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Medical risks of wilderness hiking

  • David R Boulware
    Affiliations
    Division of Pulmonary and Critical Care, Department of Medicine and Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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  • William W Forgey
    Affiliations
    Division of Pulmonary and Critical Care, Department of Medicine and Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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  • William J Martin II
    Correspondence
    Requests for reprints should be addressed to William J. Martin II, MD, College of Medicine, University of Cincinnati, P.O. Box 670555, Cincinnati, Ohio 45267-0555, USA
    Affiliations
    Division of Pulmonary and Critical Care, Department of Medicine and Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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      Abstract

      Purpose

      We sought to determine the extent to which injuries and illnesses limit long-distance or endurance outdoor recreational activities.

      Methods

      In a prospective surveillance study, 334 persons who hiked the Appalachian Trail for at least 7 days (mean [± SD] length of hike, 140 ± 60 days) in 1997 were interviewed. At the end of their hike, subjects completed a questionnaire on injuries, illnesses, water purification methods, and hygiene practices.

      Results

      Of the 280 backpackers who responded (a combined 38,940 days of wilderness exposure), 69% (n = 192) achieved their goal. The most important reasons for ending a hike prematurely were injury, time limitation, and psychosocial reasons. The most common medical complaints were feet blisters (64%; n = 180), diarrhea (56%, n = 156), skin irritation (51%, n = 143), and acute joint pain (36%, n = 102). The incidence of vector-borne disease was 4% (n = 11); physician-diagnosed Lyme disease was the most common, and 24% of hikers (n = 68) reported tick bites. The risk of diarrhea was greater among those who frequently drank untreated water from streams or ponds (odds ratio [OR] = 7.7; 95% confidence interval [CI]: 2.7 to 23; P <0.0001), whereas practicing “good hygiene” (defined as routine cleaning of cooking utensils and cleaning hands after bowel movements) was associated with a decreased risk (OR = 0.46; 95% CI: 0.22 to 0.97; P =0.04).

      Conclusion

      Diarrhea is the most common illness limiting long-distance hikers. Hikers should purify water routinely, avoiding using untreated surface water. The risk of gastrointestinal illness can also be reduced by maintaining personal hygiene practices and cleaning cookware.

      Keywords

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      References

        • National Survey on Recreation and the Environment (NSRE): 2000–2002
      1. Cordell H.K. Super G. Teasley J. Outdoor Recreation in the United States Results from the NSRE USDA Forest Service. 1997 (Available at: http://www.srs.fs.fed.us/trends/fsch2.pdf)
        • Gentile D.A.
        • Morris J.A.
        • Schimelpfenig T.
        • et al.
        Wilderness injuries and illnesses.
        Ann Emerg Med. 1992; 21: 853-861
        • Montalvo R.
        • Wingard D.L.
        • Bracker M.
        • Davidson T.M.
        Morbidity and mortality in the wilderness.
        West J Med. 1998; 168: 248-254
        • Crouse B.
        • Josephs D.
        Health care needs of Appalachian trail hikers.
        J Fam Pract. 1993; 36: 521-525
        • Caceres V.M.
        • Ball R.T.
        • Somerfeldt S.A.
        • et al.
        A foodborne outbreak of cyclosporiasis caused by imported raspberries.
        J Fam Pract. 1998; 47: 231-234
        • Forgey W.W.
        Wilderness Medicine. 5th ed. Globe Pequot, Guilford, Connecticut2000: 33-38
        • Backer H.D.
        Field water disinfection.
        in: Auerbach P.S. Geehr E.C. Management of Wilderness and Environmental Emergencies. 2nd ed. Mosby, St. Louis, Missouri1989: 805-827
        • Rose J.B.
        Occurrence and significance of cryptosporidium in water.
        J Am Water Works Assoc. 1988; 80: 53-58
        • Backer H.
        Water disinfection for international and wilderness travelers.
        Clin Infect Dis. 2002; 34: 355-364
        • Rose J.B.
        • Cerba C.P.
        • Jablonski W.
        Survey of potable water supplies for cryptosporidium and giardia.
        Environ Sci Technol. 1991; 25: 1393-1400
        • LeChevallier M.W.
        • Norton W.D.
        • Lee R.G.
        Occurrence of giardia and cryptosporidium spp. in surface water supplies.
        Appl Environ Microbiol. 1991; 57 ([published erratum appears in Appl Environ Microbiol. 1992;58:780]): 2610-2616
        • Ladegaard M.B.
        • Stage V.
        Hand-hygiene and sickness among small children attending day care centers. An intervention study.
        Ugeskr Laeger. 1999; 161 ([in Danish]): 4396-4400
        • Shahid N.S.
        • Greenough W.B.
        • Samadi A.R.
        • et al.
        Hand washing with soap reduces diarrhoea and spread of bacterial pathogens in a Bangladesh village.
        J Diarrhoeal Dis Res. 1996; 14: 85-89
        • Wilson J.M.
        • Chandler G.N.
        • Muslihatun J.
        Hand-washing reduces diarrhoea episodes.
        Trans R Soc Trop Med Hyg. 1991; 85: 819-821
        • Manun’Ebo M.
        • Cousens S.
        • Haggerty P.
        • et al.
        Measuring hygiene practices.
        Trop Med Int Health. 1997; 2: 1015-1021
        • Hoque B.A.
        • Briend A.
        A comparison of local handwashing agents in Bangladesh.
        J Trop Med Hyg. 1991; 94: 61-64
        • Hoque B.A.
        • Mahalanabis D.
        • Alam M.J.
        • Islam M.S.
        Post-defecation handwashing in Bangladesh: practice and efficiency perspectives.
        Public Health. 1995; 109: 15-24
        • Centers for Disease Control and Prevention
        Methods used for creating a national Lyme disease risk map.
        MMWR Morb Mortal Wkly Rep. 1999; 48 (Available at: www.cdc.gov/ncidod/dvbid/lyme/riskmap.htm): 21-24
        • Dennis D.T.
        • Nekomoto T.S.
        • Victor J.C.
        • et al.
        Reported distribution of ixodes scapularis and ixodes pacificus (acari: ixodidae) in the United States.
        J Med Entomol. 1998; 35: 629-638
        • Oliver J.
        • Howard J.
        Occurrence of ixodes scapularis (Acari: Ixodi-dae) on a selected segment of the Appalachian Trail.
        J Med Entomol. 1998; 35: 54-58
        • Sterre A.
        • Sikau V.
        • Meurice F.
        Vaccination against Lyme disease with recombinant borrelia burgdorferi outer-surface lipoprotein A with adjuvant.
        N Engl J Med. 1998; 339: 209-215
        • Centers for Disease Control and Prevention
        Recommendations for the use of Lyme disease vaccine. Recommendations of the advisory committee on immunization practices (ACIP).
        MMWR Morb Mortal Wkly Rep. 1999; 48: 1-17
        • Kocisova A.
        • Para L.
        Possibilities of long-term protection against blood-sucking insects and ticks.
        Cent Eur J Public Health. 1999; 7: 27-30
        • Evans S.R.
        • Korch Jr, G.W.
        • Lawson M.A.
        Comparative field evaluation of permethrin and DEET-treated military uniforms for personal protection against ticks.
        J Med Entomol. 1990; 27: 829-834