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Characterizing the Role of Animal Exposures in Cryptosporidiosis and Shiga Toxin-producing Escherichia coli Infections: South Dakota, 2012
Abstract
Cryptosporidium spp. and Shiga toxin-producing Escherichia coli strains (STEC) are important causes of human illness. Incidence rates of these illnesses are high in South Dakota compared to the USA as a whole. Direct animal contact has been identified as a possible route of exposure for these illnesses. Ruminant animals may carry STEC subclinically, while young ruminants are common sources of zoonotic strains of Cryptosporidium. South Dakota patients with either STEC or cryptosporidiosis during 2012 were interviewed regarding seven categories of animal exposure: (i) petting zoo/fair attendance, (ii) animal event/rodeo attendance, (iii) feed/pet store visits, (iv) farm visits, (v) employment or residence at a farm, (vi) residence with pets and (vii) visiting other households with pets. Of the 50 STEC cases, 78.0% reported animal exposure prior to illness onset, with 23.3% having lived or worked on a farm. Farm visitors in particular had high degrees of animal contact and infrequently practiced personal protective measures. Of the 115 cryptosporidiosis cases, 87.8% reported animal exposures, with 45.6% having lived or worked on a farm and 29.0% having visited a farm prior to illness. Cases with farm exposures reported a high degree of direct animal contact and inconsistent use of personal protective measures. Cryptosporidiosis patients were significantly more likely than STEC patients to have lived or worked on a farm prior to their illness and were older on average. Patients with these illnesses had high rates of animal contact prior to illness. Animal contact on farms emerged as an important exposure route. Educational messages about personal protective measures should be directed at these individuals.
... Living and/or working on a farm was the most frequent type of animal agriculture exposure reported (61%). This is consistent with findings of a study in South Dakota, another heavily agricultural state [28]. In Minnesota, visiting a private farm with food production animals was also a common exposure, accounting for 29% of animal agriculture exposures. ...
... Another limitation is that our findings are not generalizable across the United States, as the importance and types of animal agriculture vary dramatically by region. States with a greater agricultural economic base than Minnesota, such as South Dakota [28], can expect to have an even higher burden of illness associated with animal agriculture. Conversely, that burden is likely to be less in states in which animal agriculture is not as economically important. ...
Prospective, population-based surveillance to systematically ascertain exposures to food production animals or their environments among Minnesota residents with sporadic, domestically acquired, laboratory-confirmed enteric zoonotic pathogen infections was conducted from 2012 through 2016. Twenty-three percent ( n = 1708) of the 7560 enteric disease cases in the study reported an animal agriculture exposure in their incubation period, including 60% (344/571) of Cryptosporidium parvum cases, 28% (934/3391) of Campylobacter cases, 22% (85/383) of Shiga toxin-producing Escherichia coli (STEC) O157 cases, 16% (83/521) of non-O157 STEC cases, 10% (253/2575) of non-typhoidal Salmonella enterica cases and 8% (9/119) of Yersinia enterocolitica cases. Living and/or working on a farm accounted for 61% of cases with an agricultural exposure, followed by visiting a private farm (29% of cases) and visiting a public animal agriculture venue (10% of cases). Cattle were the most common animal type in agricultural exposures, reported by 72% of cases. The estimated cumulative incidence of zoonotic enteric infections for people who live and/or work on farms with food production animals in Minnesota during 2012–2016 was 147 per 10 000 population, vs. 18.5 per 10 000 for other Minnesotans. The burden of enteric zoonoses among people with animal agriculture exposures appears to be far greater than previously appreciated.
... The results of the current study is in disagreement with Azcona et al. (2017) in Spain, which recorded 54.4% in male and 45.6% in female, using real-time PCR technique. This result may be explained by the nature of work of females compared to males, and the increased exposure to risk factors when dealing with domesticated animals as well as a lack of awareness of personal hygiene (Daly & Hill, 2016). ...
