Cross-sectional investigation of household transmission of Cryptosporidium in England and Wales: the epiCrypt study protocol

INTRODUCTION: Infection with the Cryptosporidium parasite causes over 4000 cases of diagnosed illness (cryptosporidiosis) in England and Wales each year. Risk factors are often estimated from outbreak investigations, and in the UK include ingestion of contaminated water and food, farm/animal contact and person-to-person spread in institutions. However, reported outbreaks only represent about 10% of cases and the transmission routes for sporadic disease may not be the same. Contact with other people has been highlighted as a factor in the transmission of Cryptosporidium, but the incidence of sporadic disease has not been sufficiently established, and how frequently this arises from contact with other infected people is not well documented. This project will estimate the amount of secondary spread that occurs in the home and potentially identify asymptomatic infections which might have a role in transmission. Risk factors and characteristics associated with secondary spread will be described including any differences in transmission between Cryptosporidium species. METHODS AND ANALYSIS: The study will prospectively identify cryptosporidiosis cases from North West England and Wales over 1 year and invite them and their household to take part. Each household will complete a questionnaire and each household member will be asked to provide a stool sample. Clinical, demographic and home variables will be described, and further analyses undertaken to investigate associations with secondary spread in the home. Cryptosporidium-positive stool samples, identified by immunofluorescence microscopy, will be characterised using molecular methods to describe patterns of transmission. Data collection is expected to take 1 year, beginning in September 2018. ETHICS AND DISSEMINATION: The study has been approved by the North West–Liverpool East NHS Research Ethics Committee (Reference: 18/NW/0300) and the Confidentiality and Advisory Group (Reference 18/CAG/0084). Outputs will include scientific conferences and peer-reviewed publications. In addition, a short, lay report of findings will be produced for participants, who can opt to receive this when they take part. TRIAL REGISTRATION NUMBER: CPMS ID: 39458.