- Rivm (National Institute for Public Health and the Environment) (submittedVersion)
- Funders
- Javna Agencija za Raziskovalno Dejavnost RS
- National Institutes of Health
- Rijksinstituut voor Volksgezondheid en Milieu
- Topics
- Health Sciences › Medicine › Infectious Diseases › Viral gastroenteritis research and epidemiology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Travel-related health issues
- Physical Sciences › Environmental Science › Water Science and Technology › Fecal contamination and water quality
- Keywords
- diarrhea outbreak, triathlon, duathlon, acute gastrointestinal illness, norovirus, rotavirus, swimming, canal water, energy drinks, risk factors, waterborne diseases, recreational water safety
- MeSH terms
- Adolescent, Adult, Aged, Diarrhea, Disease Outbreaks, Female, Gastroenteritis, Humans, Male, Middle Aged, Netherlands, Sports, Swimming, Water Microbiology, Caliciviridae Infections, Norovirus, Young Adult
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