Pools or animal farms: 223 sick UK crypto could be anywhere

Janet Hughes of Gloucestershire Live writes that scientists are checking to see if summer holiday visits to animal attractions are behind a massive spike in the number of toddlers with cryptosporidium.

crypto.petting.farmPublic health chiefs are asking affected families to fill in questionnaires about where they have been and what they have eaten in an effort to trace the source of the outbreak which is particularly bad in Gloucestershire and Wiltshire.

Children aged between one and five years are most at risk from the parasite cryptosporidium which is three or four times more prevalent than normal this summer.

Doctors believe a small number of cases could be linked Oasis leisure centre in Swindon, which has been closed as a precautionary measure, and say swimming in contaminated lakes, rivers or swimming pools can cause the disease to strike.

But many of those struck down are young toddlers so other possible theories include the prospect that children might not have washed their hands after petting animals at attractions during the summer holidays.

Hand washing is never enough.

 

Crypto don’t care about borders

With cases of Cryptosporidium linked to public pools reaching 300 in Columbus, Ohio, and 100 in Phoenix, Arizona, reports have emerged that there are now 223 confirmed cases of Cryptosporidium across southwest UK.

diaper.poolAccording to Heather Pickstock of the Bath Chronicle, no source has been found as yet for the cases and it is not known if they are all linked.

Dr Toyin Ejidokun, consultant in Communicable Disease Control for PHE South West, said, “We have had confirmed reports of Cryptosporidium infection amongst a number of people who visited the Oasis swimming pool in Swindon earlier this summer. The swimming pool is one of a number of possible exposures that we are exploring. At this point, there is no confirmed source of exposure. We would like to reassure the public that we have only had reports of these cases, and if visitors to swimming pools have had similar symptoms, to contact their GP.”

Over 100 now sick with crypto from pools in Arizona

Heath officials in Arizona said Friday that more than 100 people have been sickened in an outbreak of diarrheal infection and that more than 20 water facilities may have been contaminated.

caddyshack.pool_.poop-1Maricopa County officials said that splash pads, water parks and public pools in the Phoenix area may have been contaminated with the pool-linked gastrointestinal illness cryptosporidiosis, or crypto, the Arizona Republic reported.

Dr. Rebecca Sunenshine, the medical director for the Maricopa County Department of Public Health, told the paper that there’s no reliable test for the disease in water, making the determination where the outbreak started difficult to find.

The microscopic, chlorine-resistant parasite that causes sickness is most commonly spread through water. Symptoms of the infection include diarrhea, vomiting and stomach pains, according to the Centers for Disease Control and Prevention (CDC). Crypto could be spread at streams, rivers, ponds and lakes as well.

Poop in the pool: Crypto outbreaks grow to 32 in Arizona, 100 in Ohio

Maricopa County’s cryptosporidium outbreak grew to 32 confirmed cases as of Wednesday afternoon.

caddyshack.pool.poop-1Health officials say at least four public swimming pools have been linked to infected people. Officials, who would not confirm the locations, said all the operators are complying with protocols to super-chlorinate water to kill any crypto that may exist.

Last week a mother told ABC15 said her teen daughter got sick after visiting Wet ‘N’ Wild in the north Valley.

Wet ‘N’ Wild tells ABC15 the they are in compliance with CDC and county health standards. A spokeswoman also says the pools are being super-chlorinated weekly as a precaution, and signs inform customers of healthy swimming practices. Those include showering before entering the water and not swimming after bouts of diarrhea.

Columbus Public Health along with other central Ohio agencies have declared a community outbreak of cryptosporidiosis after more than 100 cases have been reported in the area.

There has been a recent rise over the normal threshold of cases across several jurisdictions in central Ohio, including Columbus, Franklin County and Delaware County, according to Columbus Public Health.

The three jurisdictions have reported more than 107 cases so far this year, which is more than the last three years combined. This outbreak is not tied to any one location. A spokesperson with Columbus Public Health says there have been 62 cases in Columbus, 34 in Franklin County and 11 in Delaware County.

A large portion of the cases include people with multiple exposures at various recreational water facilities throughout the three jurisdictions.

