Cryptosporidium

General information
Epidemiology
Data for Wales (1990-2012)
Sources of surveillance data for Wales
Requests for further surveillance data
Links to other Cryptosporidium surveillance

General information

Cryptosporidium is a protozoan (single celled) parasite which, if ingested, can cause an illness called cryptosporidiosis (crypto).

The main symptom is severe watery diarrhoea which is often accompanied by stomach cramps, fatigue, nausea, vomiting, fever and sometimes weight loss. The illness normally last for one to three weeks and may come in cycles with periods of recovery followed by onset of symptoms again.

Some people can carry the organism but not have any symptoms although they are still able to pass the infection onto others.

Most healthy people with cryptosporidiosis will recover without treatment although the advice of a health professional should be sought in all cases of severe diarrhoea (especially in babies, children and the elderly). Oral rehydration therapy maybe advised to prevent dehydration.

Cryptosporidiosis can be a severe and potentially life-threatening illness in individuals with weakened immune systems and can lead to chronic and prolonged infection.

It is a leading cause of human gastrointestinal infection in the

. Young farm animals can also suffer from Cryptosporidium diarrhoea.

A number of species of Cryptosporidium infect mammals. In humans the main causes of disease are C. parvum and C. hominis (previously C. parvum genotype 1). C. canis, C. felis, C. meleagridis, and C. muris can also cause disease in humans.

Millions of infectious Cryptosporidium oocysts (the hardy cyst stage of the parasites lifecycle) can be released in a bowel movement from an infected human or animal. Cryptosporidium is found in soil, food, water, or on surfaces that have been contaminated with infected faeces.

Oocysts can survive in water and damp soil for prolonged periods and are resistant to levels of chlorine and other disinfectants used in conventional water treatment, their removal depending crucially on filtration.

Human infection may be acquired by four main routes: from other people, from animals and their faeces, from untreated drinking water contaminated by either agricultural or human sewage sources, and from swimming in contaminated water. Infection is frequently associated with foreign travel. Occasionally infection can result from eating and drinking contaminated food, particularly unpasteurised milk and salads/raw vegetables washed or irrigated with contaminated water or cultivated in faeces-contaminated soil.

Person to person spread, particularly within households and child care centres, may also account for a substantial proportion of cases.

Large community outbreaks of cryptosporidiosis may occur through contamination of public water supplies when physical elements of water treatment have been inadequate, and from exposure to contaminated recreational waters, especially swimming pools. Guidance for health professionals on the investigation of Cryptosporidium linked to swimming pools is available from the UK Cryptosporidium Reference Unit webpage at: http://www.wales.nhs.uk/sites3/page.cfm?orgid=457&pid=49029

Cryptosporidiosis is highly infectious so proper sanitation and good hygiene practices are important measures in the prevention of cryptosporidiosis. More details about these measures and additional information about cryptosporidiosis are available from the Public Health Wales main website at: http://www.wales.nhs.uk/sitesplus/888/page/44044

Further information about Cryptosporidium is also available from the following websites:

Epidemiology

Infection with Cryptosporidium occurs in all age group althoughthe highest incidence is in children under aged under 5 years.

People with occupational exposure to animals, such as farmers, vets and slaughterhouse workers, are at increased risk of contracting the infection.

In Wales (and the rest of the UK) Cryptosporidiosis cases show a marked seasonal trend with peaks recorded in spring and late summer/early autumn. When species typing is undertaken, Cryptosporidium parvum is the most common strain detected in the spring peak (infection mainly acquired from contact with infected lambs and calves) and Cryptosporidium hominis most common in the autumn peak (infection often acquired from overseas travel and from recreational water activities).

During October-December 2005, an outbreak of cryptosporidiosis occurred in the Anglesey and Gynwedd areas of Wales with 231 confirmed cases recorded. The probable source of the parasite was a local reservoir that supplied drinking water to those areas affected. The outbreak strain was identified as Cryptosporidium hominis. The report of the Outbreak Control Team is available from: Publications and Guidance

During August-September 2009, an outbreak of cryptosporidiosis occurred in Merthyr Tydfil with the use of a swimming pool in a local leisure centre a common risk factor in all cases. One hundred and six cases were reported with 45 of these laboratory confirmed; the most likely source of this outbreak was a faecal accident in the pool. The report of the Outbreak Control Team is available from: Publications and Guidance

Data for Wales (1990-2012)

Reports of the rates and numbers of laboratory-confirmed Cryptosporidium infections in Wales are published monthly and are available to download from: Monthly All-Wales Laboratory-Confirmed Infections and Notifications Reports

Time trend data using CoSurv laboratory/notification data for laboratory-confirmed Cryptosporidium infection for Wales from 1993-2012 can be generated interactively from this website on an individual Local Authority basis. Age range and sex can also be specified.

