1887
Surveillance Open Access
Like 0

Abstract

Background

By mid-September 2023, several event notifications related to cryptosporidiosis had been identified from different regions in Spain. Therefore, a request for urgent notification of cryptosporidiosis cases to the National Surveillance Network was launched.

Aim

We aimed at assessing the extent of the increase in cases, the epidemiological characteristics and the transmission modes and compared to previous years.

Methods

We analysed data on case notifications, outbreak reports and genotypes focusing on June–October 2023 and compared the results to 2016–2022.

Results

In 2023, 4,061 cryptosporidiosis cases were notified in Spain, which is an increase compared to 2016–2022. The cumulative incidence was 8.3 cases per 100,000 inhabitants in 2023, sixfold higher than the median of 1.4 cases per 100,000 inhabitants 2016–2022. Almost 80% of the cases were notified between June and October. The largest outbreaks were related to contaminated drinking water or swimming pools. was the most common species in the characterised samples (115/122), and the IfA12G1R5 subtype, previously unusual in Spain, was detected from 76 (62.3%) of the 122 characterised samples.

Conclusions

A substantial increase in cryptosporidiosis cases was observed in 2023. Strengthening surveillance of is essential for prevention of cases, to better understand trends and subtypes circulating and the impact of adverse meteorological events.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2024.29.28.2300733
2024-07-11
2024-07-15
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2024.29.28.2300733
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/29/28/eurosurv-29-28-4_HERRADOR.html?itemId=/content/10.2807/1560-7917.ES.2024.29.28.2300733&mimeType=html&fmt=ahah

