{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:37:23Z","timestamp":1773967043164,"version":"3.50.1"},"reference-count":22,"publisher":"Cambridge University Press (CUP)","issue":"10","license":[{"start":{"date-parts":[[2017,5,17]],"date-time":"2017-05-17T00:00:00Z","timestamp":1494979200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["www.cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:title>SUMMARY<\/jats:title><jats:p>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 \u2a7e3 mouthfuls of canal water were identified as risk factors for AGI among swimmers only (adjusted relative risks (aRR) 1\u00b76; 95% confidence intervals (CI) 1\u00b70\u20132\u00b75 and aRR 2\u00b76; 95% CI 1\u00b75\u20134\u00b78). 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.<\/jats:p>","DOI":"10.1017\/s0950268817001017","type":"journal-article","created":{"date-parts":[[2017,5,17]],"date-time":"2017-05-17T02:18:03Z","timestamp":1494987483000},"page":"2176-2184","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":10,"title":["Outbreak of diarrhoea among participants of a triathlon and a duathlon on 12 July 2015 in Utrecht, the Netherlands"],"prefix":"10.1017","volume":"145","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8955-2511","authenticated-orcid":false,"given":"S.","family":"PARKKALI","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"JOOSTEN","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"FANOY","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"PIJNACKER","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"VAN BEEK","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"BRANDWAGT","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W.","family":"VAN PELT","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2017,5,17]]},"reference":[{"key":"S0950268817001017_ref22","doi-asserted-by":"publisher","DOI":"10.1007\/s12560-014-9161-5"},{"key":"S0950268817001017_ref18","unstructured":"Royal Netherlands Meteorological Institute (KNMI) https:\/\/data.knmi.nl."},{"key":"S0950268817001017_ref15","doi-asserted-by":"publisher","DOI":"10.1007\/s12560-009-9019-4"},{"key":"S0950268817001017_ref10","unstructured":"Public Health England. Epidemiological investigation into gastrointestinal illness following public swimming in the River Thames, London October 2012\u00b72013; Public Health England (https:\/\/www.gov.uk\/government\/publications\/gastrointestinal-illness-outbreak-investigation-following-a-mass-participation-river-thames-swim)."},{"key":"S0950268817001017_ref3","doi-asserted-by":"publisher","DOI":"10.1128\/AEM.01609-07"},{"key":"S0950268817001017_ref2","first-page":"37","article-title":"Directive 2006\/7\/EC of the European Parliament and of the Council of 15 February 2006 concerning the management of bathing water quality and repealing directive 76\/160EEC","volume":"L64","year":"2006","journal-title":"Official Journal of European Union"},{"key":"S0950268817001017_ref1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/27.1.1"},{"key":"S0950268817001017_ref4","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268810002347"},{"key":"S0950268817001017_ref8","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268812000234"},{"key":"S0950268817001017_ref16","doi-asserted-by":"publisher","DOI":"10.1128\/AEM.05806-11"},{"key":"S0950268817001017_ref11","doi-asserted-by":"publisher","DOI":"10.1080\/00365540601053006"},{"key":"S0950268817001017_ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.watres.2010.10.015"},{"key":"S0950268817001017_ref17","first-page":"A7969","article-title":"Infections following recreational activities in lakes, rivers and canals: present and future risks of transmission in the Netherlands","volume":"158","author":"Schets","year":"2014","journal-title":"Nederlands Tijdschrift voor Geneeskunde"},{"key":"S0950268817001017_ref6","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0078371"},{"key":"S0950268817001017_ref9","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.8523"},{"key":"S0950268817001017_ref12","doi-asserted-by":"publisher","DOI":"10.1097\/01.ede.0000434431.06765.4a"},{"key":"S0950268817001017_ref21","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016004266.x"},{"key":"S0950268817001017_ref19","first-page":"468","article-title":"Energy drink consumption: beneficial and adverse health effects","volume":"9","author":"Alsunni","year":"2015","journal-title":"International Journal of Health Sciences (Qassim)"},{"key":"S0950268817001017_ref5","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/27.2.309"},{"key":"S0950268817001017_ref7","doi-asserted-by":"publisher","DOI":"10.1017\/S095026881300006X"},{"key":"S0950268817001017_ref13","first-page":"485","article-title":"Norovirus outbreak associated with a natural lake used for recreation \u2013 Oregon, 2014","volume":"64","author":"Zlot","year":"2015","journal-title":"MMWR Morbidity and Mortality Weekly Report"},{"key":"S0950268817001017_ref20","doi-asserted-by":"publisher","DOI":"10.1023\/A:1007629920752"}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268817001017","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,8,20]],"date-time":"2019-08-20T08:23:22Z","timestamp":1566289402000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268817001017\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,5,17]]},"references-count":22,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2017,7]]}},"alternative-id":["S0950268817001017"],"URL":"https:\/\/doi.org\/10.1017\/s0950268817001017","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,5,17]]},"assertion":[{"value":"Copyright \u00a9 Cambridge University Press 2017\u00a0","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}