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

Posted on April 29, 2015 by Douglas Powell

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.

After 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

Posted on March 27, 2015 by Douglas Powell

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.

The 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.

“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

Posted on March 17, 2015 by Douglas Powell

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.

Cryptosporidium, 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

Posted on February 26, 2015 by Douglas Powell

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.

Samples 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.

Epidemiologic 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

Posted on October 2, 2014 by Douglas Powell

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

The 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

Posted on September 25, 2014 by Douglas Powell

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.

If 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.

157 sick, up from 11 last year; reports of crypto rise in Florida county

Posted on September 13, 2014 by Douglas Powell

The Florida Department of Health in Hillsborough County is asking for the public’s help to prevent the spread of Cryptosporidiosis, a disease that spreads easily person to person in in households, child-care settings and schools, and through swimming in contaminated water or from contact with animals.

DOH-Hillsborough says the number of Cryptosporidiosis cases reported to them has increased since school started in the county.

Since July 1, 2014, 157 cases of Cryptosporidiosis have been reported by DOH-Hillsborough, as compared to 11 cases during the same time period last year. Many of these cases have reported spending time at school or day care the incubation period.

The highest number of cases of infection is in those younger than 15. Health officials are concerned that the numbers of cases could increase if proper precautions are not followed.

Gene sequencing refines threatening Cryptosporidium list

Posted on September 7, 2014 by Douglas Powell

Twenty-six species of Cryptosporidium have been recognised and 18 species declared non-valid in a recent shake-up of the parasite’s taxonomy using DNA sequencing techniques.

Cryptosporidium is the second biggest cause of infant diarrhoea and death in developing countries, and is found across 95 nations, including Australia.

The parasite spreads by reproducing in the small intestine of its hosts, generating spore-like oocysts that are shed in the faeces and then consumed in contaminated food or water.

Current testing for Cryptosporidium relies on immunoassays and microscopy, techniques that can identify the presence of oocysts, but not their species.

Since 20 of the 26 species are known to infect humans, this can have important implications for public health.

“Most of [the oocysts] look the same under the microscope, so the only way you can tell them apart is by looking at their DNA,” says Murdoch University Professor Una Ryan, who worked with the US Centre for Disease Control and the US Department of Agriculture on the taxonomy project.

The team used a variety of DNA sequencing and typing techniques to identify gene fragments that are used to characterise each species.

Person with diarrhea most likely source of Crypto at Georgia splash pad

Posted on August 21, 2014 by Douglas Powell

An infected person with diarrhea who used the East Athens Community Park splash pad earlier this month is the likely source for the recent spread of the parasite Cryptosporidium confirmed to have infected at least 16 children, the Athens-Clarke County Leisure Services Department and the Clarke County Health Department determined this week.

According to a statement, the CCHD was alerted Aug. 11 to several cases of children falling ill after attending a private party at the splash pad on Aug. 3. As part of its investigation, the health department contacted Leisure Services Aug. 12 for information and took water samples soon after. Water samples were submitted to the Centers for Disease Control and Prevention the next day, and while final CDC test results are not expected until later this week, the health department confirmed samples taken from infected children indicate Cryptosporidium, commonly known as Crypto.

One of the leading causes of recreational water illness, Crypto is spread when people swallow water recently contaminated by an infected person’s fecal matter.

Once the health department determined Crypto as a probable cause, staff at Leisure Services initiated a precautionary disinfectant treatment at the splash pad prior to reopening it to the public. The treatment used more than twice the amount of chlorine shown by CDC studies to eradicate Crypto and was used for a longer period of time than required by the health department, according to ACC Leisure Services Park Services Division Maintenance Supervisor Keith Kirkland.

Petting zoos can suck: Second outbreak of infection with a rare Cryptosporidium parvum genotype in schoolchildren associated with contact with lambs/goat kids in Norway

Posted on August 14, 2014 by Douglas Powell

In March 2012, a second outbreak of Cryptosporidium parvum affected children following a stay at a holiday farm in Norway; the first outbreak occurred in 2009. We studied a cohort of 145 schoolchildren who had visited the farm, of which 40 (28%) were cases.

Cryptosporidium oocysts were detected in faecal samples from humans, goat kids and lambs. Molecular studies revealed C. parvum subtype IIa A19G1R1 in all samples including human samples from the 2009 outbreak. A dose–response relationship was found between the number of optional sessions with animals and illness, increasing from two sessions [risk ratio (RR) 2·7, 95% confidence interval (CI) 0·6–11·5] to six sessions (RR 8·0, 95% CI 1·7–37·7). The occurrence of two outbreaks 3 years apart, with the same subtype of C. parvum, suggests that the parasite is established in the farm’s environment. We recommend greater emphasis on hand hygiene and routines related to animal contact.

Best practices for planning events encouraging human-animal interactions

Zoonoses and Public Health

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.

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

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