References

  1. European Centre for Disease Prevention and Control. Cryptosporidiosis - Annual epidemiological report for 2021. Stockholm: ECDC; 2024. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/cryptosporidiosis-annual-epidemiological-report-2021.pdf
  2. Okhuysen PC, Chappell CL, Crabb JH, Sterling CR, DuPont HL. Virulence of three distinct Cryptosporidium parvum isolates for healthy adults. J Infect Dis. 1999;180(4):1275-81.  https://doi.org/10.1086/315033  PMID: 10479158 
  3. Bourli P, Eslahi AV, Tzoraki O, Karanis P. Waterborne transmission of protozoan parasites: a review of worldwide outbreaks - an update 2017-2022. J Water Health. 2023;21(10):1421-47.  https://doi.org/10.2166/wh.2023.094  PMID: 37902200 
  4. Robertson LJ, Torgerson PR, van der Giessen J. Foodborne parasitic diseases in Europe: Social cost-benefit analyses of interventions. Trends Parasitol. 2018;34(11):919-23.  https://doi.org/10.1016/j.pt.2018.05.007  PMID: 29921499 
  5. Betancourt WQ, Rose JB. Drinking water treatment processes for removal of Cryptosporidium and Giardia. Vet Parasitol. 2004;126(1-2):219-34.  https://doi.org/10.1016/j.vetpar.2004.09.002  PMID: 15567586 
  6. Health Canada. Guidelines for Canadian drinking water quality: guideline technical document - enteric protozoa: Giardia and Cryptosporidium. Ottawa: Health Canada; 2019. Available from: https://www.canada.ca/en/health-canada/services/publications/healthy-living/guidelines-canadian-drinking-water-quality-guideline-technical-document-enteric-protozoa-giardia-cryptosporidium.html
  7. Instituto de Salud Carlos III (ISCII). Informe epidemiológico sobre la situación de la criptosporidiosis en España. Año 2021. [Epidemiological report about cryptosporidiosis in Spain. Year 2021]. Madrid: ISCII; 2022. Spanish. Available from: https://www.isciii.es/QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/EnfermedadesTransmisibles/Documents/archivos%20A-Z/Criptosporidiosis/Informe_criptosporidium_2021_final.pdf
  8. Rehn M, Wallensten A, Widerström M, Lilja M, Grunewald M, Stenmark S, et al. Post-infection symptoms following two large waterborne outbreaks of Cryptosporidium hominis in Northern Sweden, 2010-2011. BMC Public Health. 2015;15(1):529.  https://doi.org/10.1186/s12889-015-1871-6  PMID: 26041728 
  9. Instituto de Salud Carlos III. Informes anuales de vigilancia de Criptosporidiosis de la Red Nacional de Vigilancia Epidemiológica 2016-2022. [Annual cryptosporidiosis surveillance reports of the National Epidemiological Surveillance Network 2016-2022]. Madrid: ISCII. [Accessed: 26 May 2024]. Spanish. Available from: https://www.isciii.es/QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/EnfermedadesTransmisibles/Paginas/Resultados_Vigilancia_Criptosporidiosis.aspx
  10. Fuentes I, Martín C, Beristain X, Mazón A, Saugar JM, Blanco A, et al. Cryptosporidium hominis genotypes involved in increased incidence and clusters of cases, Navarra, Spain, 2012. Epidemiol Infect. 2015;143(5):1033-6.  https://doi.org/10.1017/S0950268814001836  PMID: 25017000 
  11. Segura R, Prim N, Montemayor M, Valls ME, Muñoz C. Predominant virulent IbA10G2 subtype of Cryptosporidium hominis in human isolates in Barcelona: a five-year study. PLoS One. 2015;10(3):e0121753.  https://doi.org/10.1371/journal.pone.0121753  PMID: 25816024 
  12. Abal-Fabeiro JL, Maside X, Llovo J, Bartolomé C. Aetiology and epidemiology of human cryptosporidiosis cases in Galicia (NW Spain), 2000-2008. Epidemiol Infect. 2015;143(14):3022-35.  https://doi.org/10.1017/S0950268815000163  PMID: 25699561 
  13. Azcona-Gutiérrez JM, de Lucio A, Hernández-de-Mingo M, García-García C, Soria-Blanco LM, Morales L, et al. Molecular diversity and frequency of the diarrheagenic enteric protozoan Giardia duodenalis and Cryptosporidium spp. in a hospital setting in Northern Spain. PLoS One. 2017;12(6):e0178575.  https://doi.org/10.1371/journal.pone.0178575  PMID: 28617836 
  14. de Lucio A, Merino FJ, Martínez-Ruiz R, Bailo B, Aguilera M, Fuentes I, et al. Molecular genotyping and sub-genotyping of Cryptosporidium spp. isolates from symptomatic individuals attending two major public hospitals in Madrid, Spain. Infect Genet Evol. 2016;37:49-56.  https://doi.org/10.1016/j.meegid.2015.10.026  PMID: 26518912 
