Review Article

Global Distribution, Public Health and Clinical Impact of the Protozoan Pathogen Cryptosporidium

Table 4

Worldwide distribution of principal waterborne, foodborne, travel-related, and community outbreaks reported in the last decade (1998–2008): case characteristics.

Outbreak1 typeCountryIll2AgeLikely causes for outbreak occurringSpecies /genotypeReference

2008

FoodborneFinland72 personnel of the Public Works Department in HelsinkiAdultsSalad mixture suspectedC. parvum[178]
FoodborneSweden21 guests and staff at a wedding receptionAdultsSauce containing chopped fresh parsleyC. parvum[179]

2007

WaterborneNorway89 hotel guestsAdultsIn-house water contaminationC. parvum[298]
CommunityScotland (UK)6 veterinary studentsYoung adultsLapse in hygiene, especially handwashingC. parvum (subgenotype IIaA19G2R1)[299]
WaterborneEngland (UK)57 swimming pool visitorsChildren and adultsSwimming pool contaminationC. parvum C. hominis[246]
Waterborne/ foodborneGermany201 soldiersYoung adultsTap water/food contamination in a military field exerciseC. parvum (genotype 2)[300]
WaterborneIreland (UK)182AdultsContamination of treated waterC. hominis C. parvum[98]
WaterborneSweden800–1000Children and adultsContamination of an outdoor swimming-poolC. parvum[250]

WaterborneID (USA)50 park visitorsChildren and adultsExposure to water from a splash featureC. hominis (subgenotype IaA28R4)[258]

2006

WaterborneEngland (UK)35 school peopleChildren and adultsSurface water contamination during a farm visitC. parvum[251]

Waterborne CO (USA)21 attendes to a pool partyChildren and adultsSwimming, pool contaminationC. hominis (subgenotype IbA10G2)[85]
Travelers’ infectionFL (USA)29 retired peopleElderlyEnvironmental contamination with animal fecesC. parvum (subgenotype IIaA16G1R1b)[207]
FoodborneME (USA)14 peopleNot reportedUnknownCryptosporidium spp.http://www.cdc.gov/foodborneoutbreaks/outbreak_data.htm
FoodbornePA (USA)2 peopleNot reportedUnknownCryptosporidium spp.
WaterborneFL (USA)9 children34 years4Water fountain contaminationCryptosporidium spp.[261]

FoodborneJapan4 company membersAdultsContamination of raw meat dishC. parvum (genotype IIa)[301]

2005

FoodborneDenmark99 company employeesAdultsBuffet salad eatingC. hominis[180]
CommunityScotland (UK)62 peopleAdults and childrenOutbreak linked to a wildlife centre visitC. parvum[247]
WaterborneWales (UK)100Mostly young adultsContamination of raw and treated waterC. hominis[291]
WaterborneTurkey191 inhabitants5Children and adultsContamination of water tankC. parvum[276]

2005–2004

CommunitySpain24 day-care childrenChildrenChildren diaper useC. hominis[252]

2004

WaterborneNorway1156AdultsWater supply contaminationC. parvum (bovin genotype, genotype 2, cervine genotype)[277]
CommunityCroatiaOne family membersElderly and adultsNosocomial and person-to-person contaminationC. hominis[302]

WaterborneCA (USA)273 park attendantsChildren and adultsContamination of a water parkC. parvum (genotype IIc)[127]
FoodborneNY (USA)212 people7Not reportedContamination of unpasteurized apple ciderCryptosporidium spp.http://www.cdc.gov/foodborneoutbreaks/outbreak_data.htm

2003

WaterborneYorkshire and The Humber (UK)66 people attending at the poolChildren and adultsContamination of water at a public poolCryptosporidium spp.[293]
WaterborneSouth West (UK)21 children attending at the water parkChildrenLeisure facility of a 'water splash zoneCryptosporidium spp.[249]
WaterborneSouth East of England (UK)17 people attending at the poolChildren and adultsContamination of water at a public poolCryptosporidium spp.[249]
WaterborneMidlands (UK)122 people attending at the parkChildren and adultsContamination of a fountain water in a public parkCryptosporidium spp.[249]
WaterborneSouth West of England (UK)63 people attending at the animal centreChildrenInteractive water feature at an animal attraction centreC. parvum (genotype 2)[248]
CommunityWales (UK)17 people attending at the school visitChildren and adultsOpen farm, school visitC. parvum (subgenotype IIaA15G2R1)[79]
CommunityWales (UK)36 people attending at the visitChildren and adultsResidential farmcentre, school visitC. parvum C. hominisC. meleagridis[63]
WaterborneMajorca (Spain)179 travellersChildren and adultsHotel pool water contaminationCryptosporidium spp.[292]

