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Suominen K, Vainio A, Hokkanen P, Åberg R, Isosomppi S, Särelä E, Kitowska W, Gonzalez-Perez AC, Ollgren J, Bujila I, Troell K, Hansen A, Lindblad M, Rimhanen-Finne R. Multilocus Variable-Number Tandem-Repeat Analysis as an Investigation Tool in Cryptosporidium parvum Outbreaks in Finland and Sweden in 2022. Microorganisms 2025; 13:821. [PMID: 40284657 PMCID: PMC12029223 DOI: 10.3390/microorganisms13040821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2025] [Revised: 03/29/2025] [Accepted: 04/02/2025] [Indexed: 04/29/2025] Open
Abstract
Cryptosporidium is a significant cause of foodborne outbreaks. The 60 kDa glycoprotein gene (gp60) is most often used for subtyping Cryptosporidium species but is not always sufficient for defining clusters and infections sources. The Multilocus Variable-Number Tandem-Repeat Analysis (MLVA) scheme has been developed to better differentiate between subtypes. A cryptosporidiosis outbreak, with 35 cases, was detected in Finland in September 2022. At the same time, in Sweden, three cryptosporidiosis outbreaks, with 107 cases, were detected, leading to international collaboration. In both countries, salad mixes were suspected as being the outbreak source. In the Finnish outbreak, the suspected salad mixes were produced in Sweden. In the Swedish outbreaks, salad mixes from two different producers were suspected. Twenty-nine patient samples which were positive for Cryptosporidium parvum (11 from Finland and 18 from Sweden) were sent for MLVA. The Finnish outbreak samples had different gp60 subtypes and MLVA profiles compared to the Swedish samples. In our investigation, MLVA differentiated C. parvum subtypes in more detail than gp60 typing. MLVA suggested no connection between the Finnish and Swedish outbreaks. A traceback investigation supported this conclusion. To detect outbreaks and identify infection sources, the timely subtyping of patient samples is crucial and should be implemented in routine surveillance and outbreak investigations.
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Affiliation(s)
- Kristiina Suominen
- Department of Public Health, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00271 Helsinki, Finland; (K.S.); (A.V.); (W.K.); (A.C.G.-P.); (J.O.)
| | - Anni Vainio
- Department of Public Health, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00271 Helsinki, Finland; (K.S.); (A.V.); (W.K.); (A.C.G.-P.); (J.O.)
| | - Pirkko Hokkanen
- Food Safety Unit, City of Helsinki, Työpajankatu 8, 00580 Helsinki, Finland; (P.H.); (R.Å.)
| | - Riikka Åberg
- Food Safety Unit, City of Helsinki, Työpajankatu 8, 00580 Helsinki, Finland; (P.H.); (R.Å.)
| | - Sanna Isosomppi
- Epidemiological Operations Unit, City of Helsinki, Toinen Linja 4 A, 00530 Helsinki, Finland; (S.I.); (E.S.)
| | - Eeva Särelä
- Epidemiological Operations Unit, City of Helsinki, Toinen Linja 4 A, 00530 Helsinki, Finland; (S.I.); (E.S.)
| | - Wioleta Kitowska
- Department of Public Health, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00271 Helsinki, Finland; (K.S.); (A.V.); (W.K.); (A.C.G.-P.); (J.O.)
- ECDC Fellowship Programme, Field Epidemiology Path (EPIET), European Centre for Disease Prevention and Control (ECDC), 169 73 Stockholm, Sweden
| | - Ana Cristina Gonzalez-Perez
- Department of Public Health, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00271 Helsinki, Finland; (K.S.); (A.V.); (W.K.); (A.C.G.-P.); (J.O.)
- ECDC Fellowship Programme, Public Health Microbiology Path (EUPHEM), European Centre for Disease Prevention and Control (ECDC), 169 73 Stockholm, Sweden
| | - Jukka Ollgren
- Department of Public Health, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00271 Helsinki, Finland; (K.S.); (A.V.); (W.K.); (A.C.G.-P.); (J.O.)
| | - Ioana Bujila
- Department of Microbiology, Public Health Agency of Sweden, Nobels väg 18, 171 65 Solna, Sweden;
| | - Karin Troell
- Department of Microbiology, Swedish Veterinary Institute, Ulls väg 2B, 751 89 Uppsala, Sweden;
- Norwegian Veterinary Institute, Elizabeth Stephansens vei 1, 1433 Ås, Norway
| | - Anette Hansen
- Department of Communicable Disease Control and Health Protection, Public Health Agency of Sweden, Nobels väg 18, 171 65 Solna, Sweden;
| | - Mats Lindblad
- Department of Food Hygiene, Swedish Food Agency, Dag Hammarskjölds väg 56 A, 752 37 Uppsala, Sweden;
| | - Ruska Rimhanen-Finne
- Department of Public Health, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00271 Helsinki, Finland; (K.S.); (A.V.); (W.K.); (A.C.G.-P.); (J.O.)