  15. Llorente MT, Clavel A, Goñi MP, Varea M, Seral C, Becerril R, et al. Genetic characterization of Cryptosporidium species from humans in Spain. Parasitol Int. 2007;56(3):201-5.  https://doi.org/10.1016/j.parint.2007.02.003  PMID: 17383227 
  16. Ramo A, Quílez J, Vergara-Castiblanco C, Monteagudo L, Del Cacho E, Clavel A. Multilocus typing and population structure of Cryptosporidium from children in Zaragoza, Spain. Infect Genet Evol. 2015;31:190-7.  https://doi.org/10.1016/j.meegid.2015.01.023  PMID: 25660036 
  17. Chalmers RM, Robinson G, Elwin K, Elson R. Analysis of the Cryptosporidium spp. and gp60 subtypes linked to human outbreaks of cryptosporidiosis in England and Wales, 2009 to 2017. Parasit Vectors. 2019;12(1):95.  https://doi.org/10.1186/s13071-019-3354-6  PMID: 30867023 
  18. Costa D, Razakandrainibe R, Valot S, Vannier M, Sautour M, Basmaciyan L, et al. Epidemiology of Cryptosporidiosis in France from 2017 to 2019. Microorganisms. 2020;8(9):1358.  https://doi.org/10.3390/microorganisms8091358  PMID: 32899825 
  19. Ryan UM, Feng Y, Fayer R, Xiao L. Taxonomy and molecular epidemiology of Cryptosporidium and Giardia - a 50 year perspective (1971-2021). Int J Parasitol. 2021;51(13-14):1099-119.  https://doi.org/10.1016/j.ijpara.2021.08.007  PMID: 34715087 
  20. Cacciò SM, Chalmers RM. Human cryptosporidiosis in Europe. Clin Microbiol Infect. 2016;22(6):471-80.  https://doi.org/10.1016/j.cmi.2016.04.021  PMID: 27172805 
  21. Ministerio de Sanidad, Servicios Sociales e Igualdad. Real Decreto 742/2013, de 27 de septiembre, por el que se establecen los criterios técnico-sanitarios de las piscinas. [Royal Regulation 742/2013, 27 September, which establishes the technical-sanitary criteria for swimming pools]. Madrid: Ministerio de Sanidad, Servicios Sociales e Igualdad; 2013. Spanish. Available from: https://www.boe.es/buscar/doc.php?id=BOE-A-2013-10580
  22. Ministerio de la Presidencia, Relaciones con las Cortes y Memoria Democrática. Real Decreto 3/2023, de 10 de enero, por el que se establecen los criterios técnico-sanitarios de la calidad del agua de consumo, su control y suministro. [Royal Regulation 3/2023, 10 January, which establishes the technical-sanitary criteria for the quality of drinking water]. Madrid: Ministerio de la Presidencia, Relaciones con las Cortes y Memoria Democrática; Jan 2023. Spanish. Available from: https://www.boe.es/diario_boe/txt.php?id=BOE-A-2023-628
  23. Ministerio de Sanidad, Servicios Sociales e Igualdad. Orden SSI/445/2015, de 9 de marzo, por la que se modifican los anexos I, II y III del Real Decreto 2210/1995, de 28 de diciembre, por el que se crea la Red Nacional de Vigilancia Epidemiológica, relativos a la lista de enfermedades de declaración obligatoria, modalidades de declaración y enfermedades endémicas de ámbito regional [Order SSI/445/2015, 9 March, which modifies Royal Decree 2210/1995, 28 December, which creates the National Epidemiological Surveillance Network, relating to the list of notifiable diseases, reporting modalities and regional endemic diseases]. Madrid: Ministerio de Sanidad, Servicios Sociales e Igualdad; 2015. Spanish. Available from: https://www.boe.es/eli/es/o/2015/03/09/ssi445
  24. Instituto de Salud Carlos III (ISCII). Protocolo de vigilancia de cryptosporidiosis. [Surveillance protocols for cryptosporidiosis]. Madrid: IISCII; 2013. Spanish. Available from: https://www.isciii.es/QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/EnfermedadesTransmisibles/Documents/PROTOCOLOS/Protocolo%20de%20Vigilancia%20de%20Criptosporidiosis.pdf
  25. European Commission (EC). Commission implementing decision (EU) 2018/945 of 22 June 2018 on the communicable diseases and related special health issues to be covered by epidemiological surveillance as well as relevant case definitions. Brussels: EC; 22 Jun 2018. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32018D0945&from=EN#page=17
  26. Instituto Nacional de Estadística (INē). Population figures and demographic censuses. Madrid: INē. [Accessed: 26 May 2024]. Available from: https://www.ine.es/
  27. Tiangtip R, Jongwutiwes S. Molecular analysis of Cryptosporidium species isolated from HIV-infected patients in Thailand. Trop Med Int Health. 2002;7(4):357-64.  https://doi.org/10.1046/j.1365-3156.2002.00855.x  PMID: 11952952 