19 sick with crypto in Arizona

Maricopa County Department of Public Health officials are investigating an outbreak of Cryptosporidium, a diarrheal illness caused by a parasite Cryptosporidium parvum, and are advising the public to take precautions to further prevent the spread of this disease.

diaper.poolPublic health officials said 19 cases were reported in July. Five of those initial cases have been linked to recreational water facilities.

While officials said some people with Crytosporidium show no symptoms, the most common symptom to be on the lookout for is watery diarrhea usually beginning 2-10 days from infection.

Some other symptoms include stomach cramps, dehydration, nausea, vomiting, fever and weight loss.

While chlorine typically kills most germs in swimming pools, this disease can survive even in properly chlorinated waters for long periods of time.

739 sickened in 2007: Cryptosporidium outbreak cost Ireland €19m

Paul Melia of the Irish Independent reports a Cryptosporidium outbreak that resulted in 120,000 people being forced to boil their water for five months cost €19m, a new study shows.

cryptoThe 2007 outbreak in Galway cost each household €95 and resulted in one in eight hotel and guesthouse bookings being cancelled.

One in five people in the city refuse to drink the tap water today due to concerns about its safety, the study says.

It found that had the water supply to the city and surrounding areas been subjected to an adequate treatment process costing just €1.6m, it would have resulted in an €11 saving for every €1 invested.

The ‘Economic Assessment of the Waterborne Outbreak of Cryptosporidium Hominis in Galway 2007’ study, which was funded by the Environmental Protection Agency (EPA), says the outbreak lasted for 158 days and resulted in 242 confirmed cases of cryptosporidiosis, “although it was likely the actual number affected was far higher”.

– There were 242 notified cases of cryptosporidiosis, with another 497 non-reported cases.

– 45,160 households were affected, and around 120,000 people.

– There was an 80pc increase in bottled water consumption during the outbreak, with a spend of €3.5m. Another €400,000 was spent boiling water.

– Hotels and guesthouses were obliged to provide 4.2 litres of water per day to guests, and the hospitality industry bore costs of €50,000 per day.

Cryptosporidium remains a problem across the country, with the latest data showing that 17 water supplies require upgrades to remove the threat.

The report, compiled by researchers at NUI Galway with an official from the HSE, found that households bore costs totalling €3.9m, the hospitality sector another €8m, while the local authorities spent almost €6m.

We never had a problem: 10 sick with crypto linked to Minn. farm visit

The Litchfield Independent Review reports the Minnesota Department of Health is investigating an outbreak of diarrheal illness possibly linked to school students visiting Nelson Farm southwest of Litchfield.

girl with rabbitMore than 10 cases of diarrheal illness, including three confirmed cases of Cryptosporidium infection, have been reported from five different schools. In all cases, individuals had taken field trips to Nelson Farm, according to a health advisory issued by the agency May 26.

On the morning of May 26, Department of Health officials visited the farm to tour its facilities, according to Nelson Farm owner Don Nelson.

“Right now we don’t even know if it came from our farm,” he said. “We won’t know until next week (when the test results come back).”

Outbreaks associated with farm animal contact may include multiple pathogens including Salmonella, Campylobacter, Shiga toxin-producing E. coli (STEC), and Cryptosporidium, the health advisory states. The incubation period for these illnesses range from 12 hours to as long as 14 days.

Don said he was informed the evening of May 25 of the possible outbreak, which came as a surprise to both himself and his wife, Sonja.

“We’ve done this for 30 years, and we have never ever have been called on this before,” Sonja said.

“We won’t deny that there is chance we wouldn’t have anything because everything has bacteria,” she added, but emphasized that the Department of Health has not confirmed whether Nelson Farm caused the outbreak.

topleftDon said Department of Health officials were impressed with the overall state of the farm, noting that they had positive comments on the farm’s hand washing areas and where visitors eat.

“I’m very, very concerned because we want to make it a healthy experience on the farm,” Don said. “That’s our goal.”

Since being notified by the state, Don has called all the schools that visited Nelson Farm since May 9 to see if children have gotten sick, one of which was the School of St. Philip.

