Cargando…
Outbreak of cryptosporidium hominis following river flooding in the city of Halle (Saale), Germany, August 2013
BACKGROUND: During weeks 32–33, 2013, 24 cases of cryptosporidiosis were notified in the city of Halle (annual mean 2008–2012: 9 cases). We investigated the outbreak to identify the source and recommend control measures, considering that between weeks 23–25 the river Saale which flows through the ci...
Autores principales: | , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2015
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4344771/ https://www.ncbi.nlm.nih.gov/pubmed/25879490 http://dx.doi.org/10.1186/s12879-015-0807-1 |
_version_ | 1782359484723625984 |
---|---|
author | Gertler, Maximilian Dürr, Matthias Renner, Peter Poppert, Sven Askar, Mona Breidenbach, Janina Frank, Christina Preußel, Karina Schielke, Anika Werber, Dirk Chalmers, Rachel Robinson, Guy Feuerpfeil, Irmgard Tannich, Egbert Gröger, Christine Stark, Klaus Wilking, Hendrik |
author_facet | Gertler, Maximilian Dürr, Matthias Renner, Peter Poppert, Sven Askar, Mona Breidenbach, Janina Frank, Christina Preußel, Karina Schielke, Anika Werber, Dirk Chalmers, Rachel Robinson, Guy Feuerpfeil, Irmgard Tannich, Egbert Gröger, Christine Stark, Klaus Wilking, Hendrik |
author_sort | Gertler, Maximilian |
collection | PubMed |
description | BACKGROUND: During weeks 32–33, 2013, 24 cases of cryptosporidiosis were notified in the city of Halle (annual mean 2008–2012: 9 cases). We investigated the outbreak to identify the source and recommend control measures, considering that between weeks 23–25 the river Saale which flows through the city centre overflowed the floodplain, parts of the city centre and damaged sewage systems. METHODS: We defined a case as a resident of Halle with gastroenteritis, Cryptosporidium-positive stool and disease onset weeks 27 through 47. In a case–control study among kindergarten children, we compared cases and controls regarding environmental exposure, use of swimming pools, zoo visits and tap water consumption 14 days pre-onset or a corresponding 14-days-period (controls) and adjusted for residence. Stool specimens were tested by microscopy and PCR, and Cryptosporidium DNA was sequenced. Samples from public water system, swimming pools and river Saale were examined for Cryptosporidium oocysts (microscopy and PCR). RESULTS: Overall, 167 cases were detected, 40/167 (24%) were classified as secondary cases. First disease onsets occurred during week 29, numbers peaked in week 34 and started to decrease in week 36. Median age was 8 years (range: 0–77). Compared to controls (n = 61), cases (n = 20) were more likely to report visits to previously flooded areas (OR: 4.9; 95%-CI: 1.4-18) and the zoo (OR: 2.6; 95%-CI: 0.9-7.6). In multivariable analysis visits to the floodplain remained the sole risk factor (OR: 5.5; 95%-CI: 1.4-22). Only C.hominis of a single genotype (IbA9G2) was detected in stools. Oocysts were detected in samples from the river, two local lakes and three public swimming pools by microscopy, but not in the public water supply. CONCLUSIONS: Evidence suggests that activities in the dried out floodplain led to infection among children. Secondary transmissions may be involved. Consequently, authorities recommended to avoid playing, swimming and having picnics in the flood-affected area. Health authorities should consider the potential health risks of long-term surviving parasites persisting on flooded grounds and in open waters even several weeks after the flooding and of bathing places close to sewage spill-overs. Preventive measures comprise water sampling (involving parasites), information of the public and prolonged closures of potentially contaminated sites. |
format | Online Article Text |
id | pubmed-4344771 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-43447712015-03-01 Outbreak of cryptosporidium hominis following river flooding in the city of Halle (Saale), Germany, August 2013 Gertler, Maximilian Dürr, Matthias Renner, Peter Poppert, Sven Askar, Mona Breidenbach, Janina Frank, Christina Preußel, Karina Schielke, Anika Werber, Dirk Chalmers, Rachel Robinson, Guy Feuerpfeil, Irmgard Tannich, Egbert Gröger, Christine Stark, Klaus Wilking, Hendrik BMC Infect Dis Research Article BACKGROUND: During weeks 32–33, 2013, 24 cases of cryptosporidiosis were notified in the city of Halle (annual mean 2008–2012: 9 cases). We investigated the outbreak to identify the source and recommend control measures, considering that between weeks 23–25 the river Saale which flows through the city centre overflowed the floodplain, parts of the city centre and damaged sewage systems. METHODS: We defined a case as a resident of Halle with gastroenteritis, Cryptosporidium-positive stool and disease onset weeks 27 through 47. In a case–control study among kindergarten children, we compared cases and controls regarding environmental exposure, use of swimming pools, zoo visits and tap water consumption 14 days pre-onset or a corresponding 