40 sick in Sweden from Cryptosporidium at kosläpp (letting the cows out)

Apparently it’s a thing in Sweden to go and watch the cows being let out; so is Cryptosporidium.

kosläppSome 40 people have fallen ill after being infected by Cryptosporidium, reports Skovde News.

It is associated with kosläpp, a Hjo and one in Skövde, two outbreaks occurred in May.

Infectious disease doctors in the area now warning parents to let young children petting calves at kosläpp and immediately afterwards eat food or refreshments, writes Skovde News. Then they risk getting upset stomach with abdominal pain and diarrhea.

8 sick in crypto outbreak linked to farm visit in Sweden

A class that has been on kosläpp where eight out of twenty-three children and a teacher have become ill with severe abdominal pain, vomiting and watery diarrhea, said Deputy County Medical in West Bengal, Eva Lind houses Combos.

crypto.farm.walesThe disease is caused by the parasite Cryptosporidium that five years ago affected tens of thousands of people in Östersund.

According to the infectious disease physician’s theory is that the close encounter with calves that children become infected.

8 sick: Suspected outbreak of cryptosporidium hits thousands of homes in Ireland

Almost 6,500 homes in Westport have been placed on a boil water notice after a suspected outbreak of cryptosporidium.

crypto_enlargedThe precautionary notice was issued by Irish Water to a large number of customers in the town and to those on nearby group water schemes this evening.

It will affect thousands of homes and businesses in the busy tourist town.

Irish Water says the HSE has issued the precautionary boil notice, after eight people in the Westport area reported symptoms of crytosporidium.

They say no crytosporidium had been detected in ongoing water samples, however, as a precaution they are urging customers to boil water before using it for drinking, preparing food and baby food or brushing teeth.

Don’t poop in the pool: Cryptosporidiosis surveillance, US 2011–2012

Problem/Condition: Cryptosporidiosis is a nationally notifiable gastrointestinal illness caused by extremely chlorine-tolerant protozoa of the genus Cryptosporidium.

caddyshack.pool.poop-1Reporting Period: 2011–2012.

Description of System: Fifty state and two metropolitan public health agencies voluntarily report cases of cryptosporidiosis through CDC’s National Notifiable Diseases Surveillance System.

Results: For 2011, a total of 9,313 cryptosporidiosis cases (confirmed and nonconfirmed) were reported; for 2012, a total of 8,008 cases were reported; 5.8% and 5.3%, respectively, were associated with a detected outbreak. The rates of reported nonconfirmed cases were 1.0 and 0.9 per 100,000 population in 2011 and 2012, respectively, compared with an average of 0.0 during 1995–2004, and 0.3 during 2005–2010. The highest overall reporting rates were observed in the Midwest; 10 states reported >3.5 cases per 100,000 population in 2011 and in 2012. During 2011–2012, reported cases were highest among children aged 1–4 years (6.6 per 100,000 population), followed for the first time by elderly adults aged ≥80 years (3.4), and 75–79 years (3.3). Overall, cryptosporidiosis rates were higher among females than males during both years. For specific age groups, rates were higher among males than females aged <15 years and higher among females than males aged ≥15 years. Cryptosporidiosis symptom onset increased 4.4 fold during late summer.

Interpretation: Cryptosporidiosis incidence rates remain elevated nationally, and rates of nonconfirmed cases have increased. Rates remain highest in young children, although rates among elderly adults are increasing. Transmission of Cryptosporidium occurs throughout the United States, with increased reporting occurring in Midwestern states. Seasonal onset peaks coincide with the summer recreational water season and might reflect increased use of communal swimming venues.

Public Health Action: Future research is needed to address the evolving epidemiology of cryptosporidiosis cases, with a specific focus on the increase in nonconfirmed cases and increasing incidence rates among elderly adults. National systematic genotyping and subtyping of Cryptosporidium isolates could also help elucidate Cryptosporidium transmission and thus cryptosporidiosis epidemiology in the United States.

Secondary transmission a factor: Crypto in school kids visiting farm in Norway

Two related outbreaks (in 2009 and 2012) of cryptosporidiosis in Norwegian schoolchildren during a stay at a remote holiday farm provided us with a natural experiment to investigate possible secondary transmission of Cryptosporidium parvum IIa A19G1R1.

faith.farmingAfter the children had returned home, clinical data and stool samples were obtained from their household contacts. Samples were investigated for the presence of Cryptosporidium oocysts by immunofluorescence antibody test. We found both asymptomatic and symptomatic infections, which are likely to have been secondary transmission. Laboratory-confirmed transmission rate was 17% [4/23, 95% confidence interval (CI) 7·0–37·1] in the 2009 outbreak, and 0% (95% CI 0–16·8) in the 2012 outbreak. Using a clinical definition, the probable secondary transmission rate in the 2012 outbreak was 8% (7/83, 95% CI 4·1–16·4).

These findings highlight the importance of hygienic and public health measures during outbreaks or individual cases of cryptosporidiosis. We discuss our findings in light of previous studies reporting varying secondary transmission rates of Cryptosporidium spp.

