title: Cryptosporidium hominis Is a Newly Recognized Pathogen in the Arctic Region of Nunavik, Canada: Molecular Characterization of an Outbreak.
abstract: BACKGROUND
  Cryptosporidium is a leading cause of childhood diarrhea in low-resource settings, and has been repeatedly associated with impaired physical and cognitive development. In May 2013, an outbreak of diarrhea caused by Cryptosporidium hominis was identified in the Arctic region of Nunavik, Quebec. Human cryptosporidiosis transmission was previously unknown in this region, and very few previous studies have reported it elsewhere in the Arctic. We report clinical, molecular, and epidemiologic details of a multi-village Cryptosporidium outbreak in the Canadian Arctic.
  
  
  RESULTS
  We investigated the occurrence of cryptosporidiosis using a descriptive study of cases with onset between April 2013 and April 2014. Cases were defined as Nunavik inhabitants of any age presenting with diarrhea of any duration, in whom Cryptosporidium oocysts were detected by stool microscopy in a specialised reference laboratory. Cryptosporidium was identified in stool from 51 of 283 individuals. The overall annual incidence rate (IR) was 420 / 100,000 inhabitants. The IR was highest among children aged less than 5 years (1290 /100,000 persons). Genetic subtyping for stool specimens from 14/51 cases was determined by DNA sequence analysis of the 60 kDa glycoprotein (gp60) gene. Sequences aligned with C. hominis subtype Id in all cases. No common food or water source of infection was identified.
  
  
  CONCLUSIONS
  In this first observed outbreak of human cryptosporidiosis in this Arctic region, the high IR seen is cause for concern about the possible long-term effects on growth and development of children in Inuit communities, who face myriad other challenges such as overcrowding and food-insecurity. The temporal and geographic distribution of cases, as well as the identification of C. hominis subtype Id, suggest anthroponotic rather than zoonotic transmission. Barriers to timely diagnosis delayed the recognition of human cryptosporidiosis in this remote setting.
authors.affiliation: Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, Canada.
authors.forename: Karine
authors.initials: K
authors.lastname: Thivierge
authors.affiliation: Bureau of Microbial Hazards, Food Directorate, Health Canada, Ottawa, Canada.
authors.forename: Asma
authors.initials: A
authors.lastname: Iqbal
authors.affiliation: Bureau of Microbial Hazards, Food Directorate, Health Canada, Ottawa, Canada.
authors.forename: Brent
authors.initials: B
authors.lastname: Dixon
authors.affiliation: Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, Canada.
authors.forename: Réjean
authors.initials: R
authors.lastname: Dion
authors.affiliation: Direction de la santé environnementale et de la toxicologie, Institut national de santé publique du Québec, Québec City, Canada.
authors.forename: Benoît
authors.initials: B
authors.lastname: Levesque
authors.affiliation: Centre d'expertise en analyse environnementale du Québec, Ministère du Développement durable, de l'Environnement, et de la Lutte contre les changements climatiques, Québec City, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Cantin
authors.affiliation: J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, Canada.|Department of Medical Microbiology, McGill University Health Centre, Montreal, Canada.
authors.forename: Lyne
authors.initials: L
authors.lastname: Cédilotte
authors.affiliation: National Reference Center for Parasitology, Montreal, Canada.
authors.forename: Momar
authors.initials: M
authors.lastname: Ndao
authors.affiliation: Department of Public Health, Nunavik Regional Board of Health and Social Services, Kuujjuaq, Canada.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Proulx
authors.affiliation: J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, Canada.|Department of Medical Microbiology, McGill University Health Centre, Montreal, Canada.
authors.forename: Cedric P
authors.initials: CP
authors.lastname: Yansouni
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D001110:Arctic Regions; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003457:Cryptosporidiosis / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission; D003458:Cryptosporidium / Q000235:genetics* / Q000302:isolation & purification; D016054:DNA, Protozoan / Q000235:genetics; D003967:Diarrhea / Q000453:epidemiology / Q000469:parasitology; D004196:Disease Outbreaks; D005243:Feces / Q000469:parasitology; D005260:Female; D005838:Genotype; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D033661:Oocysts / Q000648:ultrastructure; D015800:Protozoan Proteins / Q000235:genetics; D017422:Sequence Analysis, DNA; D055815:Young Adult
chemical_list: D016054:DNA, Protozoan; D015800:Protozoan Proteins