The global burden of crypto in children under 5

The protozoan Cryptosporidium is a leading cause of diarrhoea morbidity and mortality in children younger than 5 years. However, the true global burden of Cryptosporidium infection in children younger than 5 years might have been underestimated in previous quantifications because it only took account of the acute effects of diarrhoea. We aimed to demonstrate whether there is a causal relation between Cryptosporidium and childhood growth and, if so, to quantify the associated additional burden.

Methods

The Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2016 was a systematic and scientific effort to quantify the morbidity and mortality associated with more than 300 causes of death and disability, including diarrhoea caused by Cryptosporidium infection. We supplemented estimates on the burden of Cryptosporidium in GBD 2016 with findings from a systematic review of published and unpublished cohort studies and a meta-analysis of the effect of childhood diarrhoea caused by Cryptosporidium infection on physical growth.

Findings

In 2016, Cryptosporidium infection was the fifth leading diarrhoeal aetiology in children younger than 5 years, and acute infection caused more than 48 000 deaths (95% uncertainty interval [UI] 24 600–81 900) and more than 4·2 million disability-adjusted life-years lost (95% UI 2·2 million–7·2 million). We identified seven data sources from the scientific literature and six individual-level data sources describing the relation between Cryptosporidium and childhood growth. Each episode of diarrhoea caused by Cryptosporidium infection was associated with a decrease in height-for-age Z score (0·049, 95% CI 0·014–0·080), weight-for-age Z score (0·095, 0·055–0·134), and weight-for-height Z score (0·126, 0·057–0·194). We estimated that diarrhoea from Cryptosporidium infection caused an additional 7·85 million disability-adjusted life-years (95% UI 5·42 million–10·11 million) after we accounted for its effect on growth faltering—153% more than that estimated from acute effects alone.

Interpretation

Our findings show that the substantial short-term burden of diarrhoea from Cryptosporidium infection on childhood growth and wellbeing is an underestimate of the true burden. Interventions designed to prevent and effectively treat infection in children younger than 5 years will have enormous public health and social development impacts.

Morbidity, mortality, and long-term consequences associated with diarrhoea from cryptosporidium infection in children younger than 5 years: A meta-analyses study

The Lancet Global Health, DOI: https://doi.org/10.1016/S2214-109X(18)30283-3

Ibrahim A Khalil, Christopher Troeger, Puja C Rao…

https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30283-3/abstract#.WyQRPA3swGY.twitter

Funding

The Bill & Melinda Gates Foundation.

Playing in water, is it making you barf?

The U.S. Centers for Disease Control reports that outbreaks associated with treated recreational water can be caused by pathogens or chemicals.

During 2000–2014, 493 outbreaks associated with treated recreational water caused at least 27,219 cases and eight deaths. Outbreaks caused by Cryptosporidium increased 25% per year during 2000–2006; however, no significant trend occurred after 2007. The number of outbreaks caused by Legionella increased 14% per year.

The aquatics sector, public health officials, bathers, and parents of young bathers can take steps to minimize risk for outbreaks. The halting of the increase in outbreaks caused by Cryptosporidium might be attributable to Healthy and Safe Swimming Week campaigns.

Outbreaks associated with treated recreational water — United States, 2000–2014

18.may.18

Centers for Disease Control and Prevention

Michele C. Hlavsa, MPH; Bryanna L. Cikesh, MPH; Virginia A. Roberts, MSPH; Amy M. Kahler, MS; Marissa Vigar, MPH; Elizabeth D. Hilborn, DVM; Timothy J. Wade, PhD; Dawn M. Roellig, PhD; Jennifer L. Murphy, PhD; Lihua Xiao, DVM, PhD; Kirsten M. Yates, MPH; Jasen M. Kunz, MPH; Matthew J. Arduino, DrPH; Sujan C. Reddy, MD; Kathleen E. Fullerton, MPH; Laura A. Cooley, MD; Michael J. Beach, PhD; Vincent R. Hill, PhD; Jonathan S. Yoder, MPH

https://www.cdc.gov/mmwr/volumes/67/wr/mm6719a3.htm

23 sick: Cryptosporidiosis outbreak in Illinois linked to 4-H projects

The Clark and Champaign county health departments say they’re investigating 23 possible cases of cryptosporidiosis linked to dairy calves brought to the region for youth 4-H projects. 