 Symptomatic and asymptomatic secondary transmission of Cryptosporidium parvum following two related outbreaks in schoolchildren

Epidemiology and Infection / Volume 143 / Issue 08 / June 2015, pp 1702-1709

  • . H. JOHANSEN, K. HANEVIK, F. THRANA, A. CARLSON, T. STACHURSKA-HAGENa5, D. SKAARE and L. J. ROBERTSON

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9677614&utm_source=Issue_Alert&utm_medium=RSS&utm_campaign=HYG

13 sickened: Handwashing is never enough and why I’m wary of animal displays: Crypto outbreak contained in Michigan

An outbreak of cryptosporidiosis at the Centreville High School agriculture program sent one student to the hospital and infected 12 others, according to Branch-Hillsdale-St. Joseph Community Health Agency.

cow.poop2The outbreak is contained and the hospitalized student has been released.

The outbreak came in early March in the co-op vet/ag science program run through St. Joseph Intermediate School District and involving students from throughout the county, according to Rebecca Burns, environmental health director.

The parasite is commonly found near calves, Burns said the health agency identified the calf program as the source.

“The school is all in to make sure this doesn’t happened again,” Burns said. “The problem was traced to poor hand-washing.”

Burns said there was hand sanitizer in the barn, but that alone is not enough.

cow_hug_cumberland“Nothing beats soap, water and friction to get rid of the parasite,” she said.

Two other major outbreaks of crypto were reported in the tri-county health district since 2011. In Hillsdale County in 2012, 28 people were infected at a pool party. In 2011, a Quincy firefighter was hospitalized and 19 others infected while fighting a fire at a calf barn. Firefighters used water from a pond nearby to extinguish the blaze.

Cryptosporidium: 22 years since Milwaukee outbreak killed 69 sickened 400K

Twenty-two years ago this month, residents of Milwaukee started falling ill with nausea, diarrhea and abdominal cramps. At first, a highly contagious intestinal virus was blamed. But as symptoms struck tens of thousands of people – closing schools and businesses and nearly bringing the city to a standstill – health officials discovered the culprit: a tiny, pink-colored parasite.

crypto cystCryptosporidium, also known as crypto, had made its way through Milwaukee’s water treatment plant and into the city taps. Sickening more than 400,000 people and killing 69, it remains the largest waterborne outbreak in U.S. history. Since then, utilities nationwide have made improvements in water treatment and monitoring.

Public water technology to prevent crypto may have improved, but not the drugs to treat it, said Washington State University researcher Jennifer Zambriski of the Paul G. Allen School for Global Animal Health based in the College of Veterinary Medicine. Once the organism infects the small intestines, its onslaught on the body is just as toxic as it was 22 years ago, she said.

“Crypto is hardy and doesn’t die easily. When someone contracts it, there’s simply no drug to make it go away,” said Zambriski, whose research focuses on finding ways to disrupt the parasite’s pathway through the digestive tract – before it gains a stranglehold on its host.

Which is a big deal, because the parasite still lurks – in ponds, streams, day care centers and swimming pools. In developing countries like Kenya and industrial ones like the United States, it continues to make waves.

Cryptosporidiosis, the disease it causes, is one of the most frequently occurring waterborne diseases among humans in the U.S., according to the U.S. Centers for Disease Control and Prevention. And in Asia and Africa, the parasite is a leading cause of diarrheal disease and death among infants. (See Lancet study, 2013: http://www.sciencedirect.com/science/article/pii/S0140673613608442).

These soft-pink colored pathogenic foes, appearing “almost cute” under a microscope, according to Zambriski, live in the intestines of infected humans and certain animals and are shed in the stool. Once outside the body, a tough outer shell allows them to survive in dirt, water and food for 18 months or longer.

“Bleach, chlorine, freezing backwater streams and water purifying tablets – they can’t kill crypto,” she said.

Whether through contaminated water or an infected person’s unclean hands, the parasites are easily transmitted to humans.

“Ingesting just a small amount can deliver a severe spell of diarrhea to those who are healthy and a grave illness and even death to infants or people with weakened immune systems,” Zambriski said.

Always the kids: raw goats milk in Idaho sickens at least 2

On August 27, 2014, the Idaho Department of Health and Welfare’s Division of Public Health (DPH) was notified of two cases of cryptosporidiosis in siblings aged <3 years. Idaho’s Southwest District Health (SWDH) investigated and found that both children had consumed raw (unpasteurized) goat milk produced at a dairy licensed by the Idaho State Department of Agriculture (ISDA) and purchased at a retail store. Milk produced before August 18, the date of illness onset, was unavailable for testing from retail stores, the household, or the dairy.

goat.poopSamples of raw goat milk produced on August 18, 21, 25, and 28, taken from one opened container from the siblings’ household, one unopened container from the retailer, and two unopened containers from the dairy, all tested positive for Cryptosporidium by real-time polymerase chain reaction (PCR) at a commercial laboratory. On August 30, ISDA placed a hold order on all raw milk sales from the producer. ISDA and SWDH issued press releases advising persons not to consume the raw milk; SWDH issued a medical alert, and Idaho’s Central District Health Department issued an advisory to health care providers about the outbreak.

