Leptospirosis Outbreak, Following International Sports Event, Sabah Borneo
GeoSentinel Surveillance Network
The recently discovered outbreak of leptospirosis among Eco-Challenge participants demonstrated the depth of experience within the GeoSentinel network in evaluating tropical infectious diseases, the value of the network as a surveillance tool, and the value of partnerships between ISTM, CDC, and health care providers around the world.
Early on the morning of September 10, Charles Easmon, site director at The Hospital for Tropical Diseases in London, England, reported 4 cases of acute febrile illness—suspected to be leptospirosis—among athletes who participated in the 12-day Eco-Challenge Sabah 2000 Adventure Race. Immediately David Freedman queried all 26 GeoSentinel site directors with a request to immediately notify GeoSentinel of any other suspected cases.
Within hours, Brad Connor, site director at Travelers Health Services in New York, responded with a report of one case. This case provided two important pieces of information: copies of e-mail correspondence from participants beginning September 6, which indicated at least 15 others had become ill; and an e-mail alert from the race organizers on September 8 to all race participants, indicating they were aware of a larger number of ill participants. That same afternoon, Jay Keystone, site director at Toronto Hospital Tropical Disease Unit in Toronto reported 4 additional cases. By 17:00 that day, Phyllis Kozarsky and Marty Cetron in Atlanta were consulted. Because the suspected disease is treatable and because many individuals were still in the incubation period, it was determined that there was an urgent need for a worldwide alert. A decision was made to utilize all broader resources available to GeoSentinel. By 22:00 that evening a worldwide alert went out by e-mail to all GeoSentinel sites, to ProMed, TravelMed (ISTM listserv of 400 subscribers), TropMed (ASTMH listserv of 200 subscribers), the entire ISTM membership of 1,200 travel medicine specialists in 55 countries, and a request to the IDSA network to post to their 800 U.S.-based infectious disease specialists. A copy of this was forwarded to the race organizers.
One of the characteristics of this process was the speed with which everyone involved communicated and passed on the information. By early the next morning, September 11, both ProMed and IDSA had posted the alert.
As a result of the alerts, Devon Hale in Utah and Russell McMullen in Washington found the names of local participants from the race web site and attempted to contact their respective local participants. An ISTM member in South Africa and three members in the United States also notified GeoSentinel about cases. "This (the response to this outbreak) really shows what GeoSentinel and electronic dissemination can accomplish," said David Freedman.
Reports of the outbreak had also been gathered by the Idaho and California state health departments and an outbreak investigation was undertaken by the CDC. GeoSentinel agreed to be a rapid conduit to public health authorities in countries with known participants. On Wednesday, September 12, the CDC supplied GeoSentinel with lists of contacts for all Australian, Canadian, and UK participants and requested assistance in contacting participants or relevant public health authorities. GeoSentinel site coordinators Jay Keystone in Canada, Charles Easmon in London, and Graham Brown in Australia were instrumental in making these connections in their respective countries. Within 48 hours of the first GeoSentinel query, health authorities in Canada, Australia and the United Kingdom were contacted and began case finding activities. Through the assistance of Peter Buck at Health Canada, the 19 Canadian participants were notified of their potential exposure and interviewed as part of the investigation. With the help of Meirion Evans at the Communicable Disease Surveillance Center in Wales and his colleagues in Ireland, all 22 of the participants from the United Kingdom were notified and interviewed. Finally, with the assistance of Margo Eyerson-Ananan at the Commonwealth Department of Health and Aged Care, the 12 Australian participants were notified and interviewed.
By 10:00 AM, Wednesday, the Associated Press picked up the ProMed posting and contacted GeoSentinel. The next morning the story ran on the AP Wire. Brad Connor was contacted that same day by the New York Times for more information. News of the outbreak was given coverage in the Thursday edition of the newspaper.
The Eco-Challenge outbreak demonstrates that the growth of partnerships between ISTM, CDC, and other medical societies, governments, and private providers has become one of GeoSentinel's greatest assets. Continued public health response and collaboration of this sort serves to effectively contain infectious diseases and minimize disease related morbidity. "GeoSentinel is an exciting adventure in the way global surveillance data can be turned into information for action," said Marty Cetron.
