title: An outbreak of Cryptosporidium hominis infection at an Illinois recreational waterpark.
abstract: Cryptosporidium has become increasingly recognized as a pathogen responsible for outbreaks of diarrhoeal illness in both immunocompetent and immunocompromised persons. In August 2001, an Illinois hospital reported a cryptosporidiosis cluster potentially linked to a local waterpark. There were 358 case-patients identified. We conducted community-based and waterpark-based case-control studies to examine potential sources of the outbreak. We collected stool specimens from ill persons and pool water samples for microscopy and molecular analysis. Laboratory-confirmed case-patients (n=77) were more likely to have attended the waterpark [odds ratio (OR) 16.0, 95% confidence interval (CI) 3.8-66.8], had pool water in the mouth (OR 6.0, 95% CI 1.3-26.8), and swallowed pool water (OR 4.5, 95% CI 1.5-13.3) than age-matched controls. Cryptosporidium was found in stool specimens and pool water samples. The chlorine resistance of oocysts, frequent swimming exposures, high bather densities, heavy usage by diaper-aged children, and increased recognition and reporting of outbreaks are likely to have contributed to the increasing trend in number of swimming pool-associated outbreaks of cryptosporidiosis. Recommendations for disease prevention include alteration of pool design to separate toddler pool filtration systems from other pools. Implementation of education programmes could reduce the risk of faecal contamination and disease transmission.
authors.affiliation: Division of Parasitic Diseases, National Center of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Causer
authors.forename: T
authors.initials: T
authors.lastname: Handzel
authors.forename: P
authors.initials: P
authors.lastname: Welch
authors.forename: M
authors.initials: M
authors.lastname: Carr
authors.forename: D
authors.initials: D
authors.lastname: Culp
authors.forename: R
authors.initials: R
authors.lastname: Lucht
authors.forename: K
authors.initials: K
authors.lastname: Mudahar
authors.forename: D
authors.initials: D
authors.lastname: Robinson
authors.forename: E
authors.initials: E
authors.lastname: Neavear
authors.forename: S
authors.initials: S
authors.lastname: Fenton
authors.forename: C
authors.initials: C
authors.lastname: Rose
authors.forename: L
authors.initials: L
authors.lastname: Craig
authors.forename: M
authors.initials: M
authors.lastname: Arrowood
authors.forename: S
authors.initials: S
authors.lastname: Wahlquist
authors.forename: L
authors.initials: L
authors.lastname: Xiao
authors.forename: Y-M
authors.initials: YM
authors.lastname: Lee
authors.forename: L
authors.initials: L
authors.lastname: Mirel
authors.forename: D
authors.initials: D
authors.lastname: Levy
authors.forename: M J
authors.initials: MJ
authors.lastname: Beach
authors.forename: G
authors.initials: G
authors.lastname: Poquette
authors.forename: M S
authors.initials: MS
authors.lastname: Dworkin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003457:Cryptosporidiosis / Q000453:epidemiology*; D003458:Cryptosporidium / Q000472:pathogenicity*; D041381:Diapers, Infant; D003967:Diarrhea / Q000209:etiology; D004196:Disease Outbreaks; D005260:Female; D005374:Filtration; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D007223:Infant; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011998:Recreation; D012307:Risk Factors; D013551:Swimming Pools; D014871:Water Microbiology