Dear Editor,
We are writing to bring to your attention a recent outbreak of cryptosporidiosis in Devon, England, which has been confirmed to have affected about 50 individuals [1]. The source of the contamination has been traced back to a damaged air valve in the Brixham area, highlighting the importance of proper water treatment and infrastructure maintenance [2].
As healthcare professionals who work day in day out in line with globally approved public health standards, we have come together to share our expertise, concern and recommendations on this critical public health issue.
Cryptosporidiosis, the second commonest cause of moderate to severe diarrhoea in children under the age of 2 worldwide, is caused by the protozoan parasite Cryptosporidium spp, which is commonly found in contaminated water and food [3]. The parasite infects the small intestine, leading to symptoms that mimic acute gastroenteritis such as diarrhoea, abdominal cramps, weight loss, vomiting, nausea, fever, and dehydration. In immunocompromised individuals, the infection can be particularly severe and even life-threatening [3,4].
The pathophysiology of cryptosporidiosis is complex, with the parasite able to evade the host's immune system and establish a chronic infection [4,5]. The parasite's oocysts are highly resistant to environmental stressors, including chlorine treatment, allowing them to survive for extended periods outside of a host [3,4]. This, combined with their minuscule size, makes them difficult to remove from water supplies [5].
Cryptosporidiosis can be transmitted through the consumption contaminated water, swimming in contaminated water, person-to-person contact and infected animal-to-person contact [3].
To prevent future outbreaks, the following approaches can be implemented [[3], [4], [5]].
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Regular maintenance and inspection of water infrastructure, including air valves and treatment plants.
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Implementation of robust water treatment protocols, including filtration, disinfection, and routine testing.
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Public education campaigns to raise awareness about the risks of cryptosporidiosis and the importance of proper hygiene and sanitation.
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Reduced crowding, especially in daycare settings, to prevent person-to-person transmission.
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Individuals with symptoms or confirmed diseases in the area should avoid going to work or school for at least 48 hours post-diarrhoea and notify their employer.
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Use of Oral Rehydration Solution (ORS) to prevent dehydration.
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Local restaurant/food vendors should be inspected and ensured optimal hygiene, hand hygiene with soap and water, and adequate cooking.
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Temporary barriers or access restrictions to the most affected area to limit the spread until lasting measures are put in place.
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Keep sick children at home and off school and daycares.
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Emphasise hand washing with soap and water while also encouraging the locals to report any form of damage or pollution to the water system.
Stopping the cryptosporidiosis outbreak requires a combination of teamwork, creative solutions, and evidence-based decision-making. By working together and following the recommended steps, we can successfully contain the outbreak and prepare for future challenges. This unified approach will not only reduce immediate risks but also build a strong and sustainable public health system, ultimately protecting our communities' well-being.
We hope this correspondence brings attention to this important public health condition and prompts further investigation, collaboration, and action between local health departments and water authorities to ensure a prompt resolution of the outbreak before it graduates into epidemic proportions.
The authors declare no competing interests.
Ethical approval and consent to participate
Not applicable.
Availability of data and materials
No new data was generated.
Funding
Authors received no external funding for this project.
CRediT authorship contribution statement
Patrick Ashinze: Conceptualization, Data curation, Formal analysis, Supervision, Writing – original draft, Writing – review & editing. Abdullaah Idris Agbabiaka: Writing – original draft. Okeoyo Tesleem Ademola: Writing – original draft. Onosegbe Moses Aikhuomogbe: Writing – original draft. Olajuwon Tolulope Joseph: Writing – original draft. Bonu Innocent Shu: Writing – review & editing. Suleiman Nasiru Akobe: Writing – review & editing. Onyinyechukwu Ndubuisi Joyce: Writing – original draft. Izuchukwu Jonathan Obidiegwu: Writing – original draft. Ekene Nnagha: Writing – original draft. Ngozi Peace Okoro: Writing – original draft, Writing – review & editing.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgement
The authors would like to acknowledge The Lind League for providing the invaluable resources to kick start, culminate and leverage this research project.
Handling editor: Patricia Schlagenhauf
Contributor Information
Patrick Ashinze, Email: patrickashinze@yahoo.com.
Abdullaah Idris Agbabiaka, Email: Abdullah.idris.a@gmail.com.
Okeoyo Tesleem Ademola, Email: ibonujr@gmail.com.
Onosegbe Moses Aikhuomogbe, Email: onosegbe.aikhuomogbe@nhs.net.
Olajuwon Tolulope Joseph, Email: toluolajuwon@gmail.com.
Bonu Innocent Shu, Email: okeoyotesleem@gmail.com.
Suleiman Nasiru Akobe, Email: Nasiruakobesuleiman@gmail.com.
Onyinyechukwu Ndubuisi Joyce, Email: missyjoyceee@gmail.com.
Izuchukwu Jonathan Obidiegwu, Email: johnsino@gmail.com.
Ekene Nnagha, Email: nnaghae@gmail.com.
Ngozi Peace Okoro, Email: okorop41@gmail.com.
References
- 1.Ambrose T. Anger in Devon as more cases of waterborne disease expected. Guardian. 2024 May 18 https://www.google.com/amp/s/amp.theguardian.com/uk-news/article/2024/may/18/brixham-devon-water-infection-cryptosporidium-cases [Internet] [Google Scholar]
- 2.Ng E. Damaged air valve ‘potential source leading to parasite in water network.’. Independent. 2024 May 16 https://www.independent.co.uk/climate-change/news/brixham-south-devon-sky-news-south-west-conservative-b2546497.html [Internet] [Google Scholar]
- 3.Janssen B., Snowden J. StatPearls. StatPearls Publishing; Treasure Island (FL): 2024 Jan. Cryptosporidiosis. [Updated 2023 Jul 10]https://www.ncbi.nlm.nih.gov/books/NBK448085 Internet. [Google Scholar]
- 4.Leitch G.J., He Q. Cryptosporidiosis-an overview. Journal of biomedical research. 2012;25(1):1–16. doi: 10.1016/S1674-8301(11)60001-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Dixon B.R. Elsevier eBooks; 2014. Protozoa: Cryptosporidium spp; pp. 18–22.https://www.sciencedirect.com/science/article/abs/pii/B9780123786128001323 [Internet] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
No new data was generated.