Cryptosporidium is a coccidian protozoan parasite infecting alimentary system and epithelial respiratory tract of humans and a wide range of vertebrates such as mammals, birds, reptiles, and fish. This study was carried out in Al-Kut city, Iraq, in two major hospitals: Al-Kut Hospital for Gynecology, Obstetric and Pediatric and Al-Karama Teaching Hospital, which included collection of stool samples from diarrheal patients. 96 stool samples taken from patients with different ages and both genders were examined by multiplex PCR technique. The results showed that the percentage of Cryptosporidium spp. infection was 39.6% and 4.2% for C. parvum and C. hominis, respectively. There are no statistically significant associates between gender and Cryptosporidium infection. The higher infection for C. parvum (41.2%) appeared in females, while the higher infection for C. hominis was found in male (4.8%). The study showed that the percentage of C. parvum infection in the rural areas is more than the urban, where the percentage in rural areas (52.9%) showed a significant difference at p = 0.004, while the infection rate for C. hominis was 6.7% in urban area. Regarding the water source, higher cryptosporidiosis rate was found in participants who used bottled water than in those who used tap water, and there is statistical significant between C. parvum infection and water source (p = 0.03), while the high infection in individuals who used bottled water were 58%. The present study aimed to determine the common Cryptosporidium species in diarrhea samples.
... STEC colonises the gastrointestinal tract of cattle, which are mainly asymptomatic carriers, and only under specific circumstances can develop diarrhoea. It can adapt and survive in different environments such as soil and water and contaminates food, meat, and dairy products, through which it can reach and infect other animals and humans (Daly & Hill, 2016). Non-O157 STEC isolates have increasingly been reported associated with human outbreaks (Bettelheim & Goldwater, 2014). ...
Shiga toxin-producing Escherichia coli (STEC) infections are responsible for acute illnesses and deaths in humans. Cattle and humans are exposed to STEC through faeces and contaminated food and water. The big six and O157 STEC serogroups are important food and water-borne human pathogens. Additionally, Stx1a, Stx2a and Stx2c subtypes are highly associated with the haemolytic uremic syndrome. This study aimed to determine Shiga toxin-subtypes, the presence of antigen 43 families, the genotypic and phenotypic antimicrobial susceptibility profiles, O-serogrouping, phylotypes and phylogenetic relatedness of STEC of calf origin. Sixteen STEC isolates from calf origin were analysed. PCR was performed to determine Stx subtypes, serogroups, the presence of ag43 I and II and phylotypes. The antimicrobial profile was evaluated and the presence of PMQR and fosfomycin genes was determined by PCR. The clonal relatedness of STEC was studied by PFGE. The genotypes stx1a+c, stx1a+, stx1a+/stx2e+, stx1a+c/stx2e and stx2a were detected. Ag43 II was the most prevalent among subfamilies. STEC isolates were serotyped as O103 (n=5) and O111 (n=6). Fifty per cent of the isolates were classified as B1 phylogroup, 4/16 as E, 1/16 as C, and 1/16 as F. Non-O157 STEC isolates showed a high level of diversity, independent of the geographical and farm-origin. Isolates were resistant to ampicillin, ciprofloxacin, gentamicin, and fosfomycin-trometamol. The gene fosA7 was detected in 1 isolate. The virulence profiles, including Shiga toxin-subtypes and serogroups, denote the potential harm of non-O157 STEC isolates to humans. We also confirmed that circulating non-O157 STEC from cattle present genetic heterogeneity and are susceptible to antibiotics.
... Nevertheless, the excellent resolution provided by NGS in the two petting zoo-related events Open farms and similar premises often provide the only significant opportunity for the general public to have close contact with animals, and they fulfill an important educational role and provide major contributions to the tourism and leisure industries. The potential risk is the exposure of people to zoonotic hazards such as STEC (Daly and Hill, 2015). The first recorded outbreaks of STEC O157 associated with an animal exhibit occurred in England (1994), affecting 7 individuals, with 4 developing HUS, followed by Wales (1995) with another 3 individuals affected with 1 developing HUS (LeJeune and Davis, 2004). ...
... Public Health Veterinarians, 2013; Bolton, 2015). Transmission of Salmonella from small ruminants and pigs to humans has also been reported, particularly through occupational exposure (Hoelzer et al., 2011;Daly and Hill, 2016). ...