The calves were sold to children.  A Clark County epidemiologist says hydrogen peroxide is the only known disinfectant for killing the parasite. No other information has been released. 

In memorandum: Wisconsin epidemiologist Jeffrey Davis identified Milwaukee’s Cryptosporidium outbreak

I was a new doctoral student when cryptosporidiosis sickened over 400,000 people and killed 69 in Wisconsin in the spring of 1993.

I had recently started the Food Safety Network, which was bringing daily updates to scientists and public health folks who usually had to wait 6 months for the U.S. Centers for Disease Control’s Morbidity and Mortality Weekly to arrive.

It may seem trivial now, but it was a big deal in its day.

Lotsa posers and copycats over the years, so we went to barfblog.com.

Later that year, cryptosporidiosis would sicken hundreds in Kitchener-Waterloo, where I was living with my young family.

Somehow, I was speaking about this to our home-renovator-contractor-and-therapist yesterday while he unplugged our kitchen faucet.

And then I got this.

Meg Jones of the Milwaukee Journal Sentinel writes that as doctors’ offices filled with Milwaukeeans suffering from a mysterious illness in 1993, Mayor John Norquist called a meeting with state and local officials.

Norquist asked state epidemiologist Jeffrey Davis whether he would drink a glass of Milwaukee’s water and when Davis said he would not, Norquist issued a massive boil water advisory that affected more than 1 million residents.

With decades of work in public health, Davis was the perfect person to figure out a little-known parasite cryptosporidiosis could be the culprit that sickened more than 400,000 people.

As state epidemiologist for the past four decades, Davis was Wisconsin’s doctor.

He was a medical sleuth who figured out the connection between toxic shock syndrome and tampons and helped determine the infectious agent transmitted by ticks that causes Lyme disease. 

Davis, 72, died of pneumonia in Madison Jan. 16.

“Jeff’s knowledge of the literature helped identify the (Cryptosporidium) outbreak earlier. Cryptosporidiosis at that point was a pretty rare pathogen,” said State Public Health Veterinarian James Kazmierczak.

Knowing about a similar waterborne outbreak elsewhere in the U.S., Davis asked to see data on water quality in Milwaukee and noticed a spike in turbidity at the same time that people began to get sick. At the time, city water supplies were not tested for Cryptosporidium.

“Because of Jeff’s knowledge of what happened earlier with cryptosporidiosis, that became the leading suspect,” said Kazmierczak.

Davis grew up in Whitefish Bay and earned an undergraduate degree in chemistry in 1967 at University of Wisconsin-Madison and his medical degree in 1971 at the University of Chicago. He did his internship and residency in pediatrics in Florida and from 1973 to 1975 worked for the U.S. Centers for Disease Control and the South Carolina Department of Health.

After a stint at Duke University Medical Center, he returned to Wisconsin in 1978 as state epidemiologist and chief of the division of acute and communicable diseases. In 1991, his job title changed to chief medical officer and state epidemiologist for communicable diseases.

“He loved being a sleuth and medical detective, leading investigations of all sorts, from toxic shock syndrome to Legionnaires’ outbreaks, to the Cryptosporidium water supply outbreak, which was huge,” said his wife Roseanne Clark.

“He really was passionate about trying to figure out the source to reduce the impact on as many people as possible. He cared about the health of the people of Wisconsin.”

Water water everywhere, but is it safe?

Potable water and the U.S. Centers for Disease Control: two things we take for granted.

CDC reports that during 2013–2014, a total of 42 drinking water–associated outbreaks were reported, resulting in at least 1,006 cases of illness, 124 hospitalizations, and 13 deaths. Legionella was responsible for 57% of outbreaks and 13% of illnesses, and chemicals/toxins and parasites together accounted for 29% of outbreaks and 79% of illnesses. Eight outbreaks caused by parasites resulted in 289 (29%) cases, among which 279 (97%) were caused by Cryptosporidium and 10 (3%) were caused by Giardia duodenalis. Chemicals or toxins were implicated in four outbreaks involving 499 cases, with 13 hospitalizations, including the first outbreaks associated with algal toxins.

