Crypto in the US

Cryptosporidium is the leading aetiology of waterborne disease outbreaks in the United States. This report briefly describes the temporal and geographical distribution of US cryptosporidiosis cases and presents analyses of cryptosporidiosis case data reported in the United States for 1995–2012.

cryptoThe Cochran–Armitage test was used to assess changes in the proportions of cases by case status (confirmed vs. non-confirmed), sex, race, and ethnicity over the study period. Negative binomial regression models were used to estimate rate ratios (RR) and 95% confidence intervals (CI) for comparing rates across three time periods (1995–2004, 2005–2008, 2009–2012). The proportion of confirmed cases significantly decreased (P < 0·0001), and a crossover from male to female predominance in case-patients occurred (P < 0·0001). Overall, compared to 1995–2004, rates were higher in 2005–2008 (RR 2·92, 95% CI 2·08–4·09) and 2009–2012 (RR 2·66, 95% CI 1·90–3·73). However, rate changes from 2005–2008 to 2009–2012 varied by age group (Pinteraction < 0·0001): 0–14 years (RR 0·55, 95% CI 0·42–0·71), 15–44 years (RR 0·99, 95% CI 0·82–1·19), 45–64 years (RR 1·47, 95% CI 1·21–1·79) and ≥65 years (RR 2·18, 95% CI 1·46–3·25).

The evolving epidemiology of cryptosporidiosis necessitates further identification of risk factors in population subgroups. Adding systematic molecular typing of Cryptosporidium specimens to US national cryptosporidiosis surveillance would help further identify risk factors and markedly expand understanding of cryptosporidiosis epidemiology in the United States.

Evolving epidemiology of reported cryptosporidiosis cases in the United States, 1995–2012

E. Paintera1 c1, J. W. Garganoa2, J. S. Yodera2, s. A. Colliera2 and M. C. Hlavsaa2

a1 Epidemic Intelligence Service Officer, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA

a2 Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA

Epidemiology and Infection, Volume 144, Issue 8, June 2016, pages 1792-1802, DOI: http://dx.doi.org/10.1017/S0950268815003131

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10299145&utm_source=Issue_Alert&utm_medium=RSS&utm_campaign=HYG

It’s not a virus or bacterium, it’s a parasite: 7 positive, 16 sick with crypto after visit to Welsh petting farm

A Monmouthshire farm has cancelled a series of open day visits for primary school children following the outbreak of a diarrhea-causing virus.

powell.namePublic Health Wales along with Torfaen and Monmouthshire councils are continuing to investigate an outbreak of cryptosporidium associated with Coleg Gwent’s farm in Usk.

Seven people have tested positive for cryptosporidium and 16 others are suspected of having the bug after regular attendance at the farm or contact with those who have.

Heather Lewis, consultant in health protection for Public Health Wales, said: “We are continuing to work with Coleg Gwent, who have written to all students who may have been on the farm in March.

“As a precaution, Coleg Gwent have also cancelled a series of open days which were due to take place with invited primary schools from Tuesday, April 12 to Friday, April 15.”

A spokesman from Public Health Wales said: “Good hand washing after coming into contact with farm animals, their bedding or dirty equipment including clothing is of the utmost importance in preventing infection with cryptosporidium.

“There is no reason for anyone to avoid visiting petting farms as long as they ensure that anyone who has touched animals, thoroughly washes their hands with hot water and soap immediately afterwards and before eating, as hand sanitisers or alcoholic gels should not be solely relied upon.”

Handwashing is never enough.

Welsh farm investigated after visitors test positive for crypto

A Monmouthshire farm is being investigated after a number of visitors tested positive for a microscopic parasite that causes a diarrheal disease.

Coleg Gwent’s farm in UskPublic Health Wales, Torfaen County Borough Council and Monmouthshire County Council are investigating an outbreak of cryptosporidium at Coleg Gwent’s farm in Usk.

Three people have tested positive for cryptosporidium and eight others are under investigation after a regular attendance at the farm.

“All the confirmed cases had direct contact with the lambs at the college farm. As part of our investigations, we are checking on all those whom we believe had contact with these animals and Coleg Gwent is co­operating fully with our investigations.

 

But it’s such a cute lamb: 46 sickened with crypto at UK petting farm

A case-control study was conducted to investigate an outbreak of 46 cases of cryptosporidiosis in visitors to a petting farm in England.

amy_s_lamb_aug_12(1)Details of exposures on the farm were collected for 38 cases and 39 controls, recruited through snowball sampling. Multivariable logistic regression identified that cases were 5·5 times more likely than controls to have eaten without washing their hands [95% confidence interval (CI) 1·51–19·9, P = 0·01] and 10 times less likely to report being informed of risk of infection on arrival (odds ratio 0·10, 95% CI 0·01–0·71, P = 0·02).

