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Multiple risk factors associated with a large statewide increase in cryptosporidiosis

  • A. L. VALDERRAMA (a1) (a2), M. C. HLAVSA (a3), A. CRONQUIST (a4), S. COSGROVE (a4), S. P. JOHNSTON (a3), J. M. ROBERTS (a3), M. L. STOCK (a5), L. XIAO (a3), K. XAVIER (a4) and M. J. BEACH (a3)...
Summary
SUMMARY

Cryptosporidium species have emerged as a major cause of outbreaks of diarrhoea and have been associated with consumption of contaminated recreational and drinking water and food as well as contact with infected attendees of child-care programmes. In August 2007, the Colorado Department of Public Health and Environment detected an increase in cryptosporidiosis cases over baseline values. We conducted a case-control study to assess risk factors for infection and collected stool specimens from ill persons for microscopy and molecular analysis. Laboratory-confirmed cases (n=47) were more likely to have swallowed untreated water from a lake, river, or stream [adjusted matched odds ratio (aOR) 8·0, 95% confidence interval (CI) 1·3–48·1], have had exposure to recreational water (aOR 4·6, 95% CI 1·4–14·6), or have had contact with a child in a child-care programme or in diapers (aOR 3·8, 95% CI 1·5–9·6). Although exposure to recreational water is commonly implicated in summertime cryptosporidiosis outbreaks, this study demonstrates that investigations of increased incidence of cases in summer should also examine other potential risk factors. This study emphasizes the need for public health education efforts that address the multiple transmission routes for Cryptosporidium and appropriate prevention measures to avoid future transmission.

