title: Multiple risk factors associated with a large statewide increase in cryptosporidiosis.
abstract: Cryptosporidium species have emerged as a major cause of outbreaks of diarrhoea and have been associated with consumption of contaminated recreational and drinking water and food as well as contact with infected attendees of child-care programmes. In August 2007, the Colorado Department of Public Health and Environment detected an increase in cryptosporidiosis cases over baseline values. We conducted a case-control study to assess risk factors for infection and collected stool specimens from ill persons for microscopy and molecular analysis. Laboratory-confirmed cases (n=47) were more likely to have swallowed untreated water from a lake, river, or stream [adjusted matched odds ratio (aOR) 8.0, 95% confidence interval (CI) 1.3-48.1], have had exposure to recreational water (aOR 4.6, 95% CI 1.4-14.6), or have had contact with a child in a child-care programme or in diapers (aOR 3.8, 95% CI 1.5-9.6). Although exposure to recreational water is commonly implicated in summertime cryptosporidiosis outbreaks, this study demonstrates that investigations of increased incidence of cases in summer should also examine other potential risk factors. This study emphasizes the need for public health education efforts that address the multiple transmission routes for Cryptosporidium and appropriate prevention measures to avoid future transmission.
authors.affiliation: Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. AValderrama@cdc.gov
authors.forename: A L
authors.initials: AL
authors.lastname: Valderrama
authors.forename: M C
authors.initials: MC
authors.lastname: Hlavsa
authors.forename: A
authors.initials: A
authors.lastname: Cronquist
authors.forename: S
authors.initials: S
authors.lastname: Cosgrove
authors.forename: S P
authors.initials: SP
authors.lastname: Johnston
authors.forename: J M
authors.initials: JM
authors.lastname: Roberts
authors.forename: M L
authors.initials: ML
authors.lastname: Stock
authors.forename: L
authors.initials: L
authors.lastname: Xiao
authors.forename: K
authors.initials: K
authors.lastname: Xavier
authors.forename: M J
authors.initials: MJ
authors.lastname: Beach
mesh_terms: D016022:Case-Control Studies; D003120:Colorado / Q000453:epidemiology; D003457:Cryptosporidiosis / Q000453:epidemiology*; D004196:Disease Outbreaks; D006801:Humans; D012306:Risk; D013997:Time Factors