An uncommon Cryptosporidium parvum gp60 subtype (IIaA19G1R1) was identified in a lamb fecal sample and all subtyped cases (n = 22). We conclude that lack of verbal advice and non-compliance with hand washing are significantly associated with a risk of cryptosporidiosis on open farms. These findings highlight the public health importance of effectively communicating risk to petting farm visitors in order to prevent future outbreaks of zoonotic infections.

Cryptosporidiosis outbreak in visitors of a UK industry-compliant petting farm caused by a rare Cryptosporidium parvum subtype: a case-control study

Epidemiology and Infection, Volume 144, Issue 5, April 2016, pages 1000-1009, DOI: http://dx.doi.org/10.1017/S0950268815002319 

Utsi, S. J. Smith, R. M. Chalmers, and S. Padfield

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10216122&utm_source=Issue_Alert&utm_medium=RSS&utm_campaign=HYG

A table of petting zoo outbreaks is available at http://barfblog.com/wp-content/uploads/2014/04/Petting-Zoo-Outbreaks-Table-4-8-14.xlsx.

Best practices for planning events encouraging human-animal interactions

Zoonoses and Public Health 62:90-99, 2015

G. Erdozain , K. KuKanich , B. Chapman  and D. Powell

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccess

Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. It is estimated that 14% of all disease in the US caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.

petting.zoo_.guidelines

petting2

Cryptosporidium in Ireland’s water supply

There seems to be a lot of Cryptosporidium in Ireland.

Irish Water has identified cryptosporidium contamination in Carraroe’s public supply in Connemara.

cryptoThe discovery came as ten thousand homes and businesses in Cork were issued with boil water notices over fears of contaminated drinking water.

The State utility has advised some 4,700 people dependent on the public supply in Carraroe to boil their water until further notice.

This follows a similar notice issued for Leitir Móir/Tír an Fhia in south and west Connemara in January.

Sinn Féín senator Trevor Ó Clochartaigh has criticised Irish Water for failing to upgrade the Carraroe scheme when it was directed to by the Environmental Protection Agency (EPA).

“This supply has been substandard for years and the EPA have indicated for the last number of years that there has been insufficient protection for cryptosporidium, ”Senator Ó Clochartaigh said.

Pasteurization works, and don’t eat poop: 70 sickened with crypto from cow shit in cider

The cause of the cryptosporidiousis from the Pike County Fall Color Drive in apple cider is now known.

powell_kids_ge_sweet_corn_cider_00A test done by the CDC on environmental and human specimens has confirmed that this illness was due to cow manure contamination.

This unpasteurized apple cider was made on a private family farm in Adams County specifically for family consumption and sale at the Pike County Fall Color Drive October 17-18.

This cider was not produced at a licensed cider manufacturer or orchard.

Cattle were on the farm near the site of the apple cider press.

Hope for future drugs? Exploring vulnerabilities of Cryptosporidium

Cryptosporidium parvum is a gastrointestinal parasite that can cause moderate to severe diarrhea in children and adults, and deadly opportunistic infection in AIDS patients.

crypto.glcolysisBecause C. parvum is resistant to chlorine disinfectant treatment, it frequently causes water-borne outbreaks around the world. A study published on Nov. 12th in PLOS Pathogens provides a detailed analysis of a C. parvum protein that is central to glycolysis — the only pathway by which the parasite can generate energy — and identifies it as a potential drug target.

Guan Zhu and colleagues, from Texas A&M University in College Station, USA, study the parasite’s metabolism during its complicated life-cycle. C. parvum exists both in free stages (where parasites are in the environment or in the host’s digestive tract) and intracellular stages following host cell invasion, during which the parasite occupies a specialized compartment — the parasitophorous vacuole — which is delineated by a host-cell derived border called the parasitophorous vacuole membrane (PVM).

For this study, the researchers focused on lactate dehydrogenase (LDH), an enzyme central to glycolysis. Glycolysis is the only metabolic process by which organisms like C. parvum — that lack functional mitochondria to derive energy from oxygen — can generate ATP, the universal biological energy storage molecule. They found that the C. parvum LDH (CpLDH) protein is found inside the parasite’s cells during the free stages, but is then transferred to the PVM during intracellular development, indicating involvement of the PVM in parasite energy metabolism, and specifically, in lactate fermentation. They also demonstrate that two known LDH inhibitors, gossypol and FX11, can inhibit both CpLDH activity and parasite growth.

