1887
  1. Home
  2. Eurosurveillance
  3. Volume 30, Issue 9, 06/Mar/2025
  4. Article
Surveillance Open Access
Like 0
Download

Abstract

Background

Laboratory surveillance detected an unprecedented increase in spp. (predominantly ) in England and Wales in August 2023. Cases are not routinely followed up in all of England and Wales, and initial investigations identified no common exposures.

Aim

To perform a retrospective case–case study investigation of the increase in spp. in England and Wales.

Methods

We conducted an unmatched case–case study with 203 cases of laboratory-confirmed and 614 comparator cases of laboratory-confirmed spp. reported between 14 August and 30 September 2023. We fitted a multilevel logistic regression model, with random intercepts for geographical region, to estimate adjusted odds ratios (aOR) for exposures. We present the final model as aOR and 95% confidence intervals (CI).

Results

Multivariable analysis identified associations with swimming pool use (aOR: 5.3, 95% CI: 2.3–9.3), travel to Spain (aOR: 6.5, 95% CI: 3.5–12.3) and young age, with children 0–4 years having the strongest association of being a case (aOR: 3.6, 95% CI: 1.5–8.6). We also identified associations with swimming in a river, and travel to France or Türkiye, but there was low frequency of exposure among cases and comparator cases.

Conclusions

Following the largest recorded increase of spp. and in particular cases in England and Wales, we identified several exposures, suggesting that causation was likely to be multifactorial. We recommend development of a standardised questionnaire to enable rapid investigation of future case increases, which will improve existing surveillance and inform public health actions.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2025.30.9.2400493
2025-03-06
2025-03-11
/content/10.2807/1560-7917.ES.2025.30.9.2400493
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/30/9/eurosurv-30-9-2.html?itemId=/content/10.2807/1560-7917.ES.2025.30.9.2400493&mimeType=html&fmt=ahah

