Outbreak of Cryptosporidium hominis in northern Sweden: persisting symptoms in a five-year follow-up

ObjectivesIn 2010-2011, a waterborne outbreak of the parasite, Cryptosporidium hominis, affected approximately 27,000 inhabitants in the city of Östersund, Sweden. Previous research suggested that post-infectious symptoms, such as gastrointestinal symptoms and joint pain, could persist for up to two years after the initial infection. In this study, we investigated whether the parasite caused post-infectious sequelae for up to five years after the outbreak. This prospective cohort study examined whether individuals infected during the outbreak were more likely than uninfected individuals to report post-infectious symptoms five years later. The participants completed a questionnaire on whether they experienced a list of symptoms. We analysed data using logistic regression and calculated odds ratios with 95% confidence intervals.Results The analysis included 626 individuals. Among the 262 individuals infected during the outbreak, 56.5% reported symptoms at follow-up. Compared to uninfected individuals, infected individuals were significantly more likely to report watery diarrhoea, diarrhoea, swollen joints, abdominal pain, bloating, joint discomfort, acid indigestion, alternating bowel habits, joint pain, ocular pain, nausea, and fatigue at the follow-up, after adjusting for age and sex. Our findings suggested that cryptosporidiosis was mainly associated with gastrointestinal- and joint-related post-infectious symptoms for up to 5 years after the infection.

An outbreak of tularemia in southwestern Turkey

Introduction: Tularemia has reemerged and spread throughout Turkey, and the number of cases has increased. In this study, we report on a waterborne outbreak of tularemia in the spring of 2013 in a region which was previously disease-free, and we investigated the reasons for the outbreak. Methodology: The index case, a 17-year-old male, was diagnosed with oropharyngeal tularemia. An outbreak investigation was initiated after receiving information from other patients with similar symptoms from the same village along with Balkıca, Tavas, and Denizli. An epidemiological and environmental investigation was conducted. Tonsil swab specimens/lymph node aspirates collected from patients, and water samples collected from unchlorinated drinking water sources, were cultured. Additionally, a real-time polymerase chain reaction (RT-PCR) was performed on these samples. Serum samples from patients were analyzed for antibody response. Results: A total of 7 patients were found in this outbreak investigation. The attack rate was found to be 1% among the people of the village and 25% among patients’ family members. The drinking-water system was contaminated with F. tularensis during this outbreak. Conclusions: Lack of appropriate water infrastructure and sanitation was the primary reason for this tularemia outbreak in Turkey. Improving the water source infrastructure and sanitation should be the primary approach to preventing tularemia outbreaks.

Storied experiences of the Havelock North drinking water crisis: A case for a ‘narrative green victimology’

The number of victims from environmental harm far exceeds that from everyday property and interpersonal crime, yet little is known about the experience of environmental victimisation. This paper makes a case for a narrative green victimology to advance scholarship about environmental victims, drawing on data from interviews with persons affected by a waterborne outbreak of campylobacter in the small town of Havelock North, New Zealand, in August 2016. Findings demonstrate that understandings of environmental harm are developed in narratives, with narratives. In particular, participants’ stories of harm and victimisation revealed fragments of larger, cultural narratives about sacrifice, nation-building, motherhood, and environmental purity, each of which affected their understanding of the impact of the outbreak on their autonomy as agentive persons. It is proposed that a narrative green victimology offers environmental victimology a platform upon which it can foot its frameworks.

Characteristics of hospitalized patients during a large waterborne outbreak of Campylobacter jejuni in Norway

Very few reports describe all hospitalized patients with campylobacteriosis in the setting of a single waterborne outbreak. This study describes the demographics, comorbidities, clinical features, microbiology, treatment and complications of 67 hospitalized children and adults during a large waterborne outbreak of Campylobacter jejuni in Askoy, Norway in 2019, where more than 2000 people in a community became ill. We investigated factors that contributed to hospitalization and treatment choices. Data were collected from electronic patient records during and after the outbreak. Fifty adults and seventeen children were included with a biphasic age distribution peaking in toddlers and middle-aged adults. Most children, 14 out of 17, were below 4 years of age. Diarrhea was the most commonly reported symptom (99%), whereas few patients (9%) reported bloody stools. Comorbidities were frequent in adults (63%) and included cardiovascular disease, pre-existing gastrointestinal disease or chronic renal failure. Comorbidities in children (47%) were dominated by pulmonary and gastrointestinal diseases. Adult patients appeared more severely ill than children with longer duration of stay, higher levels of serum creatinine and CRP and rehydration therapy. Ninety-two percent of adult patients were treated with intravenous fluid as compared with 12% of children. Almost half of the admitted children received antibiotics. Two patients died, including a toddler. Both had significant complicating factors. The demographic and clinical findings presented may be useful for health care planning and patient management in Campylobacter outbreaks both in primary health care and in hospitals.

