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An outbreak of Cryptosporidium hominis infection at an Illinois recreational waterpark

  • L. M. CAUSER (a1) (a2), T. HANDZEL (a1) (a2), P. WELCH (a3), M. CARR (a4), D. CULP (a4), R. LUCHT (a4), K. MUDAHAR (a4), D. ROBINSON (a4), E. NEAVEAR (a3), S. FENTON (a3), C. ROSE (a3), L. CRAIG (a3), M. ARROWOOD (a1), S. WAHLQUIST (a1), L. XIAO (a1), Y.-M. LEE (a1), L. MIREL (a1), D. LEVY (a1), M. J. BEACH (a1), G. POQUETTE (a3) and M. S. DWORKIN (a5)...
Abstract
SUMMARY

Cryptosporidium has become increasingly recognized as a pathogen responsible for outbreaks of diarrhoeal illness in both immunocompetent and immunocompromised persons. In August 2001, an Illinois hospital reported a cryptosporidiosis cluster potentially linked to a local waterpark. There were 358 case-patients identified. We conducted community-based and waterpark-based case-control studies to examine potential sources of the outbreak. We collected stool specimens from ill persons and pool water samples for microscopy and molecular analysis. Laboratory-confirmed case-patients (n=77) were more likely to have attended the waterpark [odds ratio (OR) 16·0, 95% confidence interval (CI) 3·8–66·8], had pool water in the mouth (OR 6·0, 95% CI 1·3–26·8), and swallowed pool water (OR 4·5, 95% CI 1·5–13·3) than age-matched controls. Cryptosporidium was found in stool specimens and pool water samples. The chlorine resistance of oocysts, frequent swimming exposures, high bather densities, heavy usage by diaper-aged children, and increased recognition and reporting of outbreaks are likely to have contributed to the increasing trend in number of swimming pool-associated outbreaks of cryptosporidiosis. Recommendations for disease prevention include alteration of pool design to separate toddler pool filtration systems from other pools. Implementation of education programmes could reduce the risk of faecal contamination and disease transmission.

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Corresponding author
*Author for correspondence: Dr L. M. Causer, Division of Parasitic Diseases, National Center of Infectious Diseases, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop F-22, Atlanta, 30341, USA. (Email: lsc6@cdc.gov)
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2.R Fayer , UM Morgan , SJ Upton . Epidemiology of Cryptosporidium: transmission, detection and identification. Int J Parasitol 2000; 30: 13051322.

6.M Skeels , R Sokolow , C Hubbard , J Andrus , J Baisch . Cryptosporidium infection in Oregon public health clinic patients 1985–88: the value of statewide laboratory surveillance. Am J Public Health 1990; 80: 305308.

8.WR MacKenzie , NJ Hoxie , ME Proctor , A massive outbreak in Milwaukee of Cryptosporidium infection transmitted through the public water supply. N Engl J Med 1994; 331: 161167.

9.EB Hayes , TD Matte , TR O'Brien , Large community outbreak of cryptosporidiosis due to contamination of a filtered public water supply. N Engl J Med 1989; 320: 13721376.

10.PS Millard , KF Gensheimer , DG Addiss , An outbreak of cryptosporidiosis from fresh-pressed apple cider. J Am Med Assoc 1994; 272: 15921596.

18.FJ Sorvillo , K Fujioka , B Nahlen , MP Tormey , R Kebabjian , L Mascola . Swimming-associated cryptosporidiosis. Am J Public Health 1992; 82: 742744.

21.PL Meinhardt , DP Casemore , KB Miller . Epidemiologic aspects of human cryptosporidiosis and the role of waterborne transmission. Epidemiol Rev 1996; 18: 118136.

22.L Xiao , C Bern , J Limor , Identification of 5 types of Cryptosporidium parasites in children in Lima, Peru. J Infect Dis 2001; 183: 492497.

23.M Alves , L Xiao , I Sulaiman , AA Lal , O Matos , F Antunes . Subgenotype analysis of Cryptosporidium isolates from humans, cattle, and zoo ruminants in Portugal. J Clin Microbiol 2003; 41: 27442747.

25.L Xiao , K Alderisio , J Limor , M Royer , A Lal . Identification of species and sources of Cryptosporidium oocysts in storm waters with a small-subunit rRNA-based diagnostic and genotyping tool. Appl Environ Microbiol 2000; 66: 54925498.

26.L Xiao , A Singh , J Limor , TK Graczyk , S Gradus , A Lal . Molecular characterization of Cryptosporidium oocysts in samples of raw surface water and wastewater. Appl Environ Microbiol 2001; 67: 10971101.

28.WB Strong , J Gut , RG Nelson . Cloning and sequence analysis of a highly polymorphic Cryptosporidium parvum gene encoding a 60-kilodalton glycoprotein and characterization of its 15- and 45-kilodalton zoite surface antigen products. Infect Immun 2000; 68: 41174134.

32.T Navin , D Juranek . Cryptosporidiosis: clinical, epidemiologic, and parasitologic review. Rev Infect Dis 1984; 6: 313327.

33.L Jokipii , A Jokipii . Timing of symptoms and oocyst excretion in human cryptosporidiosis. N Engl J Med 1986; 315: 16431647.

37.HL Dupont , CL Chappell , CR Sterling , PC Okhuysen , JB Rose , W Jakubowski . The infectivity of Cryptosporidium parvum in healthy volunteers. N Engl J Med 1995; 332:855859.

38.B Corona-Vasquez , A Samuelson , JL Rennecker , B Marinas . Inactivation of Cryptosporidium parvum oocysts with ozone and free chlorine. Water Research 2002; 36: 40534063.

39.H Li , G Finch , D Smith , M Belosevic . Sequential inactivation of Cryptosporidium parvum using ozone and chlorine. Water Res 2001; 35: 43394348.

41.SL Roy , SM Delong , SA Stenzel , Risk factors for sporadic cryptosporidiosis among immuocompetent persons in the United States from 1999 to 2001. J Clin Microbiol 2004; 42: 29442951.

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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
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