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Management of a Cryptosporidiosis Outbreak in the South East – Lessons Learned. Dr BethAnn Roch Dr Ann Marie O’Byrne Consultants in Public Health Medicine, HSE-SE On behalf of the Incident Response Team. Outline of Presentation. Description of outbreak Results Action taken Discussion

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management of a cryptosporidiosis outbreak in the south east lessons learned

Management of a Cryptosporidiosis Outbreak in the South East – Lessons Learned

Dr BethAnn Roch

Dr Ann Marie O’Byrne

Consultants in Public Health Medicine, HSE-SE

On behalf of the Incident Response Team

outline of presentation
Outline of Presentation
  • Description of outbreak
  • Results
  • Action taken
  • Discussion
    • Issues arising
    • Lessons learned
problem identification
Problem Identification
  • Trigger: 4 cases of cryptosporidiosis in a 3 week period in Carlow
  • Notifiable disease in ROI since Jan 2004

Immediate actions

  • Enhanced surveillance
  • Contact PEHO  County Council
  • Contact GPs  advise vulnerable i.c. to boil water

 AIG to send stool samples

  • Meeting convened between HSE-SE and County Council
descriptive epidemiology
Descriptive Epidemiology
  • 31 laboratory confirmed cryptosporidiosis
  • 18 females, 13 males: 8 cases hospitalised
enhanced surveillance
Enhanced Surveillance
  • Other risk factors
    • crèche contacts (8)
    • swimming pool (5)
    • private wells (9)
    • animals (14)
    • travel (3)
  • 11 had no RF other than town water
results
Results
  • Water results
    • Cryptosporidium 0.04/10L
    • Giardia 0.02/10L
    • Microbiology clear
  • Faecal results
    • 31 laboratory confirmed cases
    • 7 samples sent for genotyping: C. hominis
actions
Actions
  • Regular meetings of IRT
  • Swimming pool sampling and advice
  • Private wells sampled
  • Crèche visits and advice
  • Council water measures
    • Water sampling
    • Risk assessments
    • Boil notice
    • Programme of works to minimise risk
issues arising
Issues arising
  • Water
  • Advice to vulnerable populations
  • Communication
cryptosporidium species
Cryptosporidium species
  • Faecal
    • C. hominis
  • Water
    • C. parvum
    • C. andersoni
    • C. muris
  • Implications – reassurance?
    • Intermittent excretion, small dose infective dose
    • Immunocompromised
    • Evidence of breakthrough
an acceptable level
An ‘acceptable’ level
  • Sampling
    • Volume 500-1000L
    • Grab/continuous
    • 2 filters/3 labs
  • Standards
    • UK
    • NI and Scotland
  • Types identified
    • Virulence of C hominis
  • Nature of source
  • Decision – 0.05 oocysts/10L
slide16

Clostridium perfringens

Source: Carlow County Council

slide18

Turbidity

Grab sample of final water turbidity

In line turbidity of filter outlet

Standard 1 NTU

Source: Carlow County Council

advice to vulnerable populations
Advice to vulnerable populations
  • Infants
    • Widespread availability/use of bottled water
    • FSAI recommendations
  • Immunocompromised
    • Advised through medical professionals
    • Recommendations
      • UK and USA
      • Proposed Irish guidelines
      • Recommendations of IRT
communication
Communication
  • Proactive
    • Council meetings
    • Press interviews
    • Notice distribution and updates
    • Helpline
    • Website
    • FAQs
    • Links
  • Website www.carlow.ie
communication interagency
Communication - interagency
  • Health Service and County Council
    • IRT – engineers, EHOs, public health doctors, surveillance scientists, microbiologist
    • Protocol for microbiological incidents
    • Water Liaison group meetings
  • Reports written in collaboration
  • Presentations supported
  • Regular meetings
  • Update protocol
lessons learned
Lessons learned
  • Interpretation of water results
  • Advice to vulnerable groups
  • Importance of communication
  • Building good working relationships
  • Management of water incidents is complex and requires input from several different disciplines.
acknowledgements
Acknowledgements
  • HSE-SE staff & Carlow County Council
  • Dr Phil Jennings, A/DPH, HSE-M
  • Dr Derval Igoe/Dr Paul McKeown, HPSC
  • Dr Maire O’Connor, Consultant in PHM, HSE-E
  • Dr Gordon Nichols, Deputy Head, Environmental & Enteric Diseases Dept, HPA
  • Dr David Stewart, DPH, EHSSB
  • Ms Gemma Leane, HSE-SE
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