Many public venues such as farms, fairs, and petting zoos encourage animal contact for both educational and entertainment purposes. However, healthy farm animals, including cattle, small ruminants, and poultry, can be reservoirs for enteric zoonotic pathogens, with human infections resulting in nausea, vomiting, diarrhea, and, in some cases, severe complications that can lead to death. As animals shed these organisms in their feces, contamination of themselves and their surroundings is unavoidable. The majority of North Americans reside in urban and suburban settings, and the general public often possess limited knowledge of agricultural practices and minimal contact with farm animals. Furthermore, there is a lack of understanding of zoonotic pathogens, particularly how these pathogens are spread and the human behaviors that may increase the risk of infection. Human risk behaviors include hand-to-mouth contact immediately after physical contact with animals and their environments, a practice that facilitates the ingestion of pathogens. It is often young children who become ill due to their under-developed immune systems and poorer hygienic practices compared with adults, such as more frequent hand-to-mouth behaviors, and infrequent or improper hand washing. These illnesses are often preventable, simply through adequate hygiene and hand washing. Our objective was to use a structured approach to review the main causal organisms responsible for human illnesses acquired in petting zoo and open farm environments, Shiga toxin-producing Escherichia coli, nontyphoidal Salmonella, Campylobacter, and Cryptosporidium. Notable outbreaks involving direct contact with farm animals and farm, fair, or petting zoo environments are discussed and recommendations for how public venues can increase safety and hand hygiene compliance among visitors are proposed. The most effective protective measures against enteric illnesses include education of the public, increasing overall awareness of the risks and the importance of hand hygiene, as well as access to hand-washing facilities.
... Lack of or limited subtyping tools make it difficult to determine the role of zoonotic transmission of Cryptosporidium chipmunk genotype I, but in a study of Cryptosporidium chipmunk genotype I isolates, it was shown to be genetically similar from humans and wild life, suggesting zoonotic transmission may play a role in human infections. Many other reports of cryptosporidiosis in North America are available [141][142][143][144][145]. ...
Background
Cryptosporidiosis is a zoonotic disease caused by the important parasitic diarrheal agent Cryptosporidium spp. Cryptosporidiosis occurs in all classes of animals and man with a rapidly expanding host range and increased importance since the occurrence of human immunodeficiency virus/acquired immunodeficiency syndrome in man.
Objectives
To review the global picture of cryptosporidiosis in man and animals with emphasis on prevalence and risk factors.
Methods
Current relevant literature on cryptosporidiosis was reviewed.
Results
Cryptosporidiosis is widely distributed and the risk factors vary from one region to another with hygiene and immune status as important risk factors.
Conclusions
Cryptosporidium spp. associated mortality has not only been reported in immune-compromised patients, but also in immune-competent patients. Yet in many countries not much attention is paid to the control and prevention of this infection in animals and man. The neglect of this disease despite the serious threat it poses to animals, their husbandry, and humans, has led the World Health Organization to list it among globally neglected diseases. To control and prevent this infection more effort needs to be directed at controlling the risk factors of the infection in man and animals.
This publication contains summary tables of the official statistics for the reported occurrence of nationally notifiable diseases in the United States for 1997. These statistics are collected and compiled from reports to the National Notifiable Diseases Surveillance System (NNDSS), which is operated by CDC in collaboration with the Council of State and Territorial Epidemiologists (CSTE). Because the dates of onset or diagnosis for notifiable diseases are not always reported, these surveillance data are presented by the week they were reported to CDC by public health officials in state and territorial health departments. These data are finalized and published in the MMWR Summary of Notifiable Diseases, United States for use by state and local health departments; schools of medicine and public health; communications media; local, state, and federal agencies; and other agencies or persons interested in following the trends of reportable diseases in the United States. The annual publication of the Summary also documents which diseases are considered national priorities for notification and the annual number of cases of such diseases.
Fecal samples from 720 healthy, domestic animals representing seven different species (cattle, sheep, goats, pigs, chickens, dogs, and cats) were investigated for verotoxin (VT [Shiga-like toxin])-producing Escherichia coli (VTEC). VTEC were isolated from 208 animals (28.9%), most frequently from sheep (66.6% VTEC carriers), goats (56.1%), and cattle (21.1%). VTEC were isolated less frequently from pigs (7.5%), cats (13.8%), and dogs (4.8%) and were not found in chickens (< 0.7%). Forty-one different O:H serotypes and 23 untypeable O-groups were isolated. Five serotypes (O5:H-, O91:H-, O146:H21, O87:H16, and O82:H8) occurred in more than one animal species. Serotypes O5:H-, O91:H-, O146:H21, O128:H2, and OX3:H8 represented 54.8% of the VTEC strains. Nearly 60% of all VTEC O:H serotypes isolated in this study have been implicated as human pathogens, indicating that healthy, domestic animals may serve as a reservoir of human pathogens. All VTEC, except nine feline strains, hybridized with one or both of the VT1 and VT2 specific DNA probes. VT production and enterohemolysin (E-Hly+) production were associated in E. coli from goats, sheep, and cattle but not in E. coli from chickens, pigs, dogs, and cats. A close association of VT with E-Hly+ was found in O5:H-, O146:H21, O128:H2, O77:H4, O119:H25, and O123:(H10) strains. Thirty of 240 (12.5%) E-Hly+ strains hybridized with an E-Hly+ specific DNA probe, indicating heterogeneity of regulatory or structural E-Hly+ genes in strains of E. coli.
