Management of a cryptosporidiosis outbreak in the south east lessons learned
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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

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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


Epidemic curve

Epidemic Curve


Descriptive epidemiology

Descriptive Epidemiology

  • 31 laboratory confirmed cryptosporidiosis

  • 18 females, 13 males: 8 cases hospitalised


Geographical distribution of cases

Geographical Distribution of Cases


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


Management of a cryptosporidiosis outbreak in the south east lessons learned

Cryptosporidium


Management of a cryptosporidiosis outbreak in the south east lessons learned

Clostridium perfringens

Source: Carlow County Council


Management of a cryptosporidiosis outbreak in the south east lessons learned

C. perfringens and Cryptosporidium


Management of a cryptosporidiosis outbreak in the south east lessons learned

Turbidity

Grab sample of final water turbidity

In line turbidity of filter outlet

Standard 1 NTU

Source: Carlow County Council


Management of a cryptosporidiosis outbreak in the south east lessons learned

Rainfall levels & onset of illness


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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