14-days-period (controls) and adjusted for residence. Stool specimens were tested by microscopy and PCR, and Cryptosporidium DNA was sequenced. Samples from public water system, swimming pools and river Saale were examined for Cryptosporidium oocysts (microscopy and PCR). RESULTS: Overall, 167 cases were detected, 40/167 (24%) were classified as secondary cases. First disease onsets occurred during week 29, numbers peaked in week 34 and started to decrease in week 36. Median age was 8 years (range: 0–77). Compared to controls (n = 61), cases (n = 20) were more likely to report visits to previously flooded areas (OR: 4.9; 95%-CI: 1.4-18) and the zoo (OR: 2.6; 95%-CI: 0.9-7.6). In multivariable analysis visits to the floodplain remained the sole risk factor (OR: 5.5; 95%-CI: 1.4-22). Only C.hominis of a single genotype (IbA9G2) was detected in stools. Oocysts were detected in samples from the river, two local lakes and three public swimming pools by microscopy, but not in the public water supply. CONCLUSIONS: Evidence suggests that activities in the dried out floodplain led to infection among children. Secondary transmissions may be involved. Consequently, authorities recommended to avoid playing, swimming and having picnics in the flood-affected area. Health authorities should consider the potential health risks of long-term surviving parasites persisting on flooded grounds and in open waters even several weeks after the flooding and of bathing places close to sewage spill-overs. Preventive measures comprise water sampling (involving parasites), information of the public and prolonged closures of potentially contaminated sites. BioMed Central 2015-02-22 /pmc/articles/PMC4344771/ /pubmed/25879490 http://dx.doi.org/10.1186/s12879-015-0807-1 Text en © Gertler et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Gertler, Maximilian Dürr, Matthias Renner, Peter Poppert, Sven Askar, Mona Breidenbach, Janina Frank, Christina Preußel, Karina Schielke, Anika Werber, Dirk Chalmers, Rachel Robinson, Guy Feuerpfeil, Irmgard Tannich, Egbert Gröger, Christine Stark, Klaus Wilking, Hendrik Outbreak of cryptosporidium hominis following river flooding in the city of Halle (Saale), Germany, August 2013 |
title | Outbreak of cryptosporidium hominis following river flooding in the city of Halle (Saale), Germany, August 2013 |
title_full | Outbreak of cryptosporidium hominis following river flooding in the city of Halle (Saale), Germany, August 2013 |
title_fullStr | Outbreak of cryptosporidium hominis following river flooding in the city of Halle (Saale), Germany, August 2013 |
title_full_unstemmed | Outbreak of cryptosporidium hominis following river flooding in the city of Halle (Saale), Germany, August 2013 |
title_short | Outbreak of cryptosporidium hominis following river flooding in the city of Halle (Saale), Germany, August 2013 |
title_sort | outbreak of cryptosporidium hominis following river flooding in the city of halle (saale), germany, august 2013 |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4344771/ https://www.ncbi.nlm.nih.gov/pubmed/25879490 http://dx.doi.org/10.1186/s12879-015-0807-1 |
work_keys_str_mv | AT gertlermaximilian outbreakofcryptosporidiumhominisfollowingriverfloodinginthecityofhallesaalegermanyaugust2013 AT durrmatthias outbreakofcryptosporidiumhominisfollowingriverfloodinginthecityofhallesaalegermanyaugust2013 AT rennerpeter outbreakofcryptosporidiumhominisfollowingriverfloodinginthecityofhallesaalegermanyaugust2013 AT poppertsven outbreakofcryptosporidiumhominisfollowingriverfloodinginthecityofhallesaalegermanyaugust2013 AT askarmona outbreakofcryptosporidiumhominisfollowingriverfloodinginthecityofhallesaalegermanyaugust2013 AT breidenbachjanina outbreakofcryptosporidiumhominisfollowingriverfloodinginthecityofhallesaalegermanyaugust2013 AT frankchristina outbreakofcryptosporidiumhominisfollowingriverfloodinginthecityofhallesaalegermanyaugust2013 AT preußelkarina outbreakofcryptosporidiumhominisfollowingriverfloodinginthecityofhallesaalegermanyaugust2013 AT schielkeanika outbreakofcryptosporidiumhominisfollowingriverfloodinginthecityofhallesaalegermanyaugust2013 AT werberdirk outbreakofcryptosporidiumhominisfollowingriverfloodinginthecityofhallesaalegermanyaugust2013 AT chalmersrachel outbreakofcryptosporidiumhominisfollowingriverfloodinginthecityofhallesaalegermanyaugust2013 AT robinsonguy outbreakofcryptosporidiumhominisfollowingriverfloodinginthecityofhallesaalegermanyaugust2013 AT feuerpfeilirmgard outbreakofcryptosporidiumhominisfollowingriverfloodinginthecityofhallesaalegermanyaugust2013 AT tannichegbert outbreakofcryptosporidiumhominisfollowingriverfloodinginthecityofhallesaalegermanyaugust2013 AT grogerchristine outbreakofcryptosporidiumhominisfollowingriverfloodinginthecityofhallesaalegermanyaugust2013 AT starkklaus outbreakofcryptosporidiumhominisfollowingriverfloodinginthecityofhallesaalegermanyaugust2013 AT wilkinghendrik outbreakofcryptosporidiumhominisfollowingriverfloodinginthecityofhallesaalegermanyaugust2013 |