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An outbreak of cryptosporidiosis associated with drinking water in north-eastern Italy, August 2019: microbiological and environmental investigations
- Armando Franceschelli1 , Lucia Bonadonna2 , Simone M Cacciò3 , Anna Rosa Sannella3 , Christian Cintori4,5 , Raffaele Gargiulo6 , Anna Maria Coccia2 , Rosa Paradiso2 , Marcello Iaconelli2 , Rossella Briancesco2 , Alberto Tripodi1
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View Affiliations Hide AffiliationsAffiliations: 1 Food Hygiene and Nutrition Service, Public Health Department, Local Health Unit of Modena, Modena, Italy 2 Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy 3 Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy 4 Public Hygiene Service, Public Health Department, Local Health Unit of Modena, Modena, Italy 5 Prevention Service and Collective Public Health, General Directorate of Care to Person, Health and Welfare, Emilia-Romagna Region, Italy 6 Provincial Laboratory of Microbiology, Local Health Unit of Modena, Modena, ItalyArmando Franceschellia.franceschelli ausl.mo.it
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Citation style for this article: Franceschelli Armando, Bonadonna Lucia, Cacciò Simone M, Sannella Anna Rosa, Cintori Christian, Gargiulo Raffaele, Coccia Anna Maria, Paradiso Rosa, Iaconelli Marcello, Briancesco Rossella, Tripodi Alberto. An outbreak of cryptosporidiosis associated with drinking water in north-eastern Italy, August 2019: microbiological and environmental investigations. Euro Surveill. 2022;27(35):pii=2200038. https://doi.org/10.2807/1560-7917.ES.2022.27.35.2200038 Received: 04 Jan 2022; Accepted: 20 Jun 2022
Abstract
Cryptosporidium is a leading global cause of waterborne disease, with many reported outbreaks related to main water supplies. In August 2019, an outbreak of cryptosporidiosis involving 80 cases occurred among 114 vacationers in a small municipality located in the Tuscan-Emilian Apennines, north-eastern Italy. After excluding a potential food-borne outbreak, the epidemiological investigation focussed on the hypothesis of a waterborne outbreak. This was confirmed by the finding of Cryptosporidium oocysts in stools of the cases and in water samples from the municipal water network. Molecular characterisation revealed the zoonotic species Cryptosporidium parvum as the causative agent. A single subtype (IIdA25G1) was found among all cases, and in one of two positive water samples. The municipality’s water supply used spring water that only received a disinfection treatment insufficient to inactivate the parasite. Possible entry means into the water mains were found through further environmental investigations. As these types of water supplies are particularly vulnerable to various environmental factors, a control system based on the risk assessment of each phase of the water supply chain is required to guarantee water safety. Effective methods for detection of protozoan pathogens, which are generally excluded from routine water supply analysis, should be applied.
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