Photo Credit CDC PHIL
While generally thought of a waterborne illness, Crypto may be found in soil, food, water, or on surfaces that have been contaminated with the feces from infected humans or animals.
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Last summer in a pair of blogs (see Tales From The Crypto & More Tales From The Crypto) I wrote about an unusual spike in gastrointestinal illnesses reported across England due to the Cryptosporidium parasite, or as it is commonly known, “Crypto”.
Today the journal EuroSurveillance carries a rapid communications that indicates that in addition to the UK, The Netherlands and Germany also experienced unusual spikes in Cryptosporidium infections last summer.
Eurosurveillance, Volume 18, Issue 2, 10 January 2013
Rapid communications
Simultaneous increase of Cryptosporidium infections in the Netherlands, the United Kingdom and Germany in late summer season, 2012
N Fournet, M P Deege, A T Urbanus, G Nichols, B M Rosner, R M Chalmers, R Gorton, K G Pollock, J W B van der Giessen, P C Wever, J W Dorigo-Zetsma, B Mulder, T G Mank, I Overdevest, J G Kusters, W van Pelt, L M Kortbeek
Date of submission: 12 December 2012
Starting August 2012, an increase in Cryptosporidium infections was reported in the Netherlands, the United Kingdom and Germany. It represented a 1.8 to 4.9-fold increase compared to previous years. Most samples were C. hominis IbA10G2. A case–control study was performed in the Netherlands but did not identify an endemic source. A case–case study in the north of England found travel abroad to be the most common risk factor.
A good deal of data is presented, and several theories as to what may have contributed to this simultaneous spike in Crypto cases, but as the following passage indicates, no specific cause has been determined.
Because the number of Cryptosporidium-positive samples in the Netherlands, the UK and Germany increased during the same period, common exposures or influencing factors might be expected. However, no single source has been found that could explain the increase of cryptosporidiosis seen in these countries. Foreign travel has been an important risk in the UK and bottled mineral water raised as a hypothesis in the Netherlands.
However, plausible factors might include multiple sources, extreme weather conditions, person-to-person transmission and other, still unidentified risk factors. Alternatively, the increase in different countries may have developed independently which could explain the difference in age distribution compared to previous years in the Netherlands but not in the UK and Germany.
This increase in cryptosporidiosis across a wider geographic area highlights the need for wider surveillance, development of better subtyping methods, the inadequacy of controls for travel-related infections and a need for further work on bottled waters [18] and foods as potential Cryptosporidium risks.
Although rarely fatal in healthy individuals, `Crypto’ can prove deadly for the very young, the very old, and those with compromised immune systems. For most healthy individuals, a Crypto infection is an unpleasant, but not life threatening illness. The most common symptoms (which generally last 1 to 2 weeks) are:
- Watery Diarrhea
- Stomach cramps or pain
- Dehydration
- Nausea
- Vomiting
- Fever
- Weight loss
According to an EID Journal study published in early 2011, Americans are estimated to get 750,000 Crypto infections each year (see Foodborne Illness Acquired in the United States—Major Pathogens), although only about 8,000 are laboratory confirmed.
Occasionally campers, swimmers, or those drawing water from untreated wells will contract Crypto here in the United States. The largest outbreak occurred in Milwaukee in 1993, when Cryptosporidium entered the public water supply (exactly how, remains a mystery), and sickened 400,000 people and killed more than 100 who were immunocompromised.
Cryptosporidium is an extremely chlorine-tolerant parasite, making it particularly difficult to eliminate from swimming pools, fountains, and public water sources.
The Milwaukee incident has led to increased water testing, and the use of ozone, filters, and other interventions across the nation to help make our water supply safer.
Given its prevalence in the environment, and the number of human infections each year, prevention is key. The CDC maintains an extensive webpage devoted to Prevention & Control of Cryptosporidiosis.
Practice Good Hygiene
Everywhere
- Wash hands with soap and water for at least 20 seconds, rubbing hands together vigorously and scrubbing all surfaces:
- Before preparing or eating food
- After using the toilet
- After changing diapers or cleaning up a child who has used the toilet
- Before and after tending to someone who is ill with diarrhea
- After handling an animal or animal waste
At child care facilities
- To reduce the risk of disease transmission, children with diarrhea should be excluded from child care settings until the diarrhea has stopped.
At recreational water venues (pools, interactive fountains, lakes, ocean)
- Protect others by not swimming if you are experiencing diarrhea (this is essential for children in diapers). If diagnosed with cryptosporidiosis, do not swim for at least 2 weeks after diarrhea stops.
- Shower before entering the water.
- Wash children thoroughly (especially their bottoms) with soap and water after they use the toilet or their diapers are changed and before they enter the water.
- Take children on frequent bathroom breaks and check their diapers often.
- Change diapers in the bathroom, not at the poolside.
Around animals
- Minimize contact with the feces of all animals, particularly young animals.
- When cleaning up animal feces, wear disposable gloves, and always wash hands when finished.
- Wash hands after any contact with animals or their living areas.
Outside
- Wash hands after gardening, even if wearing gloves.
Immunocompromised persons
- Avoid close contact with any person or animal that has cryptosporidiosis. Cryptosporidiosis can become a life threatening disease for immunocompromised persons.
- Do not handle animal feces because infection can be life threatening for immunocompromised persons.
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