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Peake L, Bardsley M, Bartram S, Bharuchi S, Howkins J, Robinson G, Charlett A, Chalmers R, Bird S, Young N. A large cryptosporidiosis outbreak associated with an animal contact event in England: a retrospective cohort study, 2023. Epidemiol Infect 2024; 152:e91. [PMID: 38800856 PMCID: PMC11736449 DOI: 10.1017/s0950268824000591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/12/2024] [Accepted: 03/31/2024] [Indexed: 05/29/2024] Open
Abstract
Development of gastrointestinal illness after animal contact at petting farms is well described, as are factors such as handwashing and facility design that may modify transmission risk. However, further field evidence on other behaviours and interventions in the context of Cryptosporidium outbreaks linked to animal contact events is needed. Here, we describe a large outbreak of Cryptosporidium parvum (C. parvum) associated with a multi-day lamb petting event in the south-west of England in 2023 and present findings from a cohort study undertaken to investigate factors associated with illness. Detailed exposure questionnaires were distributed to email addresses of 647 single or multiple ticket bookings, and 157 complete responses were received. The outbreak investigation identified 23 laboratory-confirmed primary C. parvum cases. Separately, the cohort study identified 83 cases of cryptosporidiosis-like illness. Associations between illness and entering a lamb petting pen (compared to observing from outside the pen; odds ratio (OR) = 2.28, 95 per cent confidence interval (95% CI) 1.17 to 4.53) and self-reported awareness of diarrhoeal and vomiting disease transmission risk on farm sites at the time of visit (OR = 0.40, 95% CI 0.19 to 0.84) were observed. In a multivariable model adjusted for household clustering, awareness of disease transmission risk remained a significant protective factor (adjusted OR (aOR) = 0.07, 95% CI 0.01 to 0.78). The study demonstrates the likely under-ascertainment of cryptosporidiosis through laboratory surveillance and provides evidence of the impact that public health messaging could have.
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Affiliation(s)
- Lewis Peake
- Health Protection Operations, United Kingdom Health Security Agency, Bristol, UK
| | - Megan Bardsley
- Health Protection Operations, United Kingdom Health Security Agency, Bristol, UK
| | - Samantha Bartram
- Food Safety and Health & Safety, South Hams District Council and West Devon Borough Council, UK
| | - Shireen Bharuchi
- Health Protection Operations, United Kingdom Health Security Agency, Bristol, UK
| | - Josh Howkins
- Health Protection Operations, United Kingdom Health Security Agency, Bristol, UK
| | - Guy Robinson
- Cryptosporidium Reference Unit, Public Health Wales, Swansea, UK
| | - André Charlett
- Statistics, Modelling and Economics, United Kingdom Health Security Agency, London, UK
| | - Rachel Chalmers
- Cryptosporidium Reference Unit, Public Health Wales, Swansea, UK
| | - Sarah Bird
- Health Protection Operations, United Kingdom Health Security Agency, Bristol, UK
| | - Nick Young
- Health Protection Operations, United Kingdom Health Security Agency, Bristol, UK
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Peake L, Inns T, Jarvis C, King G, Rabie H, Henderson J, Wensley A, Jarratt R, Roberts C, Williams C, Orife O, Browning L, Neilson M, McCarthy C, Millar P, Love N, Elwin K, Robinson G, Mannes T, Young N, Chalmers R, Elson R, Vivancos R. Preliminary investigation of a significant national Cryptosporidium exceedance in the United Kingdom, August 2023 and ongoing. Euro Surveill 2023; 28:2300538. [PMID: 37883039 PMCID: PMC10604540 DOI: 10.2807/1560-7917.es.2023.28.43.2300538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/25/2023] [Indexed: 10/27/2023] Open
Abstract
Routine laboratory surveillance has identified an unprecedented and ongoing exceedance of Cryptosporidium spp. across the United Kingdom, notably driven by C. hominis transmission, since 14 August 2023. Information from 477 reported cases in England and Wales, followed up with a standardised exposure questionnaire as of 25 September 2023, identified foreign travel in 250 (54%) of 463 respondents and swimming in 234 (66%) of 353 cases. A significant, common exposure has not yet been identified in first analyses.
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Affiliation(s)
- Lewis Peake
- United Kingdom Health Security Agency, London, the United Kingdom
| | - Thomas Inns
- United Kingdom Health Security Agency, London, the United Kingdom
| | | | - Grace King
- United Kingdom Health Security Agency, London, the United Kingdom
| | - Hussein Rabie
- United Kingdom Health Security Agency, London, the United Kingdom
| | - Joan Henderson
- United Kingdom Health Security Agency, London, the United Kingdom
| | - Adrian Wensley
- United Kingdom Health Security Agency, London, the United Kingdom
| | - Reece Jarratt
- United Kingdom Health Security Agency, London, the United Kingdom
| | | | | | | | | | | | | | - Paul Millar
- Health and Safety Committee (HSC) Public Health Agency, Belfast, Northern Ireland, the United Kingdom
| | - Nicola Love
- United Kingdom Health Security Agency, London, the United Kingdom
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Gastrointestinal Infections, Liverpool, the United Kingdom
| | - Kristin Elwin
- Cryptosporidium Reference Unit, Public Health Wales, Swansea, the United Kingdom
| | - Guy Robinson
- Cryptosporidium Reference Unit, Public Health Wales, Swansea, the United Kingdom
| | - Trish Mannes
- United Kingdom Health Security Agency, London, the United Kingdom
| | - Nick Young
- United Kingdom Health Security Agency, London, the United Kingdom
| | - Rachel Chalmers
- Cryptosporidium Reference Unit, Public Health Wales, Swansea, the United Kingdom
| | - Richard Elson
- United Kingdom Health Security Agency, London, the United Kingdom
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Gastrointestinal Infections, Liverpool, the United Kingdom
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, the United Kingdom
| | - Roberto Vivancos
- United Kingdom Health Security Agency, London, the United Kingdom
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Gastrointestinal Infections, Liverpool, the United Kingdom
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, the United Kingdom
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