Nearly 20 kindergarten, first-grade and second-grade students at the School of St. Philip visited the farm May 23 for their annual spring field trip.

“At this point we have not heard of any instances associated with that outbreak,” Principal Michelle Kramer said.

While on the farm, students toured an old barn, visited animals, played in the hay barn and had lunch at the farm.

“I’m sure we’ll be back at Nelson Farm next year. These things happen, and we have to take every precaution that we can, but we’re not going to cut them out of our school schedule because they have a very great deal to add to our programming here,” Kramer said.

For Don and Sonja, the investigation has become a teaching opportunity in how to prevent the transmission of illnesses.

“Thirty years ago it was our goal to get close to the animals to give the best possible learning experience,” Don said.

Many of the students who are visiting the farm are now more susceptible to diseases than 30 years ago, he explained.

“Our young students don’t play in the dirt as much, not around as many farm animals, generally live in cleaner environments such as schools, homes, businesses, therefore immunity and resistance to diseases is lower today,” Don said.

Another time for Don’s version of the hygiene hypothesis. For now, focus on the kids.

A table of petting zoo outbreaks is available at http://barfblog.com/wp-content/uploads/2016/05/Petting-Zoo-Outbreaks-Table-5-5-16.xlsx

Best practices for planning events encouraging human-animal interations

Zoonoses and Public Health 62:90-99

Erdozain , K. KuKanich , B. Chapman and  D. Powell, 2015

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 USA 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.

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.

pool.safety.signThe 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

Epidemiology and Infection, Volume 144, Issue 08, June 2016, Pages 1792–1802, http://dx.doi.org/10.1017/S0950268815003131

J.E. Painter, J.W. Gargano, J.S. Yoder, S.A. Collier, M.C. Hlavsa

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10299145&fileId=S0950268815003131

Epi works: Over 300 sickened from crypto on pre-cut salad greens in UK, 2012

In May 2012, people in England and Scotland started getting sick with Cryptosporidium. In June, 2012, the UK Health Protection Agency first announced 267 people were sick with Cryptosporidium across four areas of the UK, double the normal rate.

lettuce.harvestTen months later, HPA said the crypto that sickened about 300 people was most likely linked to eating pre-cut bagged salad products which were likely to have been labeled as ‘ready-to-eat.’

The outbreak was short lived and the numbers of cases returned to expected seasonal levels within a month of the first cases being reported. Most of those affected had a mild to moderate form of illness and there were no deaths associated with the outbreak.

During the investigation, an initial link was found between illness and pre-cut spinach. When specific retailers were included in the analysis, the strongest association with infection was found to be with consumption of ready to eat pre-cut mixed salad leaves from a major supermarket chain.

In this analysis, exposure to pre-cut spinach only reached conventional levels of significance for one retailer – a second major supermarket chain. A link to spinach from a number of other retailers was also suggested but these were not statistically significant. Together these findings suggest that one or more types of salad vegetables could have been contaminated.

Dr Stephen Morton, regional director of the HPA’s Yorkshire and the Humber region and head of the multi-agency Outbreak Control Team, said, “Our findings suggest that eating mixed leaf bagged salad was the most likely cause of illness. It is however often difficult to identify the source of short lived outbreaks of this type as by the time that the outbreak can be investigated, the affected food and much of the microbiological evidence may no longer be available

Dr Alison Gleadle, director of food safety at the FSA, took the opportunity to further confuse consumers, stating, “We’d like to remind everyone of our usual advice to wash all fruits and vegetables, including salad, before you eat them, unless they are labeled ready-to-eat.”

lettuce.skull.e.coli.O145But wasn’t this outbreak linked to ready-to-eat salads? How is that advice of any use? Could have offered some details, like, additional washing of ready-to-eat products is largely ineffective. FSA is refocusing its efforts on farm management to limit such contamination, before it happens.

A spokesthingy from retailer Morrisons said, rather defensively, “Morrisons is not the source of this outbreak. We have received no complaints of illness and no Morrisons products have tested positive for Cryptosporidia.

