Abstract
In October 2007 an increase in laboratory-confirmed cryptosporidiosis cases in Staffordshire, England prompted an outbreak investigation. Case ascertainment included interviewing suspected cases and contacts and obtaining faecal specimens from those with diarrhoea for laboratory identification. Over a three-month period we identified 57 cases of cryptosporidiosis (39 confirmed) distributed across 36 households. The majority of cases (69%) were younger than 20 years. The most plausible exposure was multiple swimming episodes (56% of cases) in 13 local public swimming pools. One large swimming pool was most frequently visited by swimmers and considered a significant contributor to transmission because of substandard filtration and maintenance systems. Control measures focused on inspecting and improving operating standards at swimming pools, hygiene information to swimmers, and early detection and exclusion of cases. The rapid case investigation described in this paper provided adequate information for the early detection and control of a typical seasonal swimming pool related cryptosporidiosis outbreak. Ensuring adequate filtration standards at public swimming pools particularly before the high use periods of late summer and autumn remains a priority.
Highlights
The improvement of water treatment systems in England and Wales has resulted in fewer drinking water-related cryptosporidiosis outbreaks in recent years [1]
A confirmed case of cryptosporidiosis was defined as any northern Staffordshire resident with diarrhoea confirmed by the detection of Cryptosporidium oocysts in a stool sample by microscopic examination, from 15 October to 24 December 2007
An outbreak management team consisting of public health investigators, microbiologists, environmental health officers, and a media officer was convened to oversee the investigation and the implementation of control measures
Summary
The improvement of water treatment systems in England and Wales has resulted in fewer drinking water-related cryptosporidiosis outbreaks in recent years [1]. By contrast, swimming poolassociated outbreaks continue to occur, with incidence peaking in late summer and autumn when swimming pool use is highest [2]. Outbreaks linked to interactive water features have increased in prominence [3]. In November 2007 laboratory surveillance indicated a fourfold increase of cryptosporidiosis cases in northern Staffordshire, England, compared to 2006 data (16 vs 4 cases). Routine questioning of cases by environmental health officers revealed all had recent public swimming pool exposures. We undertook a rapid case investigation aimed at targeting timely and appropriate control measures
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