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Corresponding author
*Author for correspondence: A. L. Valderrama, Ph.D., R.N., National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Hwy, NE, Atlanta, GA 30341, MS K-47. (Email: AValderrama@cdc.gov)
References
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1. Chen XM, et al. Cryptosporidiosis. New England Journal of Medicine 2002; 346: 17231731.
2. Nichols G. Epidemiology. In: Fayer R, Xiao L, eds. Cryptosporidium and Cryptosporidiosis, 2nd edn. Boca Raton, FL: CRC Press, 2008, pp. 79–118.
3. Casemore DP. Epidemiological aspects of human cryptosporidiosis. Epidemiology and Infection 1990; 104: 128.
4. Yoder JS, Beach MJ. Cryptosporidiosis surveillance – United States, 2003–2005. Morbidity and Mortality Weeekly Report 2007; 56: 110.
5. Xiao L, Ryan UM. Molecular epidemiology. In: Fayer R, Xiao L, eds. Cryptosporidium and Cryptosporidiosis, 2nd edn. Boca Raton, FL: CRC Press, 2008, pp. 119172.
6. King BJ, Monis PT. Critical processes affecting Cryptosporidium oocyst survival in the environment. Parasitology 2007; 134: 309323.
7. Korich DG, et al. Effects of ozone, chlorine dioxide, chlorine, and monochloramine on Cryptosporidium parvum oocyst viability. Applied and Environmental Microbiology 1990; 56: 14231428.
8. Yoder J, et al. Surveillance for waterborne disease and outbreaks associated with drinking water and water not intended for drinking – United States, 2005–2006. Morbidity and Mortality Weeekly Report. Surveillance Summaries 2008; 57: 3962.
9. Yoder JS, et al. Surveillance for waterborne disease and outbreaks associated with recreational water use and other aquatic facility-associated health events – United States, 2005–2006. Morbidity and Mortality Weeekly Report. Surveillance Summaries 2008; 57: 138.
10. Beach MJ. Waterborne: recreational water. In: Fayer R, Xiao L, eds. Cryptosporidium and Cryptosporidiosis, 2nd edn. Boca Raton, FL: CRC Press, 2008, pp. 335370.
11. Blackburn BG, et al. Cryptosporidiosis associated with ozonated apple cider. Emerging Infectious Diseases 2006; 12: 684686.
12. Millard PS, et al. An outbreak of cryptosporidiosis from fresh-pressed apple cider. Journal of the American Medical Association 1994; 272: 15921596.
13. Quiroz ES, et al. An outbreak of cryptosporidiosis linked to a foodhandler. Journal of Infectious Diseases 2000; 181: 695700.
14. Centers for Disease Control and Prevention. Foodborne outbreak of diarrheal illness associated with Cryptosporidium parvum – Minnesota, 1995. Morbidity and Mortality Weeekly Report 1996; 45: 783784.
15. Centers for Disease Control and Prevention. Foodborne outbreak of cryptosporidiosis – Spokane, Washington, 1997. Morbidity and Mortality Weeekly Report 1998; 47: 565567.
16. Turabelidze G, et al. Communitywide outbreak of cryptosporidiosis in rural Missouri associated with attendance at child care centers. Archives of Pediatrics and Adolescent Medicine 2007; 161: 878883.
17. Alpert G, et al. Outbreak of cryptosporidiosis in a day-care center. Pediatrics 1986; 77: 152157.
18. Centers for Disease Control and Prevention. Cryptosporidiosis among children attending day-care centers – Georgia, Pennsylvania, Michigan, California, New Mexico. Morbidity and Mortality Weeekly Report 1984; 33: 599601.
19. Tangermann RH, et al. An outbreak of cryptosporidiosis in a day-care center in Georgia. American Journal of Epidemiology 1991; 133: 471476.
20. Xiao L, et al. Identification of 5 types of Cryptosporidium parasites in children in Lima, Peru. Journal of Infectious Diseases 2001; 183: 492497.
21. Sulaiman IM, et al. Unique endemicity of cryptosporidiosis in children in Kuwait. Journal of Clinical Microbiology 2005; 43: 28052809.
22. Jones TF. Changing challenges of bacterial enteric infection in the United States. Journal of Infectious Diseases 2009; 199: 465466.
23. Cordell RL, Addiss DG. Cryptosporidiosis in child care settings: a review of the literature and recommendations for prevention and control. Pediatric Infectious Disease Journal 1994; 13: 310317.
24. Centers for Disease Control and Prevention. Control measures for the child care setting during an outbreak of cryptosporidiosis (http://www.cdc.gov/ncidod/dpd/parasites/cryptosporidiosis/Childcare_outbreak.pdf. 2007). Accessed 27 February 2008.
25. Centers for Disease Control and Prevention. Day care facilities (http://www.cdc.gov/crypto/daycare.html). Accessed 1 February 2009.
26. Centers for Disease Control and Prevention. Preventing cryptosporidiosis: a guide to water filters and bottled water (http://www.cdc.gov/crypto/factsheets/filters.html). Accessed 19 November 2008.
27. Yoder J, et al. Surveillance for waterborne disease and outbreaks associated with drinking water and water not intended for drinking – United States, 2005–2006. Morbidity and Mortality Weeekly Report. Surveillance Summaries 2008; 57: 3962.
28. Hunter PR, et al. Sporadic cryptosporidiosis case-control study with genotyping. Emerging Infectious Diseases 2004; 10: 12411249.
29. Robertson B, et al. Case-control studies of sporadic cryptosporidiosis in Melbourne and Adelaide, Australia. Epidemiology and Infection 2002; 128: 419431.
30. Roy SL, et al. Risk factors for sporadic cryptosporidiosis among immunocompetent persons in the United States from 1999 to 2001. Journal of Clinical Microbiology 2004; 42: 29442951.
31. Casemore D. Towards a US national estimate of the risk of endemic waterborne disease – sero-epidemiologic studies. Journal of Water Health 2006; 4 (Suppl. 2): 121163.
32. Leitch GJ, et al. Dietary fiber and giardiasis: dietary fiber reduces rate of intestinal infection by Giardia lamblia in the gerbil. American Journal of Tropical Medicine and Hygiene 1989; 41: 512520.
33. Fox LM, Saravolatz LD. Nitazoxanide: a new thiazolide antiparasitic agent. Clinical Infectious Diseases 2005; 40: 11731180.
34. Anderson VR, Curran MP. Nitazoxanide: a review of its use in the treatment of gastrointestinal infections. Drugs 2007; 67: 19471967.
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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
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