  28. Feltus DC, Giddings CW, Schneck BL, Monson T, Warshauer D, McEvoy JM. Evidence supporting zoonotic transmission of Cryptosporidium spp. in Wisconsin. J Clin Microbiol. 2006;44(12):4303-8.  https://doi.org/10.1128/JCM.01067-06  PMID: 17005736 
  29. Agencia Estatal de Meteorología (AEMET). Avance climático Nacional del año 2023. [National climate data of 2023]. Madrid: AEMET; 2023. Spanish. Available from: https://www.aemet.es/documentos/es/noticias/2024/01/avance_climatico2023.pdf
  30. Chhetri BK, Takaro TK, Balshaw R, Otterstatter M, Mak S, Lem M, et al. Associations between extreme precipitation and acute gastro-intestinal illness due to cryptosporidiosis and giardiasis in an urban Canadian drinking water system (1997-2009). J Water Health. 2017;15(6):898-907.  https://doi.org/10.2166/wh.2017.100  PMID: 29215354 
  31. Graydon RC, Mezzacapo M, Boehme J, Foldy S, Edge TA, Brubacher J, et al. Associations between extreme precipitation, drinking water, and protozoan acute gastrointestinal illnesses in four North American Great Lakes cities (2009-2014). J Water Health. 2022;20(5):849-62.  https://doi.org/10.2166/wh.2022.018  PMID: 35635777 
  32. European Centre for Disease Prevention and Control (ECDC). Communicable disease threats report, 15–22 October 2023, week 42. Stockholm: ECDC; 20 Oct 2023. Available from: https://www.ecdc.europa.eu/en/publications-data/communicable-disease-threats-report-15-22-october-2023-week-42
  33. Peake L, Inns T, Jarvis C, King G, Rabie H, Henderson J, et al. Preliminary investigation of a significant national Cryptosporidium exceedance in the United Kingdom, August 2023 and ongoing. Euro Surveill. 2023;28(43):2300538.  https://doi.org/10.2807/1560-7917.ES.2023.28.43.2300538  PMID: 37883039 
  34. Love NK, Elliot AJ, Chalmers RM, Douglas A, Gharbia S, McCormick J, et al. Impact of the COVID-19 pandemic on gastrointestinal infection trends in England, February-July 2020. BMJ Open. 2022;12(3):e050469.  https://doi.org/10.1136/bmjopen-2021-050469  PMID: 35314468 
  35. Adamson JP, Chalmers RM, Thomas DR, Elwin K, Robinson G, Barrasa A. Impact of the COVID-19 restrictions on the epidemiology of Cryptosporidium spp. in England and Wales, 2015-2021: a time series analysis. J Med Microbiol. 2023;72(6).  https://doi.org/10.1099/jmm.0.001693  PMID: 37288574 
  36. Knox MA, Garcia-R JC, Ogbuigwe P, Pita A, Velathanthiri N, Hayman DTS. Absence of Cryptosporidium hominis and dominance of zoonotic Cryptosporidium species in patients after Covid-19 restrictions in Auckland, New Zealand. Parasitology. 2021;148(11):1288-92.  https://doi.org/10.1017/S0031182021000974  PMID: 34120663 
  37. Huang W, Guo Y, Lysen C, Wang Y, Tang K, Seabolt MH, et al. Multiple introductions and recombination events underlie the emergence of a hyper-transmissible Cryptosporidium hominis subtype in the USA. Cell Host Microbe. 2023;31(1):112-123.e4.  https://doi.org/10.1016/j.chom.2022.11.013  PMID: 36521488 
  38. Lebbad M, Winiecka-Krusnell J, Stensvold CR, Beser J. High Diversity of Cryptosporidium species and subtypes identified in cryptosporidiosis acquired in Sweden and abroad. Pathogens. 2021;10(5):523.  https://doi.org/10.3390/pathogens10050523  PMID: 33926039 
  39. Braima K, Zahedi A, Oskam C, Reid S, Pingault N, Xiao L, et al. Retrospective analysis of Cryptosporidium species in Western Australian human populations (2015-2018), and emergence of the C. hominis IfA12G1R5 subtype. Infect Genet Evol. 2019;73:306-13.  https://doi.org/10.1016/j.meegid.2019.05.018  PMID: 31146044 
  40. Garcia-R JC, Pita AB, Velathanthiri N, French NP, Hayman DTS. Species and genotypes causing human cryptosporidiosis in New Zealand. Parasitol Res. 2020;119(7):2317-26.  https://doi.org/10.1007/s00436-020-06729-w  PMID: 32494897 
  41. Guzman Herrador B, de Blasio BF, Carlander A, Ethelberg S, Hygen HO, Kuusi M, et al. Association between heavy precipitation events and waterborne outbreaks in four Nordic countries, 1992-2012. J Water Health. 2016;14(6):1019-27.  https://doi.org/10.2166/wh.2016.071  PMID: 27959880 
  42. Semenza JC, Paz S. Climate change and infectious disease in Europe: Impact, projection and adaptation. Lancet Reg Health Eur. 2021;9:100230.  https://doi.org/10.1016/j.lanepe.2021.100230  PMID: 34664039 
/content/10.2807/1560-7917.ES.2024.29.28.2300733
Loading

Data & Media loading...

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error