Communitywide Cryptosporidiosis Outbreak--Utah, 2007
The Utah Department of Health (UDOH) received 1,902 case reports of laboratory-confirmed cryptosporidiosis during June-December 2007, compared with an annual median of 16 reports of laboratory-confirmed cases (range: six to 20) during 2002-2006. All 1,902 cases met the outbreak-related case definition.
Clearly, this was an outbreak made for eventual analysis for specific publication in the Journal of the American Medical Association (JAMA). That document has now been published and can be found here.
Below are the recommendations for health professionals in dealing with Crypto.
BOX. Preventing communitywide cryptosporidiosis outbreaks—Recommendations for health departments
Before increased transmission of Cryptosporidium is detected
- Establish strong working relationships with community partners, such as operators of treated recreational water venues (e.g., pools, water parks, and interactive fountains) and child care programs. For example, maintain updated e-mail, fax, and telephone lists for community partners.
- Set disease action threshold (e.g., a twofold to threefold increase over baseline for the previous 5 years) at which community partners will be notified and mobilized to implement additional control measures.
- Develop health communications about cryptosporidiosis control and outbreak response.
- Educate community partners about how they can prevent Cryptosporidium transmission and about the control measures they will need to implement if the preset disease action threshold is exceeded.
- Collaborate with community partners to educate the public about healthy swimming and good handwashing behaviors.
If the preset disease action threshold is exceeded or an outbreak is detected, public health officials should rapidly mobilize community partners to implement additional control measures
- Control measures for operators of treated recreational water venues:
- Reinforce efforts to educate the public about healthy swimming behaviors (e.g., not swimming while ill with diarrhea and not swallowing the water).
- Post diarrhea-exclusion messages where patrons can easily see and read them before entering the facility and the water.
- Restrict staff members who are ill with diarrhea from entering the water. Consider reassigning them to duties that do not require them to enter the water (e.g., administrative duties) until their symptoms resolve.
- Hyperchlorinate the water (when not being used) at levels that inactivate Cryptosporidium if the health department notifies the facility of the need to hyperchlorinate.
- Consider regular hyperchlorination (e.g., weekly) to help prevent the spread of Cryptosporidium.
- Discuss other possible prevention measures with local or state health department (e.g., suspending high-risk group events, such as visits from child care groups).
- Control measures for operators of child care programs:
- Educate parents and staff about cryptosporidiosis and how they can help stop Cryptosporidium transmission.
- Reinforce the facility's diarrhea-exclusion policy. For example, reassign staff ill with diarrhea to jobs that minimize the risk for transmission (e.g., administrative work instead of food preparation).
- Reinforce good hand-washing practices among attendees and staff. Assist young children with hand washing as needed. (Note: Alcohol-based hand gels and sanitizers are ineffective against Cryptosporidium.)
- Follow good diaper-changing practices. For example, with each diaper change, use new disposable paper over diaper-changing surfaces and new gloves.
- Suspend all water-play and swimming activities (e.g., visits to public pools).
- Disinfect surfaces, particularly diaper-changing areas and toys, with hydrogen peroxide. (Note: Bleach solutions are ineffective against Cryptosporidium.)
