Wisconsin Division of Public Health Disease Surveillance Manual (EpiNet, February 2005)

I. IDENTIFICATION

A. CLINICAL DESCRIPTION: An illness caused by the protozoan Cryptosporidium parvum and characterized by profuse watery diarrhea, abdominal cramps, anorexia, low-grade fever, nausea and vomiting. Infected persons may be asymptomatic. The disease can be prolonged and life-threatening in severely immunocompromised people.

B. REPORTING CRITERIA: Laboratory confirmation.

C. LABORATORY CRITERIA FOR CONFIRMATION:

• Demonstration of Cryptosporidium oocysts in stool, OR
• Demonstration of Cryptosporidium in small bowel biopsy or other clinical specimens, OR
• Demonstration of Cryptosporidium antigen in stool by a specific immunodiagnostic test such as enzyme-linked immunosorbent assay (ELISA).

D. WISCONSIN CASE DEFINITION: A case that is laboratory confirmed.

II. ACTIONS REQUIRED / PREVENTION MEASURES

A. WISCONSIN DISEASE SURVEILLANCE CATEGORY II: Report to the patient's local health officer on an Acute and Communicable Disease Case Report (DPH 4151) or other means within 72 hours of the identification of a case or suspected case.

B. EPIDEMIOLOGY REPORTS REQUESTED:

• Acute and Communicable Diseases Case Report (DPH 4151).
• Routine Enteric Follow-up Worksheet – (See page 1 of the Worksheet for specific recommendations regarding which sections are recommended during routine follow-up)

C. PUBLIC HEALTH INTERVENTIONS:

• Assess case for association with high-risk setting (e.g., day care, food worker, or health care provider) and apply DPH guidelines for prevention and control.
• Exclude symptomatic patients from food handling, generally until asymptomatic.The LHD can require two negative stool cultures taken at least 24 hours apart if they consider the patient’s personal hygiene to be inadequate.
• Conduct cluster investigation if two or more cases occur in a close geographic or temporal setting or if cases share a common potential exposure (e.g., recreational water, community event, farm-animal-related exposure).

III. CONTACTS FOR CONSULTATION

A. BCDP / COMMUNICABLE DISEASE EPIDEMIOLOGY SECTON: (608) 267-7422.

B. REGIONAL STAFF: See Epinet Introduction: “REGIONAL OFFICE CONTACTS”.

C. WSLH / PARASITOLOGY: (608) 263-3421.

IV. RELATED REFERENCES

1. “Cryptosporidiosis” DPH Disease Fact Sheet Series: View a list of all current Communicable Disease Fact Sheets

2. Heymann DL, ed. CRYPTOSPORIDIOSIS. In: Control of Communicable Diseases Manual. 18 th ed. Washington , DC : American Public Health Association, 2004:138-141.

3. Cryptosporidium Infection in Wisconsin , 1993-1995. Wisconsin Epidemiology Bulletin (WEB), 1996; 17(1).

4. Pickering LK, ed. Cryptosporidiosis. In: Red Book: 2003 Report of the Committee on Infectious Diseases. 26 th ed. Elk Grove Village , IL : American Academy of Pediatrics, 2003:255-257.

5. MacKenzie WR, Hoxie NJ , et al. A massive outbreak in Milwaukee of Cryptosporidium infection transmitted through the public water supply. New England Journal of Medicine . 1994;331:161-167.

6. DPH Guidelines for High-risk Settings:

• General Guidelines - Cryptosporidiosis Case Follow-Up
• Cryptosporidiosis in Food Handlers
• Cryptosporidiosis in Health Care Workers
• Cryptosporidiosis in Day Care Settings
• Fact Sheet for Swimming Pool Operators

V. DISEASE TRENDS