“The HPA’s claim is based solely on statistics, not testing. The very same statistics also implicated products from other retailers that the HPA recognize as ‘implausible’.”

Why doesn’t Morrison’s say what they do to enhance the safety of products they sell rather than trash epidemiology?

In the scientific paper on the outbreak, McKerr et. al reported a widespread foodborne outbreak of Cryptosporidium parvum in England and Scotland in May 2012. Cases were more common in female adults, and had no history of foreign travel. Over 300 excess cases were identified during the period of the outbreak. Speciation and microbiological typing revealed the outbreak strain to be C. parvum gp60 subtype IIaA15G2R1.

METHODS: Hypothesis generation questionnaires were administered and an unmatched case control study was undertaken to test the hypotheses raised. Cases and controls were interviewed by telephone. Controls were selected using sequential digit dialling. Information was gathered on demographics, foods consumed and retailers where foods were purchased.

RESULTS: Seventy-four laboratory confirmed cases and 74 controls were included in analyses. Infection was found to be strongly associated with the consumption of pre-cut mixed salad leaves sold by a single retailer. This is the largest documented outbreak of cryptosporidiosis attributed to a food vehicle.

An outbreak of cryptosporidium parvum across England & Scotland associated with consumption of fresh pre-cut salad leaves, May 2012

PubMed

McKerr C1, Adak GK2, Nichols G3, Gorton R4, Chalmers RM5, Kafatos

PLoS One, 2015, doi: 10.1371/journal.pone.0125955. eCollection 2015.

http://www.ncbi.nlm.nih.gov/m/pubmed/26017538/

Parasites at retail: Not so much (cause testing don’t tell ya much)

Cyclospora and Cryptosporidium are protozoan parasites which infect humans, primarily through contaminated food and water. Cyclospora is endemic in a number of subtropical and tropical countries. Cryptosporidium infection can be found in people worldwide. Cyclospora and Cryptosporidium infections can cause mild to severe gastrointestinal (GI) symptoms including, but not limited to, diarrhea, weight loss, cramping, flatulence, nausea, fatigue and low grade fever.

basil.salmonellaCyclospora and Cryptosporidium were ranked 13th and 5th, respectively, out of 24 parasites in overall global ranking for their public health importance by a Food and Agriculture Organization of the United Nations/World Health Organization (FAO/WHO) expert committee (September 3 to 7, 2012). Produce such as fresh herbs and berries have been identified in the past as sources of Cyclospora and Cryptosporidium contamination in Canada. This survey focused on fresh herbs, berries, green onions and mushrooms.

The objective of this survey was to determine the occurrence and distribution of Cyclospora and Cryptosporidium contamination in fresh produce such as herbs, berries, mushrooms and green onions. A total of 1,590 samples were analyzed for the presence of Cyclospora and 1,788 samples were analyzed for Cryptosporidium. Samples were collected at retail from various regions across Canada between May 2011 and March 2013.

raspberryOf the samples analyzed for Cyclospora, none were positive for the parasite. Of the samples analyzed for Cryptosporidium, six samples of green onions, one sample of parsley, and one sample of mushroom were positive, however, the analytical method used to detect the parasites in the samples cannot determine if the parasite is viable and potentially infectious. It is important to note that there were no reported illnesses associated with the consumption of the products found to be positive for Cryptosporidium. Positive results are followed up by the Canadian Food Inspection Agency (CFIA). In this case, because of the perishable nature of the products and the time elapsed between sample pick up and the completion of analysis, the fresh product was no longer available on the market when the parasite was detected. As such, no direct follow up was possible. This information was used to inform CFIA’s programs and inspection activities.

The Canadian Food Inspection Agency regulates and provides oversight to the industry, works with provinces and territories, and promotes safe handling of foods throughout the food production chain. However, it is important to note that the food industry and retail sectors in Canada are ultimately responsible for the food they produce and sell, while individual consumers are responsible for the safe handling of the food they have in their possession. Moreover, general advice for the consumer on the safe handling of foods is widely available. The CFIA will continue its surveillance activities and inform stakeholders of its findings.