The yearly geographical distribution of Cryptosporidium infection in Wales (1997-2011) is also available. Please use the link below to access the interactive trend data tool on this website:

Get Interactive Trend Data for Wales

Please note: these data may vary from HPA reports

Laboratory reports of Cryptosporidium in Wales: 1990-2011

Data retrieved 28 September 2012; Numbers will rise as further reports are received, particularly for recent years.

Source: CDSC Wales:
http://www.wales.nhs.uk/sites3/page.cfm?orgid=457&pid=27920

Laboratory reports of Cryptosporidium in Wales: 1990-2012*

Year	*Laboratory reports of Cryptosporidium* spp**	Rate per 100,000 population
1990	199	6.9
1991	340	11.8
1992	338	11.7
1993	330	11.5
1994	340	11.8
1995	381	13.2
1996	258	8.9
1997	242	8.4
1998	285	9.9
1999	342	11.8
2000	356	12.3
2001	237	8.2
2002	175	6.0
2003	329	11.2
2004	192	6.5
2005	461	15.6
2006	209	7.0
2007	191	6.4
2008	246	8.2
2009	440	14.7
2010	286	9.5
2011	248	8.1
2012*	283	9.2

* Data until 28/09/2012; Numbers will rise as further reports are received, particularly for recent years.

Source: CDSC Wales:
http://www.wales.nhs.uk/sites3/page.cfm?orgid=457&pid=27920

Laboratory reports of Cryptosporidium in Wales by month: 1999-2012*

* Data until 28/09/2012; Numbers will rise as further reports are received, particularly for recent years.

Source: CDSC Wales:
http://www.wales.nhs.uk/sites3/page.cfm?orgid=457&pid=27920

Laboratory reports of Cryptosporidium in Wales by age range and sex: 2011*

Cryptosporidium laboratory confirmations by age and sex: 2011

* Data until 28/09/2012;; Numbers will rise as further reports are received, particularly for recent years.

Source: CDSC Wales:
http://www.wales.nhs.uk/sites3/page.cfm?orgid=457&pid=27920

Laboratory reports of Cryptosporidium in Wales by age range and sex: 2011

	<1	01-04	05-14	15-24	25-34	35-44	45-54	55-64	65+	NK	Total
Female	3	24	29	23	24	16	7	6	0	1	133
Male	0	42	27	18	8	6	2	1	5	0	109
Unknown	0	3	2	0	1	0	0	0	0	0	6
Total	3	69	58	41	33	22	9	7	5	1	248

* Data retrived 28/09/2012; Numbers will rise as further reports are received, particularly for recent years.

Source: CDSC Wales:
http://www.wales.nhs.uk/sites3/page.cfm?orgid=457&pid=27920

Sources of surveillance data for Wales

Recent and historical Trends: In Wales, Cryptosporidium infection is confirmed by laboratory testing of (usually) faecal samples.

Laboratory confirmed data for Cryptosporidium in Wales is compiled by our database CoSurv and it is these data that is used to generate the trend data from 1990-2011.

These are raw data and has therefore not yet been subject to data cleaning and maybe incomplete. Differences in small numbers should not necessarily be interpreted as reflecting real changes. These data are made available with these caveats to enable universal access to timely data on broad trends in infectious diseases in Wales.

Notification data: Cryptosporidium is one of a number of organisms which give rise to gastro-intestinal illness. Gastro-intestinal infections that are foodborne are categorised as food poisoning. A food is defined as any substance or product, whether processed, partially processed or unprocessed intended to be, or reasonably expected to be ingested by humans (Reg. (EC) No 178/2002), including drinking water (Reg. (EC) No 178/2002).

Food poisoning is a notifiable infectious disease in Wales and the UK. Numbers of food poisoning notifications for Wales are collated on a weekly basis by Public Health Wales: view surveillance data for food poisoning in Wales

Cryptosporidium is identified as the causative agent in a proportion of food poisoning notifications after laboratory testing. Additional testing may also be undertaken to determine the species of Cryptosporidium present.

The Cryptosporidium Reference Unit, the reference laboratory for Cryptosporidium and which provides specialist microbiology tests and services for England and Wales, is based at Public Health Wales Microbiology ABM.

Requests for further surveillance data

If further surveillance data for Cryptosporidium in Wales is required, it may be possible to provide it on special request. Please use the surveillance data request form provided from this link.

Links to other Cryptosporidium surveillance

Last updated: 01/10/2012