All seven of Idaho’s Public Health Districts and DPH continued to monitor cryptosporidiosis reports submitted from Idaho health care providers and laboratories statewide as required by Idaho law. Public Health Districts investigated reports by interviewing ill persons or their parents using a standardized questionnaire. After the hold order, SWDH and the Central District Health Department identified nine ill persons in four households. Four persons who had regularly consumed raw goat milk produced before August 18 experienced symptoms of gastroenteritis, and five household members who had not consumed the milk experienced onsets of symptoms of gastroenteritis 3–8 days after the first household member became ill. No other common exposures were identified. CDC case definitions for cryptosporidiosis were used (1). In total, the 11 ill persons were aged 2 months–76 years (median = 11 years); six were female. One patient was hospitalized. Stool specimens were obtained in three primary cases (i.e., illnesses in those who drank the raw goat milk) and three secondary cases (i.e., illness in contacts of those who drank the raw goat milk); CDC isolated Cryptosporidium parvum subtype IIaA16G3R1 from all six. The last reported outbreak-associated illness was a secondary case with an onset date of September 3.

In addition to the four tested milk samples from containers, five of five milk samples collected along the production line on September 2 tested positive for Cryptosporidium by PCR at the commercial laboratory. Testing of all nine milk samples (four from containers and five from the production line) at CDC for Cryptosporidium by PCR and direct fluorescent antibody test was negative. CDC and the commercial laboratory collaborated to validate the negative result by using sequencing to determine that false-positive results at the commercial laboratory were likely caused by goat DNA amplification during PCR. An inspection of the dairy did not reveal any obvious contamination sources. Water from the producer’s well tested negative at Idaho Bureau of Laboratories for Cryptosporidium by direct fluorescent antibody test after ultrafiltration. Goat stool was unavailable for testing. Negative results led ISDA to release the hold order on September 18.

goat.petting.zooEpidemiologic evidence implicated contaminated raw goat milk as the outbreak source. It was not possible to obtain confirmatory laboratory evidence of milk contamination. Milk consumed before illness onset was unavailable for testing and could have been subjected to a single, undetected contamination event. No other common source was identified, and isolation of the identical Cryptosporidium genotype from ill persons did not disprove a common source. This outbreak highlights an infrequently reported cryptosporidiosis risk from unpasteurized milk (2,3), the value of sequencing to validate PCR protocols, the utility of genotyping Cryptosporidium isolates for strengthening epidemiologic evidence, and the risk for secondary transmission of Cryptosporidium. An increasing number of enteric outbreaks are associated with raw milk consumption (4,5). Resources for consumers, health care providers, and public health officials regarding risks from raw milk consumption are available at http://www.cdc.gov/foodsafety/rawmilk/raw-milk-index.html.

Cryptosporidiosis associated with consumption of unpasteurized goat milk — Idaho, 2014

CDC MMWR 64(07);194-195

Mariana Rosenthal, Randi Pedersen, Scott Leibsle, Vincent Hill, Kris Carter, Dawn M. Roellig

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6407a9.htm?s_cid=mm6407a9_e

Hold order lifted on Idaho dairy after two potentially sickened with crypto

Raw goat milk tested at Treasured Sunrise Acres turned up negative for an illness that left two sick in August.

napoleon.raw.milkThe hold order preventing the Parma dairy farm from selling its milk was lifted Sept. 18, according to a post on the dairy’s Facebook page.

Public health officials recommended the public throw away any raw milk bought from the dairy between Aug. 24 and Aug. 31, but the release of the hold order posted to the Facebook page said all the samples of raw goat and cow milk tested negative for cryptosporidiosis.

Thousands sickened in 2005 crypto outbreak at NY splash park; settlement of lawsuit in the works

The New York State Court of Claims has granted preliminary approval to a proposed settlement of the class action lawsuit filed over the 2005 Cryptosporidium outbreak at the Seneca Lake State Park spray park.

OLYMPUS DIGITAL CAMERAIf the settlement receives final approval, it would end nine years of litigation with the state of New York involving some 2,500 class members that was weeks from going to trial.

Under terms of the proposed settlement, the state, defendant in the case, has agreed to pay $5 million to end the litigation without going to trial.

That amount, minus any attorney fees and costs awarded by Court of Claims Judge Nicholas Midey Jr. to lawyers for the class will be distributed among the class members according to their award category.

The categories are those who were hospitalized with the diarrheal illness, those who were treated at an emergency room, those who were treated at a non-hospital emergency room and those who received other forms of medical care.

The money also would be used to pay settlement administration costs.

Any funds remaining after the allocation of class member awards and payments for administration expenses would then be allocated on a pro-rated basis among class members who filed a claim form.