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EPIDEMIOLOGIC AND ENVIRONMENTAL INVESTIGATION OF A RECREATIONAL WATER OUTBREAK CAUSED BY TWO GENOTYPES OF CRYPTOSPORIDIUM PARVUM IN OHIO IN 2000

In August 2000, the Ohio Department of Health requested assistance to investigate a cryptosporidiosis outbreak with more than 700 clinical case-patients. An epidemiologic and environmental investigation was conducted. Stool specimens, pool water, and sand filter samples were analyzed. A community-based case-control study showed that the main risk factor was swimming in pool A (odds ratio [OR] = 42, 95% confidence interval [CI] = 12.3–144.9). This was supported by results of polymerase chain reaction (PCR) analysis, which showed the presence of both the human and bovine genotypes of Cryptosporidium parvum in case-patients and samples from the filter of pool A. A pool-based case-control study indicated that the highest risk was related to exposure to pool water via the mouth (OR = 5.1, 95% CI = 2.1–12.5) or to pool sprinklers (OR = 2.5, 95% CI = 1.3–4.7). Fecal accidents at the pool were documented. Records indicated that the pool met local health regulations. The outbreak, caused by co-infection with two C. parvum genotypes (human and bovine), underscores the need for concerted action to improve public health policies for recreational water facilities and enhanced education regarding the potential for disease transmission through pools.

Received October 31, 2003. Accepted for publication May 11, 2004.

Acknowledgments: We thank the public health nurses, environmental staff, and all support staff from the Delaware City and County Health Department for their enthusiastic support and collaboration; the Ohio Department of Health (Dr. Darryl Koop, Ronald Genevie, Dr. William Becker, Dr. Elizabeth Koch, and Dr. Forrest Smith) and the Division of Parasitic Diseases, National Center of Infectious Diseases, CDC for their support; and a special thank to the interview team, especially Sue Lisman and Rachelene Charles, for conducting all the telephone calls.

Authors’ addresses: Els Mathieu, Deborah A. Levy, Stephanie Johnston, Thomas Handzel, Allen Hightower, Lihua Xiao, Yeuk-Mui Lee, Michael Arrowood, and Jeffrey L. Jones, Division of Parasitic Diseases, National Center of Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341-3724, Telephone: 770-488-3603, Fax: 770-488-7761, E-mails: mm7{at}cdc.gov, del7{at}cdc.gov, sip5{at}cdc.gov, tnh7{at}cdc.gov, awh1{at}cdc.gov, lax0{at}cdc.gov, yal5{at}cdc.gov, mja0{at}cdc.gov, and jlj1{at}cdc.gov. Fran Veverka and Nancy Shapiro, Delaware City and County Health Department, 1 West Winter Street, Delaware, OH 43015, Telephone: 740-368-1700, Fax: 740-368-1736, E-mails: fveverka{at}rrcol.com and nshapiro{at}rrcol.com. Mary-Kay Parrish and Steve York, Ohio Department of Health, 246 North High Street, PO Box 118, Columbus, OH 43266-0118, Telephone: 614-466-2253, Fax: 614-644-0085, E-mails: mparrish{at}gw.odh.state.oh.us and syork{at}odh.ohio.gov. John Sarisky and Robin Lee, Environmental Health Services Branch, Division of Emergency and Environmental Health Services, National Center of Environmental Health, Centers for Disease Control and Prevention, Mailstop F-28, 4770 Buford Highway, Atlanta, GA 30341-3724, Telephone: 770-488-4131, Fax: 770-488-7310, E-mails: zse1{at}cdc.gov and rpl5{at}cdc.gov.

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