Abstract
During the 2001 epidemic of foot and mouth disease (FMD) in livestock in England and Wales, we discovered a corresponding decrease in laboratory reports of cryptosporidiosis in humans. Using a regression model of laboratory reports of cryptosporidiosis, we found an estimated 35% (95% confidence interval [CI] 20% to 47%) reduction in reports during the weeks spanning the period from the first and last cases of FMD. The largest reduction occurred in northwest England, where the estimated decrease was 63% (95% CI 31% to 80%). Genotyping a subgroup of human isolates suggested that the proportion of Cryptosporidium genotype 2 strain (animal and human) was lower during the weeks of the FMD epidemic in 2001 compared with the same weeks in 2000. Our observations are consistent with livestock making a substantial contribution to Cryptosporidium infection in humans in England and Wales; our findings have implications for agriculture, visitors to rural areas, water companies, and regulators.
Highlights
During the 2001 epidemic of foot and mouth disease (FMD) in livestock in England and Wales, we discovered a corresponding decrease in laboratory reports of cryptosporidiosis in humans
From the national laboratory database, we downloaded laboratory reports to PHLS–CDSC of Cryptosporidium oocysts identified in fecal smears with dates for obtaining specimens between January 1, 1991, and December 31, 2001
The timing of clearly identifiable spring and autumn peaks of Cryptosporidium laboratory reports was fairly consistent from year to year (Figure 1)
Summary
During the 2001 epidemic of foot and mouth disease (FMD) in livestock in England and Wales, we discovered a corresponding decrease in laboratory reports of cryptosporidiosis in humans. Cryptosporidium in water supplies was studied by three expert committees commissioned by U.K. departments of health and environment in the 1990s, which made recommendations on improving management of slurry, on human hygiene relating to livestock, and on best practices in water treatment and outbreak investigation [5,6,7]. Surveillance of human enteric infection in England and Wales (which encompass 89% of the U.K. population [8]) is conducted by the voluntary reporting of positive laboratory test results from individual case-patients and outbreak summaries to the Public Health Laboratory Service–Communicable Disease Surveillance Centre (PHLS–CDSC) in Colindale, London. England and Wales have 229 microbiology laboratories, of which 47 are public health laboratories [11,12]
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