Public health priority: High.
PHU response time: Respond to confirmed cases within one working day of notification. Enter confirmed cases on NCIMS within 3 working days.
Case management: Identify risk factors. Exclude case from childcare until symptoms have resolved. Where a cluster is identified, control the suspected source.
Contact management: Not applicable.
A confirmed case requires laboratory definitive evidence.
Detection of Cryptosporidium.
Laboratory diagnosis of cryptosporidiosis usually involves identification of Cryptosporidium oocysts from stool samples by microscopy or a monoclonal antibody test. PCR may also be used.
Cryptosporidiosis is to be notified by laboratories on confirmation (ideal reporting by routine mail).
Only confirmed cases should be entered onto NCIMS.
The coccidian protozoa Cryptosporidium. Multiple species of Cryptosporidium exist, but two are thought to be the main cause of human disease: C. hominis is specific to humans, while C. parvum infects people, cattle and a range of other mammals.
Cryptosporidiosis is transmitted by the faecal-oral route directly from person to person, from animal to person and by ingesting contaminated food and water. Outbreaks have been linked to sources such as contaminated drinking water and swimming pools and to petting infected animals.
The typical incubation period is probably about 1 to 12 days, with an average of 7 days.
Patients are infectious while they excrete oocysts. This may continue for several weeks after diarrhoea stops.
Infection may be asymptomatic, but usually presents as profuse watery diarrhoea and abdominal cramps. Children may present with a prodrome of anorexia and vomiting.
Within 1 working day of notification of a confirmed case begin follow-up investigation.
Within 3 working days of notification enter confirmed cases on NCIMS.
The response to a notification will normally be carried out in collaboration with the case's health carers. But regardless of who does the follow-up, PHU staff should ensure that action has been taken to:
Treatment is supportive
The case or relevant care-giver should be informed about the nature of the infection and the mode of transmission. Emphasise the importance of hygienic practices, particularly:
Recommend that children with diarrhoea not attend child care for at least 24 hours after symptoms have resolved.
Where a water-borne source is suspected, discuss with CDB for advice on further assessment and control measures.
Where more than one case is epidemiologically linked to the same childcare facility, ask the director to telephone the PHU if new cases of diarrhoea are reported. The director should recommend that parents take their symptomatic children to a GP for assessment. The facility should be telephoned or visited at least once a week for 2 weeks after onset of the last case to verify that surveillance and appropriate infection control measures are being carried out.
Where more than one case is epidemiologically linked to a swimming pool or other swimming facility, then the PHU should ensure that the facility is reviewed for compliance with NSW Health's Public Swimming Pool and Spa Pool Advisory Document.This includes superchlorination of the pool, and ensuring (through prominent signage and handouts) that patrons are aware of the importance of not entering the pool if they have had diarrhoea in the previous 2 weeks, and of showering before entering the pool.
Where an ongoing source of infection is suspected, consider the need for an epidemiological study and specific interventions. Seek advice from CDB.