Number of Cryptosporidium positive faecal samples by week of confirmation in 4 laboratories*, Netherlands, January 2010 to November 2012
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1 Background Cases of cryptosporidiosis occur sporadically or as part of water or foodborne outbreaks Majority of the cases occur due to sporadic infections Most of current knowledge on cryptosporidiosis has been obtained from outbreak studies No risk factor studies on sporadic cryptosporidiosis from the Netherlands exist
2 Number of Cryptosporidium positive faecal samples by week of confirmation in 4 laboratories*, Netherlands, January 2010 to November Weeks 36 38: 180 cases 20 in in 2011 Nb Weeks 31 45: 472 cases in in Week *CBSL (Hilversum), Haarlem, Saltro (Utrecht) and Labmicta (Enschede)
3 Conclusion Case Control Study 2012 No single source of infection Mineral water? Apple juice? Contamination of surface water? Cannot be excluded Additional question asked to some cases
4 CRYPTO study Since beginning April 2013 Study objectives: To describe the epidemiology of sporadic Cryptosporidium infections in the Netherlands. To identify risk factors for sporadic (eventually clustered) clinical infections with Cryptosporidium in the Netherlands in order to acquire information for control strategies
5 Methods Study duration: 2 year, METC (niet WMO form completed) Invitation for participation of laboratories sent end February April 2013: study start Species determination on those samples for which a questionnaire was completed Molecular typing only carried out if an outbreak (e.g. food borne) is suspected Monthly updates by e mail to participating labs (CRYPTO news)
6 Sporadic cryptosporadium study design 6 Cases are approached by for follow up study of symptoms RIVM (Epi&lab) 5 Patient return questionnaire Case patient B envelopes distributed before the study Laboratory sends the sample for futher typing 3 Laboratory sends B envelope to GP 4 GP forward A envelope to patient 1 3 Patient visit GP, GI symptoms Regional GP Laboratories GP B envelopes includes: letter to GP Pos. Crypto results Smaller A envelope (to be sent to patients Code 2 GP sends sample to laboratory A envelopes includes: Letter to patient Informed consent form Questionnaire A4 retur envelop Study goes on for 2 years, starting April 2013
7 Study flow B envelopes include: letter to GP Positive Crypto results from the lab Smaller A envelope (to be sent to cases) Code 123 Code 123 B envelope Code put on the sample (with other information on lab form) Date of birth post code Gender travel history date of diagnosis A envelope A envelope includes: Information letter for patient Informed consent form Questionnaire A4 return envelop
8 Questionaires for cases and controls Symptoms, hospitalization, immune deficiency Recall period for exposures: 2 weeks prior to onset Personal hygiene / attending day care / living situation Drinking water intake (general, prior to illness) Outdoor activities Contact with Recreational water Food history (unpasteurised dairy products, raw vegetables) Animal contact (pets, farm animals) Travel history Follow up questionnaire for cases only: 4 months after illness onset to assess long term manifestations after crypto episode
9 Preliminary Results 256 specimens received at IDS Only feces (n=135), only DNA (n=76), feces and DNA (n=35) In total, 16 participating laboratories submitting samples Three laboratories did not submit samples until now: Maastricht, Nieuwegein, Gouda
10 Cryptosporidiosis cases by week of diagnostics and participating laboratory (n=231*, by Sep )
11 Questionnaire response 90 questionnaires back from cases (response rate 41%) and 146 from controls (response rate 29%) Online follow up questionnaire 4 months after illness onset sent out to cases
12 Laboratory results In the database of received samples we had on wednesday september 18th 276 samples DNA 85 Faeces 139 DNA & faeces 41
13 In total we specified: 100 C. parvum 23 C. hominis 20 undetermined
14 C.parvum C. hominis W17 W18 W19 W20 W21 W22 W23 W24 W25 W26 W27 W28 W29 W30 W31 W32 W33 W34 W35 W36 W37 W38 W39 W40
15 Interested in CRYPTO study? E mail adress study for lab signals: crypto studie@cib.healthandsafety.nl Contact details CRYPTO study: Jussi Sane, EPI jussi.sane@rivm.nl tel Rody Zuidema, EPI rody.zuidema@rivm.nl tel Barbara Schimmer, EPI barbara.schimmer@rivm.nl tel Jeroen Roelfsema, IDS jeroen.roelfsema@rivm.nl tel
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