Tough mudders beware: there is E. coli risk

In August 2018, Public Health England (PHE) was made aware of five probable cases of Shiga toxin‐producing Escherichia coli (STEC) O157:H7 among individuals reporting participation in a mud‐based obstacle race. An additional four cases, identified via routine whole‐genome sequencing, were subsequently linked to the same event. Two of the nine cases were due to secondary household transmission.

Despite an agreement between the event organizers and the local authority, to ensure that all livestock were removed from the site 28 days before the event, sheep were observed grazing on some of the routes taken by the runners 2 days prior to the race taking place. A retrospective review of incidents reported to PHE between 2015 and 2018 identified 41 cases of gastroenteritis associated with muddy assault course events. Of these, 25 cases were due to infection with STEC O157:H7, of which all but one were associated with outbreaks.

Due to the environment in which such events take place, it is impossible to entirely remove the risk of exposure to potentially pathogenic zoonoses. However, race organizers should ensure that livestock are removed from the course 28 days before the event. They should also ensure that participants are made aware of the risk of contracting gastrointestinal disease from the environment, and to stress the importance of hand hygiene post‐event and the risk of secondary transmission, particularly to children who are at risk of developing haemolytic uraemic syndrome.

An outbreak of shiga toxin-producing Escherichia coli O157:H7 linked to a mud-based obstacle course, England, August 2018

Zoonoses and Public Health

Alexander Sharp, Elizabeth Smout, Lisa Byrne, Rebecca Greenwood, Richard Abdoollah, Charlotte Hutchinson, Claire Jenkins, Nachi Arunachalam, Simon Padfield, Gareth Hughes, Mike Gent

https://doi.org/10.1111/zph.12744

https://onlinelibrary.wiley.com/doi/abs/10.1111/zph.12744

Beware the mud: Mountain bikers and cross-country runners at risk of E.coli poisoning

Mountain bikers and cross-country runners are at risk from the deadly stomach bug E. coli if they get splashed with mud, doctors warned today.

mudMedics at Aberdeen Royal Infirmary say they treated a 23-year-old cyclist for an E. coli O157 infection after he was admitted to the hospital suffering from vomiting, abdominal pain and bloody diarrhea.

The man – a vegetarian – said he had not eaten undercooked meat or vegetables, nor had he spent time with livestock or visiting farms before falling ill.

But eight days before his symptoms began the man had competed in a cycling event along wet, muddy tracks in eastern Scotland.

He, along with other competitors, had removed the mudguards from his bicycle to reduce weight, and mud and water had splashed on his face during the race. 

It is thought this was how he became infected with the bug, which can be found in animal feces and farm slurry.

The man said he had taken part in a ‘Tough Mudder’ event, which involves a 10 -12 mile race with obstacles such as climbing vertical walls and plunging through ice pools.

The cyclist, who has not been identified, recovered – but the doctors have highlighted his case in the Journal of Infection Prevention.

mountain.bike.mudWriting in the research paper, the doctors warned: ‘Sporting endeavours such as cycling and cross-country running events often take participants through such high-risk areas and may be an important cause of contact with E. coli O157.

‘This case highlights such exposure and should alert clinicians to the possibility of E.coli O157 infection and the importance of individuals presenting with bloody diarrhea with a history of participation in similar sporting or other events.’

In 2012, three people contracted E.coli 0O57 infection following a 12-mile ‘Tough Mudder’ event at Drumlanrig Castle, Dumfriesshire, which involved immersion or contact with mud.

Also in 2012, a study of one of the world’s largest mountain bike races, the 95k Birkebeinerrittet in Norway, which annually attracts 19,000 participants, found that when mudguards were attached to bikes, there were fewer cases of gastrointestinal illness.  

Michigan Tough Mudder race organizers share info about avoiding illnesses

Over the past 6 months I’ve been running a few times a week as a way to get some decent exercise while I try to get to a more healthy weight.

Not an activity that I liked until I was about 30, I do most of my running on treadmills while I watch sports and listen to podcasts. There are a few guys on my hockey team who have taken up endurance mud running as a way to work off the chicken sandwiches and beer we consume every Monday night. A couple of them ran the Tough Mudder in South Carolina a couple of years ago and are trying to talk me into joining them in the spring. Not sure I’m into it.TMSplash

From the organizer’s website, “Tough Mudder events are hardcore 10-12 mile obstacle courses designed by British Special Forces to test your all around strength, stamina, mental grit, and camaraderie. Triathlons, marathons, and other lame-ass mud runs are more stressful than fun. Not Tough Mudder. As hardcore as our courses are, we meet you at the finish line with a beer, a laugh, and a rockin’ live band.”

The site lists a set of obstacles with names like Arctic Enema, Dirty Ballerina and Kiss of Mud.

The races have a history of testing more than physical and mental toughness – they have been linked to multiple pathogen outbreaks.

A 2012 Tough Mudder in Scotland was linked to at least three cases of E. coli O157.  Last year a Michigan event recent was linked to norovirus.

According to Mlive, the organizers of this weekend’s Michigan event are addressing pathogen concerns.

Tough Mudder officials want to remind anyone planning to compete or attend this year’s event to practice good hygiene before and after attending.

“Illnesses of this nature are extremely rare. More than 1.5 million Mudders have run a Tough Mudder course; this issue is highly isolated,” said Ben Johnson, a spokesperson for Tough Mudder, via email. “However, safety is our No. 1 priority, and we encourage all participants, spectators, and volunteers to take the following preventative measures:

– It is important to not attend the event if you are feeling ill. We can provide a transfer to a future event.

– Practice good hygiene before and after the event:

Stay home for at least 48 hours after symptoms disappear.

Use chlorine-bleach based household cleaners to disinfect contaminated surfaces.

Free transfers to a future event is a good step – maybe that will result in sick folks skipping it until they’re done shedding pathogens.