To better quantify the impact of foodborne diseases on health in the United States, we compiled and analyzed information from multiple surveillance systems and other sources. We estimate that foodborne diseases cause approximately 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year. Known pathogens account for an estimated 14 million illnesses, 60, 000 hospitalizations, and 1,800 deaths. Three pathogens, Salmonella, Listeria, and Toxoplasma, are responsible for 1,500 deaths each year, more than 75% of those caused by known pathogens, while unknown agents account for the remaining 62 million illnesses, 265,000 hospitalizations, and 3,200 deaths. Overall, foodborne diseases appear to cause more illnesses but fewer deaths than previously estimated.
In 173 urban residents and 232 rural dairy-farm residents (age range, 0–70 years) who were stratified for age, the frequency
of antiverocytotoxin 2 antibodies (VT2 Abs) (frequency in urban residents, 46%; frequency in rural residents, 65%) was significantly
higher than that of antiverocytotoxin 1 antibodies (VT1 Abs) (frequency in urban residents, 12%; frequency in rural residents,
39%) (P⩽.001). The frequency of VT2 Abs (93%) was also significantly higher than that of VT1 Abs (50%) in 14 patients with
hemolytic uremic syndrome (HUS) associated with verocytotoxin-producing Escherichia coli (VTEC) strains that expressed both toxins. In urban residents, the frequency of both antibodies tended to decrease between
the first and the second decades of life, and it then increased until the fifth decade of life, before, in the case of VT2
Abs, decreasing again. This pattern, which inversely reflects the age-related incidence of HUS, is consistent with a role
for antiverocytotoxin antibodies in protective immunity. In dairy-farm residents, peak frequencies of antibodies to both toxins
occurred during the first decade of life and remained elevated for 3 decades before decreasing, a pattern consistent with
frequent exposure to bovine VTEC from an early age
In the past 10 years, an increasing number of outbreaks of enteric disease associated with animals in public settings, such
as fairs and petting zoos, have been reported. Fifty-five of these outbreaks that occurred in the United States during 1991–2005
are reviewed in this article. Lessons learned from these outbreaks and recommendations for prevention are also discussed.
Physicians should be aware of this important public health problem and play an active role in prevention of human illness
associated with animals in public settings.
Cryptosporidiosis is a nationally notifiable gastrointestinal illness caused by extremely chlorine-tolerant protozoa of the genus Cryptosporidium.
2011-2012.
Fifty state and two metropolitan public health agencies voluntarily report cases of cryptosporidiosis through CDC's National Notifiable Diseases Surveillance System.
For 2011, a total of 9,313 cryptosporidiosis cases (confirmed and nonconfirmed) were reported; for 2012, a total of 8,008 cases were reported; 5.8% and 5.3%, respectively, were associated with a detected outbreak. The rates of reported nonconfirmed cases were 1.0 and 0.9 per 100,000 population in 2011 and 2012, respectively, compared with an average of 0.0 during 1995-2004, and 0.3 during 2005-2010. The highest overall reporting rates were observed in the Midwest; 10 states reported >3.5 cases per 100,000 population in 2011 and in 2012. During 2011-2012, reported cases were highest among children aged 1-4 years (6.6 per 100,000 population), followed for the first time by elderly adults aged ≥80 years (3.4), and 75-79 years (3.3). Overall, cryptosporidiosis rates were higher among females than males during both years. For specific age groups, rates were higher among males than females aged <15 years and higher among females than males aged ≥15 years. Cryptosporidiosis symptom onset increased 4.4 fold during late summer.
Cryptosporidiosis incidence rates remain elevated nationally, and rates of nonconfirmed cases have increased. Rates remain highest in young children, although rates among elderly adults are increasing. Transmission of Cryptosporidium occurs throughout the United States, with increased reporting occurring in Midwestern states. Seasonal onset peaks coincide with the summer recreational water season and might reflect increased use of communal swimming venues.
Future research is needed to address the evolving epidemiology of cryptosporidiosis cases, with a specific focus on the increase in nonconfirmed cases and increasing incidence rates among elderly adults. National systematic genotyping and subtyping of Cryptosporidium isolates could also help elucidate Cryptosporidium transmission and thus cryptosporidiosis epidemiology in the United States.
