title: An evaluation of health protection practices for the investigation and management of Cryptosporidium in England and Wales.
abstract: Cryptosporidium is a major cause of gastroenteritis (cryptosporidiosis). Case and outbreak report rates vary geographically, which may in part reflect public health practice.
  
  
  
  To examine the public health management of cryptosporidiosis, an online questionnaire was administered to the 28 Health Protection Teams (HPTs) in England and Wales in 2014. Practices for investigation and management of cases and outbreaks were compared.
  
  
  
  Practice varied among the 24 (86%) respondents in terms of who undertook actions (HPT or Local Authority) to investigate and manage cryptosporidiosis. HPTs without exceedance monitoring detected fewer outbreaks (1/5, 20%) than those with it (13/19, 68%) (P = 0.12), and those that always administered a risk-factor questionnaire detected more outbreaks (12/19, 63%) than those who did this only sometimes (2/5, 40%) (P = 0.62). Significantly more HPTs with a system to detect common exposures reported at least one outbreak (14/19, 74%) compared to HPTs with no system (0/5) (P = 0.01).
  
  
  
  Applying exceedance monitoring, using a standardized questionnaire taking into account the incubation period for Cryptosporidium, and having a structured system to detect common exposures increased outbreak detection. Information about all cases should be shared between local public health authorities, and current guidance used for the prevention of spread.
authors.affiliation: Public Health Wales Microbiology and Health Protection, Singleton Hospital, Swansea SA2 8QA, UK.|Swansea University Medical School, Grove Building, Swansea University, Singleton Park, Swansea SA2 8PP, UK.
authors.forename: R M
authors.initials: RM
authors.lastname: Chalmers
authors.affiliation: Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.|NIHR Health Protection Research Unit in GI Infections, University of Oxford, Oxford OX1 3PS, UK.
authors.forename: N
authors.initials: N
authors.lastname: McCarthy
authors.affiliation: Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
authors.forename: K L
authors.initials: KL
authors.lastname: Barlow
authors.affiliation: Health Protection Team, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, UK.
authors.forename: R
authors.initials: R
authors.lastname: Stiff
mesh_terms: D003457:Cryptosporidiosis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D003458:Cryptosporidium; D004196:Disease Outbreaks; D060766:Drinking Water / Q000469:parasitology; D004739:England; D004784:Environmental Monitoring; D006801:Humans; D011159:Population Surveillance; D015980:Public Health Practice / Q000592:standards; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013551:Swimming Pools; D014852:Wales; D014881:Water Supply
chemical_list: D060766:Drinking Water