During the Paris 2024 Olympic and Paralympic Games, athletes from various nautical and aquatic disciplines will be in contact with the water of the Seine at the foot of the Eiffel Tower and that of the Vaires-sur-Marne basin (eastern Parisian suburbs). The risk of them contracting leptospirosis is not negligible. This is why the Academy of Pharmacy, the Veterinary Academy and the French Academy of Agriculture have drawn up a report on this pathology for the attention of health and sports authorities, general practitioners and pharmacists, who believe they are largely under-informed on the subject.
Human leptospirosis occurs through contact with fresh water or sludge contaminated by the urine of rodents (muskrats, Norway rats, coypu) excreting the Leptospira interrogans (most common form) of Gram-negative spiral bacteria. Its first symptoms are non-specific, flu-like (high fever, chills, headaches, myalgia and arthralgia), hence the often late treatment of moderate and severe forms. Its icterohemorrhagic form requires hospitalization in intensive care and leads to death in approximately 10% of cases. Administered early, antibiotic therapy with cyclines (doxycycline) or macrolides (azithromycin) reduces the risk of complications, but does not modify the duration of the infection.
Only one vaccine is available in France. Its effectiveness has not been evaluated by the High Authority of Health. No mention of actual benefit (SMR) or improvement in actual benefit (ASMR) is available. Its price is “ free and expensive », without coverage by Health Insurance. Prophylactic administration of doxycycline is of no benefit.
The three Academies formulated a series of recommendations.
1) For the attention of health and sports authorities.
The three Academies recommend:
- A position on the relevance of vaccination for athletes exposed to risk.
- Vigilance regarding the appearance of an influenza syndrome, three to thirty days after exposure to the risk in athletes and associated personnel, with clinical monitoring from the first symptoms and the performance of a diagnostic test in an approved laboratory. Antibiotic treatment should be implemented as soon as possible if this test is positive.
- Information for health professionals, in particular doctors and pharmacists of sports teams from all countries, but also general practitioners and community pharmacists about the risks incurred by people practicing aquatic and water sports.
- The use of waterproof dressings, contamination occurs mainly via wounds and scratches (but repeated contact with contaminated water is also involved).
2) For the attention of public authorities.
The three Academies recommend:
- Measuring leptospira concentrations in the waters of Olympic venues at regular intervals, as early as possible.
- Evaluation of the interest and feasibility of systematic trapping of rodents that excrete urinary leptospires, with a view to regulating their population.
- The establishment of a contingency plan for the conduct of the tests to offer water of correct sanitary quality in the event of exceptional hydrological events, the most to fear being drought, which causes a concentration of leptospires in contaminated water.