A review on Cryptosporidium and biofilm interactions

Biofilms are increasingly implicated as suspected to play a major role in waterborne cryptosporidiosis. This review aims to synthesize all currently available data on interactions between Cryptosporidium oocysts and biofilms. Initially described following a waterborne outbreak, the integration of Cryptosporidium oocysts in biofilm has been well demonstrated. Biofilms appear important in the dissemination/protection of oocysts in the environment. Consequently, it has been suggested that substrate-associated biofilms should be systematically considered in oocyst water quality assessment. The influence of physicochemical parameters has been studied on oocyst biofilm retention. Biofilm surface roughness, ionic concentration (especially Ca2+), laminar/turbulent flow, shear stress and electrostatic repulsion forces appear important to consider regarding oocyst release from biofilm. However, data analysis carried out during this review, also revealed important gaps in biological interactions within biofilms offering many perspectives for future works.

Waterborne Outbreak of Acute Gastroenteritis Caused by Recombinant Norovirus GII.P7–GII.6 in Khabarovsk in 2019

Background: Noroviruses are common causative agents of acute gastroenteritis worldwide. Person-to-person transmission is the dominant transmission route for norovirus infection but contaminated water also often leads to outbreaks. Objectives: Our purpose was to do epidemiologic and molecular genetic analyses of waterborne norovirus infection outbreak among children in Khabarovsk in 2019. Materials and methods: Clinical and water samples were screened for the presence of norovirus RNA using real-time RT-PCR detection kit. The norovirus nucleotide sequences were determined by Sanger sequencing. The obtained sequences were subjected to a phylogenetic analysis. Results: In July 2019, 34 children developed acute gastroenteritis in Khabarovsk. The epidemiologic investigation showed that on the eve of the disease onset all patients played and bathed in a pedestrian fountain complex. A molecular genetic analysis of 18 biological samples from children with acute gastroenteritis and a water sample from the fountain revealed a recombinant norovirus GII.P7-GII.6. We established a 100.0% identity of all obtained nucleotide sequences to each other. A phylogenetic analysis of ORF2 partial sequences showed that the capsid protein of the Khabarovsk GII.P7-GII.6 strains belonged to the variant GII.6a. Conclusions: Contaminated water in the pedestrian interactive fountain complex was the most likely cause of the norovirus infection outbreak among children in Khabarovsk in 2019 associated with the lack of proper maintenance and regular disinfection measures.

Hepatitis E genotype 1 outbreak in Jharkhand, India: A descriptive analysis

Introduction: A waterborne outbreak of hepatitis E virus occurred in the Jamshedpur city of Jharkhand from March 2018 to October2018. In the present study, we attempt to study the hepatitis E virus outbreak clinically, serologically and etiologically. Methods: Five hundredand eighty four clinically and biochemically documented cases were screened for the hepatotropic viral markers (HepatitisA, B, C, and E) by the ELISA. Demographic data such as gender, age,clinical diagnosis, location, the outcome, time of admission were extracted from the online hospital management system.Water samples from affected area were tested for HEV RNA detection. Genotyping of HEV virus was carried out by sequencing and phylogenetic analysis. Result: Hepatitis E genotype 1 was confirmed as the major etiological agent inthis outbreak due to faecal contamination of drinking water supply while establishing illegal water connections. Mixed infection of HEV-HAV (5.31%) or HEV-HBV (0.91%) was also detected in the present series of acute viral hepatitis. Conclusions: The study highlights the importance of screening forboth enterically transmitted hepatotropic viral markers as well as the parenterally transmitted hepatotropic viral markersduring outbreaks of acute viral hepatitis.