Abstract
BackgroundCryptosporidium is a leading cause of childhood diarrhea in low-resource settings, and has been repeatedly associated with impaired physical and cognitive development. In May 2013, an outbreak of diarrhea caused by Cryptosporidium hominis was identified in the Arctic region of Nunavik, Quebec. Human cryptosporidiosis transmission was previously unknown in this region, and very few previous studies have reported it elsewhere in the Arctic. We report clinical, molecular, and epidemiologic details of a multi-village Cryptosporidium outbreak in the Canadian Arctic.Methodology/Principal FindingsWe investigated the occurrence of cryptosporidiosis using a descriptive study of cases with onset between April 2013 and April 2014. Cases were defined as Nunavik inhabitants of any age presenting with diarrhea of any duration, in whom Cryptosporidium oocysts were detected by stool microscopy in a specialised reference laboratory. Cryptosporidium was identified in stool from 51 of 283 individuals. The overall annual incidence rate (IR) was 420 / 100,000 inhabitants. The IR was highest among children aged less than 5 years (1290 /100,000 persons). Genetic subtyping for stool specimens from 14/51 cases was determined by DNA sequence analysis of the 60 kDa glycoprotein (gp60) gene. Sequences aligned with C. hominis subtype Id in all cases. No common food or water source of infection was identified.Conclusions/SignificanceIn this first observed outbreak of human cryptosporidiosis in this Arctic region, the high IR seen is cause for concern about the possible long-term effects on growth and development of children in Inuit communities, who face myriad other challenges such as overcrowding and food-insecurity. The temporal and geographic distribution of cases, as well as the identification of C. hominis subtype Id, suggest anthroponotic rather than zoonotic transmission. Barriers to timely diagnosis delayed the recognition of human cryptosporidiosis in this remote setting.
Highlights
Cryptosporidium is an apicomplexan parasite that is increasingly recognised among immunocompetent hosts as a leading cause of childhood diarrhea in low-resource settings and of waterborne diarrheal outbreaks in high-income countries.[1, 2] C. hominis, for which humans are the only natural host, and C. parvum, which infects bovines, wild animals and humans, account for the majority of human infections.[3]
In mid-2013, an outbreak of moderate-to-severe diarrhea caused by Cryptosporidium was identified in the Arctic region of Nunavik, Quebec, and it predominantly affected young children
Cryptosporidium is a leading cause of childhood diarrhea in low-resource settings, but was previously unknown in this region. This is important because cryptosporidiosis has been repeatedly associated with impaired growth and development, and may interact with other challenges currently faced by children in remote Arctic communities, such as overcrowding and food-insecurity
Summary
Cryptosporidium is an apicomplexan parasite that is increasingly recognised among immunocompetent hosts as a leading cause of childhood diarrhea in low-resource settings and of waterborne diarrheal outbreaks in high-income countries.[1, 2] C. hominis, for which humans are the only natural host, and C. parvum, which infects bovines, wild animals and humans, account for the majority of human infections.[3] Cryptosporidium oocysts are transmitted via the fecaloral route, including by person-to-person spread, from contaminated food or water, or from contact with infected animals. Cryptosporidium is a leading cause of childhood diarrhea in low-resource settings, and has been repeatedly associated with impaired physical and cognitive development. Molecular, and epidemiologic details of a multi-village Cryptosporidium outbreak in the Canadian Arctic
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