ON OCTOBER 15, 1996, a physician notified the Illinois Department of Public Health about five patients with an un-known febrile illness who had returned from a white-water rafting trip on flooded rivers in Costa Rica during September 27-28, 1996. The five patients had been members of a white-water rafting expedition involving 26 rafters from five states, the District of Columbia, and Costa Rica. This report summarizes the findings of the multistate investigation conducted by the Illinois Department of Public Health and by CDC in collaboration with the Ministry of Health of Costa Rica. The findings implicated leptospirosis as the cause of disease and contaminated river water as the probable source of illness. A participant list was obtained from the trip organizer. Investigators interviewed all 26 trip participants to assess symptoms and potential environmental and behavioral risk factors, and reviewed medical records of those who sought medical attention. Based on the
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A 1997 study studied this question.