References

  1. Hunter PR, Hughes S, Woodhouse S, Raj N, Syed Q, Chalmers RM, et al. Health sequelae of human cryptosporidiosis in immunocompetent patients. Clin Infect Dis. 2004;39(4):504-10.  https://doi.org/10.1086/422649  PMID: 15356813 
  2. Lilja M, Widerström M, Lindh J. Persisting post-infection symptoms 2 years after a large waterborne outbreak of Cryptosporidium hominis in northern Sweden. BMC Res Notes. 2018;11(1):625.  https://doi.org/10.1186/s13104-018-3721-y  PMID: 30165888 
  3. Hunter PR, Nichols G. Epidemiology and clinical features of Cryptosporidium infection in immunocompromised patients. Clin Microbiol Rev. 2002;15(1):145-54.  https://doi.org/10.1128/CMR.15.1.145-154.2002  PMID: 11781272 
  4. 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 
  5. Goñi P, Almagro-Nievas D, Cieloszyk J, Lóbez S, Navarro-Marí JM, Gutiérrez-Fernández J. Cryptosporidiosis outbreak in a child day-care center caused by an unusual Cryptosporidium hominis subtype. Enferm Infecc Microbiol Clin. 2015;33(10):651-5.  https://doi.org/10.1016/j.eimc.2015.02.003  PMID: 25770777 
  6. Utsi L, Smith SJ, Chalmers RM, Padfield S. Cryptosporidiosis outbreak in visitors of a UK industry-compliant petting farm caused by a rare Cryptosporidium parvum subtype: a case-control study. Epidemiol Infect. 2016;144(5):1000-9.  https://doi.org/10.1017/S0950268815002319  PMID: 26424385 
  7. McKerr C, Adak GK, Nichols G, Gorton R, Chalmers RM, Kafatos G, et al. An outbreak of Cryptosporidium parvum across England & Scotland associated with consumption of fresh pre-cut salad leaves, May 2012. PLoS One. 2015;10(5):e0125955.  https://doi.org/10.1371/journal.pone.0125955  PMID: 26017538 
  8. Gherasim A, Lebbad M, Insulander M, Decraene V, Kling A, Hjertqvist M, et al. Two geographically separated food-borne outbreaks in Sweden linked by an unusual Cryptosporidium parvum subtype, October 2010. Euro Surveill. 2012;17(46):20318.  https://doi.org/10.2807/ese.17.46.20318-en  PMID: 23171824 
  9. Göpfert A, Chalmers RM, Whittingham S, Wilson L, van Hove M, Ferraro CF, et al. An outbreak of Cryptosporidium parvum linked to pasteurised milk from a vending machine in England: a descriptive study, March 2021. Epidemiol Infect. 2022;150:e185.  https://doi.org/10.1017/S0950268822001613  PMID: 36305017 
  10. Widerström M, Schönning C, Lilja M, Lebbad M, Ljung T, Allestam G, et al. Large outbreak of Cryptosporidium hominis infection transmitted through the public water supply, Sweden. Emerg Infect Dis. 2014;20(4):581-9.  https://doi.org/10.3201/eid2004.121415  PMID: 24655474 
  11. McCann R, Jones R, Snow J, Cleary P, Burgess S, Bothra V, et al. An outbreak of cryptosporidiosis at a swimming club--can rapid field epidemiology limit the spread of illness? Epidemiol Infect. 2014;142(1):51-5.  https://doi.org/10.1017/S0950268813001143  PMID: 23673004 
  12. Hall V, Taye A, Walsh B, Maguire H, Dave J, Wright A, et al. A large outbreak of gastrointestinal illness at an open-water swimming event in the River Thames, London. Epidemiol Infect. 2017;145(6):1246-55.  https://doi.org/10.1017/S0950268816003393  PMID: 28162113 
  13. Chalmers R, Johnston R. Understanding the public health risks of Cryptosporidium in swimming pools: a transmission pathway approach. Perspect Public Health. 2018;138(5):238-40.  https://doi.org/10.1177/1757913918772795  PMID: 30156483 
  14. Noufaily A, Morbey RA, Colón-González FJ, Elliot AJ, Smith GE, Lake IR, et al. Comparison of statistical algorithms for daily syndromic surveillance aberration detection. Bioinformatics. 2019;35(17):3110-8.  https://doi.org/10.1093/bioinformatics/bty997  PMID: 30689731 
  15. 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 
  16. Robinson G, Elwin K, Chalmers RM. Cryptosporidium Diagnostic Assays: Molecular Detection. In: Mead JR, Arrowood MJ, editors. Cryptosporidium: Methods and Protocols. New York, NY: Springer New York; 2020. p. 11-22.
  17. Health Protection Surveillance Centre (HPSC). Statutory notifications of infectious diseases reported in Ireland via the computerised infectious disease reporting (CIDR) system, 2023. Dublin: HPSC; 2023. Available from: https://www.hpsc.ie/notifiablediseases/weeklyidreports
  18. Schoeps A, Röbl K, Walter N, Neute A, Walter B, Freudenau I, et al. Increased number of cryptosporidiosis cases with travel history to Croatia might be related to swimming pools, Germany, 2023. Euro Surveill. 2024;29(1):2300699.  https://doi.org/10.2807/1560-7917.ES.2024.29.1.2300699  PMID: 38179624 
  19. Peñuelas Martinez M, Carmena D, Guzmán Herrador BR, Palau Miguel M, Saravia Campelli G, García Álvarez RM, et al. Marked increase in cryptosporidiosis cases, Spain, 2023. Euro Surveill. 2024;29(28):2300733.  https://doi.org/10.2807/1560-7917.ES.2024.29.28.2300733  PMID: 38994603 
  20. Office of National Statistics (ONS). Travel trends: 2023. Newport: ONS; 2024. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/leisureandtourism/articles/traveltrends/2023
  21. Fournet N, Deege MP, Urbanus AT, Nichols G, Rosner BM, Chalmers RM, et al. Simultaneous increase of Cryptosporidium infections in the Netherlands, the United Kingdom and Germany in late summer season, 2012. Euro Surveill. 2013;18(2):20348.  https://doi.org/10.2807/ese.18.02.20348-en  PMID: 23324424 
  22. 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 
  23. European Centre for Disease Prevention and Control (ECDC). Communicable disease threats report, 22-28 October 2023, week 43. Stockholm: ECDC; 2023. Available from: https://www.ecdc.europa.eu/en/publications-data/communicable-disease-threats-report-22-28-october-2023-week-43
  24. 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 
  25. Gertler M, Dürr M, Renner P, Poppert S, Askar M, Breidenbach J, et al. Outbreak of Cryptosporidium hominis following river flooding in the city of Halle (Saale), Germany, August 2013. BMC Infect Dis. 2015;15(1):88.  https://doi.org/10.1186/s12879-015-0807-1  PMID: 25879490 
  26. Copernicus Climate Change Service (C3S). European summer 2023: a season of contrasting extremes. Brussels: C3S; 2023. Available from: https://climate.copernicus.eu/european-summer-2023-season-contrasting-extremes
  27. Lake IR, Bentham G, Kovats RS, Nichols GL. Effects of weather and river flow on cryptosporidiosis. J Water Health. 2005;3(4):469-74.  https://doi.org/10.2166/wh.2005.048  PMID: 16459850 
  28. Jagai JS, Castronovo DA, Monchak J, Naumova EN. Seasonality of cryptosporidiosis: A meta-analysis approach. Environ Res. 2009;109(4):465-78.  https://doi.org/10.1016/j.envres.2009.02.008  PMID: 19328462 
  29. Chalmers RM, McCarthy N, Barlow KL, Stiff R. An evaluation of health protection practices for the investigation and management of Cryptosporidium in England and Wales. J Public Health (Oxf). 2018;40(1):114-20. PMID: 28039197 
Retrospective case–case study investigation of a significant increase in Cryptosporidium spp. in England and Wales, August to September 2023
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Sarah+V+Williams&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Williams Sarah V</a>, <a href="/search?value1=Eve+Matthews&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Matthews Eve</a>, <a href="/search?value1=Thomas+Inns&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Inns Thomas</a>, <a href="/search?value1=Christopher+Roberts&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Roberts Christopher</a>, <a href="/search?value1=Joshua+Matizanadzo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Matizanadzo Joshua</a>, <a href="/search?value1=Paul+Cleary&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cleary Paul</a>, <a href="/search?value1=Richard+Elson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Elson Richard</a>, <a href="/search?value1=Chris+J+Williams&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Williams Chris J</a>, <a href="/search?value1=Reece+Jarratt&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jarratt Reece</a>, <a href="/search?value1=Rachel+M+Chalmers&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Chalmers Rachel M</a>, <a href="/search?value1=Roberto+Vivancos&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vivancos Roberto</a></span>. Retrospective case–case study investigation of a significant increase in Cryptosporidium spp. in England and Wales, August to September 2023. <a href="/content/ecdc">Euro Surveill.</a> 2025;30(9):pii=2400493. <a href="https://doi.org/10.2807/1560-7917.ES.2025.30.9.2400493" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2025.30.9.2400493</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 24 Jul 2024;&nbsp;&nbsp; <span class="generated">Accepted</span>: 14 Oct 2024 </span> </p>
/content/10.2807/1560-7917.ES.2025.30.9.2400493
/content/10.2807/1560-7917.ES.2025.30.9.2400493
Loading

Data & Media loading...

Supplementary data

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