Headlines

Cluster of Tularemia Cases Linked to a Sporting EventTwo cases of tularemia were recently reported in June and July 2015 in two different regions (Pays de Loire and Centre-Val de Loire). The only thing they had in common was that they had participated in the same “raid”-style sporting event in the forest, held on April 25 and 26 in Saint Roch, Indre-et-Loire. The race involved 140 participants. It combined orienteering and mountain biking events in the woods, in undeveloped areas, and included a camping trip. The two patients developed initial symptoms on May 1 and May 4, respectively. Both had an ulceroganglionic form of tularemia, with lesions on the lower limbs suggesting infection during the race. No other risk exposures were reported for these two patients. Tularemia is a rare disease in France (approximately 40 cases per year). Humans can become infected through direct skin contact with infected animals or contaminated animal products, or indirectly through contact with plants (particularly forage), water, or soil contaminated by animal feces or carcasses, ingestion of contaminated food or water, a bite from an infected tick, or inhalation of the bacteria. The occurrence of a cluster of this rare disease, especially in a sporting context, constitutes a particularly unusual public health event. Nevertheless, it could be linked to recent clusters of infectious gastrointestinal syndromes associated with running events in the PACA region, Aquitaine, Franche-Comté in 2013 (Ornans trail run), and Normandy in 2006 during a sand yacht race.This type of sporting event (raids, “mud days,” “crazy races,” etc.), driven by values of sportsmanship and closeness to nature, appears to be increasingly common. The issues of assessing infection risks associated with this type of sporting activity and providing participants with relevant information prior to registration should therefore be considered.