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      A Community Outbreak of Cryptosporidiosis in Sydney Associated with a Public Swimming Facility: A Case-Control Study

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          Abstract

          In February, 2008, the South Eastern Sydney Illawarra Public Health Unit investigated an outbreak of cryptosporidiosis within the south east region of Sydney, Australia. Thirty-one cases with laboratory-confirmed cryptosporidiosis and 97 age- and geographically matched controls selected by random digit dialling were recruited into a case-control study and interviewed for infection risk factors. Cryptosporidiosis was associated with swimming at Facility A (matched odds ratio = 19.4, 95% confidence interval: 3.7–100.8) and exposure to household contacts with diarrhoea (matched odds ratio = 7.7, 95% confidence interval: 1.9–31.4) in multivariable conditional logistic regression models. A protective effect for any animal contact was also found (matched odds ratio = 0.2, 95% confidence interval: 0.1–0.7). Cryptosporidium hominis subtype IbA10G2 was identified in 8 of 11 diagnostic stool samples available for cases. This investigation reaffirms the importance of public swimming pools as potential sources of Cryptosporidium infection and ensuring their compliance with water-quality guidelines. The protective effect of animal contact may be suggestive of past exposure leading to immunity.

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          Most cited references 35

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          The infectivity of Cryptosporidium parvum in healthy volunteers.

          Small numbers of Cryptosporidium parvum oocysts can contaminate even treated drinking water, and ingestion of oocysts can cause diarrheal disease in normal as well as immunocompromised hosts. Since the number of organisms necessary to cause infection in humans is unknown, we performed a study to determine the infective dose of the parasite in healthy adults. After providing informed consent, 29 healthy volunteers without evidence of previous C. parvum infection, as determined by the absence of anti-cryptosporidium-specific antibodies, were given a single dose of 30 to 1 million C. parvum oocysts obtained from a calf. They were then monitored for oocyst excretion and clinical illness for eight weeks. Household contacts were monitored for secondary spread. Of the 16 subjects who received an intended dose of 300 or more oocysts, 14 (88 percent) became infected. After a dose of 30 oocysts, one of five subjects (20 percent) became infected, whereas at a dose of 1000 or more oocysts, seven of seven became infected. The median infective dose, calculated by linear regression, was 132 oocysts. Of the 18 subjects who excreted oocysts after the challenge dose, 11 had enteric symptoms and 7 (39 percent) had clinical cryptosporidiosis, consisting of diarrhea plus at least one other enteric symptom. All recovered, and there were no secondary cases of diarrhea among household contacts. In healthy adults with no serologic evidence of past infection with C. parvum, a low dose of C. parvum oocysts is sufficient to cause infection.
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            Virulence of three distinct Cryptosporidium parvum isolates for healthy adults.

            The infectivity of three Cryptosporidium parvum isolates (Iowa [calf], UCP [calf], and TAMU [horse]) of the C genotype was investigated in healthy adults. After exposure, volunteers recorded the number and form of stools passed and symptoms experienced. Oocyst excretion was assessed by immunofluorescence. The ID50 differed among isolates: Iowa, 87 (SE, 19; 95% confidence interval [CI], 48.67-126); UCP, 1042 (SE, 1000; 95% CI, 0-3004); and TAMU, 9 oocysts (SE, 2.34; 95% CI, 4.46-13.65); TAMU versus Iowa, P=.002 or UCP, P=.019. Isolates also differed significantly (P=.045) in attack rate between TAMU (86%) and Iowa (52%) or UCP (59%). A trend toward a longer duration of diarrhea was seen for the TAMU (94.5 h) versus UCP (81.6 h) and Iowa (64.2 h) isolates. C. parvum isolates of the C genotype differ in their infectivity for humans.
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              Case-control studies: design conduct, analysis

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                Author and article information

                Journal
                Interdiscip Perspect Infect Dis
                IPID
                Interdisciplinary Perspectives on Infectious Diseases
                Hindawi Publishing Corporation
                1687-708X
                1687-7098
                2011
                13 December 2011
                : 2011
                Affiliations
                1South Eastern Sydney Illawarra Public Health Unit, Health Reform Transition Organisation—Southern, Locked Mail Bag 9, Wollongong, NSW 2526, Australia
                2South Eastern Sydney Illawarra Public Health Unit, Health Reform Transition Organisation—Southern, Locked Bag 88, Randwick, NSW 2031, Australia
                3School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Level 2 and 3 Samuels Building, UNSW Sydney, 2052 NSW, Australia
                4School of Medicine Sydney, University of Notre Dame Australia, 160 Oxford Street, Darlinghurst NSW 2010, Australia
                Author notes

                Academic Editor: Dinesh Mondal

                Article
                10.1155/2011/341065
                3238377
                22194741
                Copyright © 2011 Darren J. Mayne et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Research Article

                Infectious disease & Microbiology

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