To provide information about drinking water–associated waterborne disease outbreaks in the United States in which the first illness occurred in 2013 or 2014 (https://www.cdc.gov/healthywater/surveillance/drinking-surveillance-reports.html), CDC analyzed outbreaks reported to the CDC Waterborne Disease and Outbreak Surveillance System through NORS (https://www.cdc.gov/nors/about.html) as of December 31, 2015. For an event to be defined as a waterborne disease outbreak, two or more cases must be linked epidemiologically by time, location of water exposure, and illness characteristics; and the epidemiologic evidence must implicate water exposure as the probable source of illness. Data requested for each outbreak include 1) the number of cases, hospitalizations, and deaths; 2) the etiologic agent (confirmed or suspected); 3) the implicated water system; 4) the setting of exposure; and 5) relevant epidemiologic and environmental data needed to understand the outbreak occurrences and for determining the deficiency classification.§ One previously unreported outbreak with onset date of first illness in 2012 is presented but is not included in the analysis of outbreaks that occurred during 2013–2014.

Public health officials from 19 states reported 42 outbreaks associated with drinking water during the surveillance period (Table 1) (https://www.cdc.gov/healthywater/surveillance/drinking-water-tables-figures.html).

One outbreak reported during 2013–2014 in an individual system led to 100 estimated illnesses associated with a wedding. The public health challenges highlighted here underscore the need for rapid detection, identification of the cause, and response when drinking water is contaminated by infectious pathogens, chemicals, or toxins to prevent and control waterborne illness and outbreaks.

‘Many sick’ from crypto in Norway

Thanks to our Norwegian correspondent, we now know the Norwegian Food Safety Authority was notified on September 26, 2017, of a Cryptosporidium outbreak, and after talking to the sick, they could narrow the time of infection to 14-16. September,

The Food Safety Authority believes the people were infected at the Taqueros Taco & Tequila restaurant (because when I think Norway, I think tacos and tequila, not schnapps and raw fish).

The restaurant decided to shut one day to wash the premises when they heard about the outbreak and that the infection came from them.

The source of the infection was not found, but the Norwegian Food Safety Authority emphasizes that they do not discourage people from eating at the restaurant.

Specialist warden Erik Wahl in Mattilsynet in Trondheim and surroundings said, “We have reason to believe that the infection is now gone, as no people who have become ill after September 16 have not been reported. We have no reason to discourage people to eat at this restaurant.”

 

‘Pathetic’ £450,000 fine because of crypto in UK water supply

Ed Walker of Blog Preston writes the reason why Prestonians couldn’t drink their water without boiling it for a month has finally been revealed.

United Utilities has been fined after a cryptosporidium outbreak at its Franklaw treatment plants to the north of Preston,

The Drinking Water Inspectorate found the problems came from the Franklaw works using a different reservoir to source water

Rainwater running off agricultural land was able to access an underground water tank at Barnacre.

A ‘planned change in operations’ allowed the entry of the contaminated water into the treatment process.

Traces of cryptosporidium were detected in the water at Franklaw triggering a shut off of supplies for 700,000 people across Lancashire.

Supplies for many were knocked out for a month during the summer of 2015 as engineers worked to fix the issue.

At Preston Crown Court the hearing fined United Utilities £300,000 and additional costs of £150,000 were also agreed. The firm had pleaded guilty to supplying water unfit for human consumption.

United Utilities was criticised for not acting fast enough to issue the boil water warning to households and businesses.

It has since paid out £20million in compensation to customers through reduced water bills.

The fine was branded ‘pathetic’ by Preston MP Mark Hendrick.

How bad FSANZ is at risk communication (or restrained by gov’t rules): At least 5 sick from crypto linked to raw milk

Below is the official Food Standards Australia New Zealand (FSNAZ) public announcement of an outbreak of crypto that has sickened at least 5 people linked to a raw milk cow share agreement:

RAW COW’S MILK

1 litre, 2 litre, 3 litre

Date marking:   NONE

MS & HJ TYLER is conducting a recall of the above product. The product has been available for sale online and at farm gate in SA.