The researchers summarize that their observations “not only reveal a new function for the poorly understood PVM structure in hosting the intracellular development of C. parvum, but also suggest LDH as a potential target for developing therapeutics against this opportunistic pathogen, for which fully effective treatments are not yet available”. Acknowledging that the ultimate validation of CpLDH as a drug target requires tools for knockout or knockdown of genes of interest in Cryptosporidium, they say recent advances towards this goal raise hope that such validation will be possible in the near future.

Overall, they conclude that “the present data, together with the fact that C. parvum relies on glycolysis for producing ATP, support the notion that CpLDH is worth exploring as a potential target for the development of anti-cryptosporidial therapeutics.”

70 now sick: E. coli or Cryptosporidium linked to apple cider at Illinois fair

Apple cider served at the Pike Country Color Drive that happened in Pike County, Illinois has now sickened at least 70 people.

powell_kids_ge_sweet_corn_cider_00Health officials have already sent out a warning to those purchasers during the event and even advised health care providers to check for E. coli and Cryptosporidium, as these could be the reasons as well. As of the moment, they haven’t confirmed any information regarding the exact cause of those foodborne illnesses

A list of cider and juice-related outbreaks — 84 outbreaks leading to over 3,500 illnesses going back to 1924 – is available here.

30 now sick: Cider at Illinois fair

The Pike County Health Department and the Adams County Health Department along with the Illinois Department of Public Health (IDPH) is investigating a cluster of gastrointestinal (GI) illness associated with the Pike County Color Drive, a large fall festival that spans several communities in Pike County, IL.

powell_kids_ge_sweet_corn_cider_00There have been 30 suspect cases of GI illness identified in attendees of the festival who consumed apple cider purchased from vendors at two locations. The etiologic agent has not yet been confirmed; health care providers should be encouraged to test for E. coli and Cryptosporidium until further information is available.

Ill individuals have reported symptoms including profuse diarrhea, bloody diarrhea, abdominal cramping and vomiting. Onset dates range from October 20 – 28. Persons have been hospitalized as a result of this illness, and additional illnesses continue to be reported. Further laboratory testing is pending. Symptoms usually last about 1 to 2 weeks (with a range of a few days to 4 or more weeks) in persons with healthy immune systems. Occasionally, people may experience a recurrence of symptoms after a brief period of recovery before the illness ends. Symptoms can come and go for up to 30 days. People who are especially vulnerable to this illness include: pregnant women, children under 2 years, elderly and immunocompromised individuals. If you attended the festival or consumed apple cider purchased from vendors at the festival and feel that you have these symptoms, contact your health care provider.

Investigators are seeking additional cases of GI illness that attended the Pike County Color Drive during October 17-18 and consumed apple cider purchased during the event. If you have apple cider that was purchased during the event that is fresh or frozen for future use, do not consume it. Contact your local health department so that the cider can be tested. Pike County Health Department: 217/285.4407 Adams County Health Department: 217.222.8440. Health officials who identify cases with this exposure history are asked to contact the IDPH Communicable Disease Control Section at 217-782-2016 or email justin.albertson@illinois.gov.

Cider again? 6 sick with crypto linked to Illinois fair

After attending the same event in Barry, Illinois, Oct. 17, Adams County Health Department says there’s been an outbreak of cryptosporidiosis disease in Pike County, Illinois.

pike.county.fall.color.driveAdams County Health Department Director of Clinical and Environmental Services Shay Drummond says the health department is helping Pike County Health Department investigate the parasitic illness that has infected six people.

County Health Department RN, BSN Jan Bleich says everyone infected had been at the Pike County Fall Color Drive. The source, she says, may have been apple cider.

Bleich says some of the people were hospitalized.

Drummond says the disease is caused by microscopic parasites called cryptosporidium, which is found in water, food, soil or on surfaces or dirty hands that have been contaminated with human or animal feces that are infected.

Cryptosporidium can be spread by swallowing contaminated water from swimming pools, fountains, lakes and rivers. The parasite can survive for long periods of time in chlorinated drinking and swimming pool water. It can also be spread by swallowing water, ice or drinks contaminated with poop from infected people or animals, or by eating undercooked food or drinking unpasteurized or raw apple cider or milk that is contaminated. People can also get it from touching their mouths with contaminated hands.