Contact with animals and their environment is an important, and often preventable, route of transmission for enteric pathogens. This study estimated the annual burden of illness attributable to animal contact for 7 groups of pathogens: Campylobacter species, Cryptosporidium species, Shiga toxin-producing Escherichia coli (STEC) O157, STEC non-O157, Listeria monocytogenes, nontyphoidal Salmonella species, and Yersinia enterocolitica.
By using data from the US Foodborne Diseases Active Surveillance Network and other sources, we estimated the proportion of illnesses attributable to animal contact for each pathogen and applied those proportions to the estimated annual number of illnesses, hospitalizations, and deaths among US residents. We established credible intervals (CrIs) for each estimate.
We estimated that 14% of all illnesses caused by these 7 groups of pathogens were attributable to animal contact. This estimate translates to 445 213 (90% CrI, 234 197-774 839) illnesses annually for the 7 groups combined. Campylobacter species caused an estimated 187 481 illnesses annually (90% CrI, 66 259-372 359), followed by nontyphoidal Salmonella species (127 155; 90% CrI, 66 502-219 886) and Cryptosporidium species (113 344; 90% CrI, 22 570-299 243). Of an estimated 4933 hospitalizations (90% CrI, 2704-7914), the majority were attributable to nontyphoidal Salmonella (48%), Campylobacter (38%), and Cryptosporidium (8%) species. Nontyphoidal Salmonella (62%), Campylobacter (22%), and Cryptosporidium (9%) were also responsible for the majority of the estimated 76 deaths (90% CrI, 5-211).
Animal contact is an important transmission route for multiple major enteric pathogens. Continued efforts are needed to prevent pathogen transmission from animals to humans, including increasing awareness and encouraging hand hygiene.
The aims of this study were to investigate the incidence of Salmonella, verocytotoxigenic Escherichia coli (VTEC)/Escherichia coli O157 and Campylobacter on four mixed farms and to characterize the isolates in terms of a range of virulence factors. Eighty-nine composite (five different samples from the same animal species combined) faecal [cattle (24), pigs (14), sheep (4), poultry (4), horses (7), deer (4), dogs (9), rodents (2) and wild birds (20)] samples, 16 composite soil samples plus 35 individual water samples were screened using culture-based, immunomagnetic separation and molecular methods. Salmonella was detected in bovine faeces, cattle and poultry house water. Salmonella serotypes/phage types included Dublin, Kiel and Typhimurium DT193, and most isolates were spvC, invA and rck positive. The pefA and rck genes were found exclusively in the non-Typhimurium strains, while Salmonella Dublin and Salmonella Kiel strains carried Salmonella genomic island I marker(s). VTEC/E. coli O157 were found in deer and dog faeces only. The E. coli O157 isolate was an enteroinvasive E. coli, while the VTEC isolate was untypable but carried the vt1, eaeA, hlyA, tir and eptD genes. This article reports the first confirmed carriage of E. coli O157 in Irish deer. Campylobacter species were not detected over the course of this study. It was concluded that [1] Salmonella, VTEC and Campylobacter have low (<5%) prevalence or are absent on the farms in this study; [2] water was an important source of bacterial pathogens; [3] both dogs and deer may act as a source of pathogenic E. coli and [4] key virulence and resistance determinants are widespread in farm Salmonella strains. This study highlights the need to control water as a source of pathogens and suggests that the domestic pets and deer should be considered in any farm risk assessment.
Cryptosporidiosis is a nationally notifiable gastrointestinal illness caused by chlorine-tolerant protozoa of the genus Cryptosporidium.
2006-2008.
State and two metropolitan health departments voluntarily report cases of cryptosporidiosis through CDC's National Notifiable Diseases Surveillance System.
During 2006-2008, the number of reported cases of cryptosporidiosis increased dramatically (79.9%), from 6,479 for 2006 to 11,657 for 2007, and then decreased (9.9%) to 10,500 in 2008. All jurisdictions reported cryptosporidiosis cases during the reporting period, and the number of jurisdictions reporting >2.5 cases per 100,000 population increased from 20 in 2006 to 26 in 2007 and 27 in 2008. A greater number of case reports were received for children aged 1-9 years and for adults aged 25-39 years than were received for persons in other age groups. The number of cases reported among males and females was similar. Racial and ethnic comparisons were difficult because many case-reports did not report race and ethnicity. Peak onset of illness occurred annually during early summer through early fall.