Problem: The recall is due to microbial (Cryptosporidium) contamination

Food safety hazard: Food products contaminated with (Cryptosporidium) may cause illness if consumed.

What to do: Any consumers concerned about their health should seek medical advice and should return the product to the place of purchase for a full refund.

For further information please contact:

Mark Tyler

0414492466

mooviewdairy.com.au

Media recorded actual facts about people being sick.

You’d think government could do the same.

At least 5 sick with crypto: Raw milk from Moo View Dairy recalled by South Australian health types

There was this one time, about 1979, when me and my high school buddies fell into some tickets for Can-Am car racing, which none of us cared about.

So we stayed up all night as high school students do, and then I was the designated driver to Mosport, Ontario, a few hours away.

On the way we stopped at a truck stop off the 401 near Bowmanville, Ontario, and my friends, who were quite stoned, couldn’t stop laughing about the moo-moo cow creamer on every table.

It was pasteurized.

The stuff from Willunga Hill’s Moo View Dairy is not, and the dairy will be prohibited from selling and distributing raw cow’s milk after it was linked to at least five cases of gastroenteritis.

Brad Crouch, medical reporter at The Advertiser, writes, SA Health has taken the action under the Food Act 2001 and the South Australian Public Health Act 2011, after the sicknesses were linked to drinking unpasteurised (raw) cow’s milk.

SA Health Director of Public Health Associate Professor Kevin Buckett said the sale of raw cow’s milk for human consumption is illegal in Australia due to its high risk of contamination.

“We’ve confirmed at least five cases where people aged between three and 70 contracted gastrointestinal illness caused by the Cryptosporidium parasite after consuming raw cow’s milk products purchased from Moo View Dairy, and this number is likely to be higher,” he said.

“Luckily, these people did not require hospitalisation, but it is important to remember that raw cow’s milk products should not be consumed as they can contain harmful bacteria such as E.coli, salmonella, campylobacter, and listeria, as well as cryptosporidium.

“In June we noticed higher than expected numbers of cryptosporidiosis cases and following interviews and investigations, we identified Moo View Dairy’s raw cow’s milk as a common factor between five cases,” Assoc Prof Buckett said.

“We’ve also identified another two potential cases that implicate raw cow’s milk as the cause of illness.

And the next year, Mosport had this (and yes, that’s John (J.D.) Roberts doing some of the interviews for Much Music. He can be now found as chief White House correspondent for Fox News (gag me). Oh, and I arranged Teenage Head to play our high school in 1979.

Raw is risky.

Fall fairytale: Lawsuit filed after crypto-in-apple-cider sickened more than 100 in 2015

In Oct. 2015, fall festival revellers flocked to the Pike Country Color Drive in Pike County, Illinois, and a bunch of them were soon barfing.

Unpasteurized apple cider – a staple of the northern U.S. and Canadian fall festival circuit was blamed for causing more than 100 people to fall ill with cryptosporidiosis.

Nick Draper of My Journal Courier reports a lawsuit has now been files against several groups, including the Pike County Chamber of Commerce and the Barry Business Association.

Melissa Kinman of Quincy filed the civil action against Steven and Linda Yoder of Yoder Brothers Dairy Farm, the Pike County Chamber of Commerce and the Barry Business Association. In it, she contends the Yoders were selling and offering free samples of unpasteurized cider that was tainted with Cryptosporidium.

The outbreak sickened people ranging in age from less than 1 year old to 89 years old.

Health workers from Pike and Adams counties, the state and the Centers for Disease Control and Prevention began investigating reports of profuse or bloody diarrhea, abdominal cramping and vomiting. Tests done in December 2015 by the CDC confirmed there was cider contaminated with Cryptosporidium.

Cider was not sold at last year’s drive after officials decided to pull the product.

A list of cider and juice-related outbreaks — 84 outbreaks leading to over 3,500 illnesses going back to 1924 – is available here.

http://barfblog.com/wp-content/uploads/2015/11/Juice-related-outbreaks-11-5-15.xlsx