In 2009, following a bike race, a gastrointestinal illness outbreak affected many participants. A cohort study showed an attack rate of 16·3% with the main risk factor being mud splashes to the face. Considering these findings, in 2010 recommendations to participants in the bike race were issued and environmental control measures were implemented. In 2010, a retrospective cohort study using web-based questionnaires was conducted to measure the use of preventive measures and to assess risk factors associated with gastrointestinal illness. A 69% response rate was achieved and 11721 records analysed, with 572 (attack rate 4·9%) matching the case definition, i.e. participants reporting diarrhoea within 10 days of race. There was a clear increase in the use of mudguards (96·7% reported access to/receiving information on preventive measures) and a significant decrease in gastrointestinal illness. This may indicate that the measures have been effective and should be considered, both in terms of environmental control measures as well as individual measures.
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