Transmission of cryptosporidiosis occurs throughout the United States, with more frequent diagnosis or reporting occurring in northern states. An increase in cases reported for 2007 and 2008 is attributable partially to multiple large recreational water-associated outbreaks. State incidence figures should be compared with caution because individual state surveillance systems have varying capabilities to detect cases, and reporting might vary. The seasonal peak in age-specific case reports coincides with the summer recreational water season and likely reflects increased use of communal swimming venues (e.g., lakes, rivers, swimming pools, and water parks) by young children.
Local and state health departments can use cryptosporidiosis surveillance data to better understand the epidemiologic characteristics and the disease burden of cryptosporidiosis in the United States, design efforts to prevent the spread of disease, and establish research priorities.
The role of dogs and cats in human cryptosporidiosis has been the focus of much attention. Studies in which genotyping of Cryptospiridium oocysts in feces of dogs and cats have been successful and have demonstrated that most infections in these animals are caused by host-specific C. canis and C. felis, respectively. Most human cases of cryptosporidiosis are associated with C. hominis and C. parvum; C. canis and C. felis are responsible for only a small number of cases. Thus, molecular epidemiologic studies support the contention that the risk of zoonotic transmission of Cryptosporidium spp. from pet cats and dogs is low. Veterinarians can inform their clients of this minimal risk, but nevertheless advise them to minimize contact with pet cat and dog feces.
For three years investigations from 1996 to 1998, we tried to isolate Escherichia coli O157:H7 from fecal samples collected from dogs and cats. In results, E. coli O157:H7 was isolated from 1 out of 614 samples (0.16%). This isolate produced Stx1 and Stx2 and was isolated from a dog kept by a human patient infected with E. coli O157:H7. Excluding in this case, dogs and cats as companion animals, therefore, may not give harbor to E. coli O157:H7.
Cryptosporidium causes a debilitating illness in immunocompromised individuals, yet the source of sporadic Cryptosporidium infections is unknown. Because early cases of cryptosporidiosis were associated with animals, and pets are a source of companionship to individuals with AIDS, determination of the risk of cryptosporidiosis associated with pets is important. To assess this risk, we conducted a case-control study of HIV-infected individuals with and without cryptosporidiosis. No statistically significant difference in the rate of overall pet ownership, cat ownership, or bird ownership was found between the two groups. Dog ownership reached borderline statistical significance; 15 of 48 (31%) cases owned a dog, compared with 17 of 99 (17%) controls (odds ratio [OR] = 2.19; p = .05; 95% confidence interval [CI], 0.9-5.3). No statistically significant differences between cases and controls were found in the frequency of surface water ingestion, rural exposure, travel history, or contact with diarrheic individuals. Our findings indicate that pets do not represent a major risk factor for acquisition of Cryptosporidium for HIV-infected individuals. Whether dog ownership presents a minimal risk for cryptosporidiosis needs further investigation.
Cryptosporidiosis, a gastrointestinal illness, is caused by protozoa of the genus Cryptosporidium.
2003-2005.
State and two metropolitan health departments voluntarily reported cases of cryptosporidiosis through CDC's National Notifiable Diseases Surveillance System.
During 2003--005, the total number of reported cases of cryptosporidiosis increased from 3,505 for 2003 to 3,911 for 2004 and to 8,269 for 2005. All reporting areas submitted reports, with more reports from northern states. Compared with other age groups, a greater number of case reports were received for children aged 1-9 years and adults aged 30-39 years. Peak onset of illness occurred annually during early summer through early fall.
Transmission of cryptosporidiosis occurs throughout the United States, with increased diagnosis or reporting occurring in northern states. An increase in cases reported for 2005 was attributable primarily to the occurrence of a single large recreational water-associated outbreak. State incidence figures should be compared with caution because individual state surveillance systems have varying capabilities to detect cases, and reporting might vary. The seasonal peak in age-specific case reports coincides with the summer recreational water season and might reflect increased use of communal swimming venues (e.g., lakes, rivers, swimming pools, and water parks) by young children.
Cryptosporidiosis surveillance provides data to educate public health practitioners and health-care providers about the epidemiologic characteristics and the disease burden of cryptosporidiosis in the United States. These data are used to improve reporting of cases, plan prevention efforts, and establish research priorities.
South Dakota State and County Demographic Profiles
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2013 Epitools epidemiological calculators AusVet Animal Health Services and Australian Biosecurity Cooperative Research Centre for Emerging Infectious Disease http
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