FoodborneOH (USA)144 inhabitantsChildren and adultsContamination of unpasteurized apple ciderC. parvum subgenotype IIaA15G2R1, IIaA17G2R1[182]
CommunityMN (USA)31 middle-/high-school studentsYoung peopleContact with calvesC. parvum[303]
CommunityMN (USA)37 middle-/high-school studentsYoung peopleManure on handsC. parvum[303]
FoodborneMN (USA)9 peopleNot reportedContamination of food in a hotel banquet roomCryptosporidium spp.http://www.cdc.gov/foodborneoutbreaks/outbreak_data.htm

2002

CommunityYorkshire and The Humber (UK)47 people attending at the nurseryChildren and adultsContamination at a day care nurseryC. parvum C. hominis C. meleagridis[63]
Multiple exposure: Waterborne and CommunityWales (UK)4 people3 children and 1 adultContamination of a private drinking water supply private water supply, farm visits and personal contactC. parvum (subgenotype IIaA17G1R1)[79]
WaterborneSouth East of England (UK)21 peopleNot reportedContamination of a public drinking water supplyCryptosporidium spp.[293]
WaterborneSouth East of England (UK)31 peopleNot reportedContamination of a public drinking water supplyCryptosporidium spp.[293]
WaterborneNorth West of England (UK)50 school people8Adults and childrenContamination of a private drinking water supply at a collegeCryptosporidium spp.[293, 294]
WaterborneNorthern Ireland (UK)29 peopleAdultsContamination of raw and treated water, and land surrounding the lake watershedCryptosporidium spp.[99]
CommunityNetherlandsNot reportedChildrenNot reported, during a pet farm visitC. parvum (genotype C1)http://www.cryptosporidium.it/

CommunityNY (USA)13 veterinary studentsYoung peopleHands contamination by calves contactsCryptosporidium spp.[304]
FoodborneFL (USA)37 peopleNot reportedContamination of food in a hotel banquet roomCryptosporidium spp.http://www.cdc.gov/foodborneoutbreaks/outbreak_data.htm
FoodborneGA (USA)6 peopleNot reportedContamination of food in a private homeCryptosporidium spp.

2001

WaterborneFrance291 county inhabitantsAdults and childrenPublic water supply contaminationC. hominis (genotype Ib,Id) C. parvum (genotype IIa)[84]
WaterborneFrance573AdultsContamination of tap waterC. parvum (genotype 1)[305]
WaterborneSouth West of England (UK)14Adults and childrenContact with astream at a beachCryptosporidium spp.[294]
CommunitySouth East of England (UK)30Adults and childrenContamination at a day care nurseryCryptosporidium spp.Unpublished data
WaterborneSouth East of England (UK)152 people attending at a school8Adults and childrenContamination of outdoor school pool waterCryptosporidium spp.[294, 295]

WaterborneCanada (USA)1039 peopleYoung adultsContamination of drinking waterC. parvum[296]
WaterborneCanada (USA)59 people attending an Ukrainian dance festivalAdultsContamination of a swimming pool in a hotelC. parvum[297]
Waterborne(IL) USA358 waterpark attendantsAdults and childrenContamination of waterpark and person-to-person contactC. hominis (genotype Ia)[259]
FoodborneQueensland (Australia)8 inhabitantsChildrenContamination of drinking unpasteurised milkCryptosporidium spp.[262]
CommunityNew Zealand20 farm inhabitantsChildrenHand contamination by calve contactCryptosporidium spp.[264]
CommunityTasmania (Australia)36 participants at the agricultural showAdultsContamination associated with an animal nurseryCryptosporidium spp.[306]

CommunityBrazil224 day care attendantsChildrenPerson-to-person contactC. hominis (genotype 1)[307]

2001–2000

WaterborneNorthern Ireland (UK)347AdultsContamination of drinking waterC. parvum (bovine genotype; human genotype)[80]

WaterborneHaiti93 patientsAdults and childrenContaminated water and overcrowded conditions of urban slumsC. hominis, C. parvum, C. felis [69]

2000

WaterborneEngland and Wales (UK)58AdultsContamination of drinking waterC. parvum (genotype 2)[308]
WaterborneEngland and Wales (UK)207Not reportedContamination of drinking waterC. hominis and C. parvum alleles[309]
WaterborneYorkshire and The Humber (UK)41 people attending a public poolAdults and childrenContamination of pool waterC. parvum (subgenotype IIaA17G1R1)[79, 295]
WaterborneMajorca (Spain) 250Adults and childrenContamination of a hotel pool waterCryptosporidium spp.[81]
CommunityNetherlandsNot reportedChildrenSchool children visiting a pet farmCryptosporidium spp.http://www.cryptosporidium.it/

FoodborneIL (USA)8Not reportedContamination of coleslaw in a private homeC. parvumhttp://www.cdc.gov/foodborneoutbreaks/outbreak_data.htm

1999

WaterborneRussia50AdultsContamination of drinking waterCryptosporidium spp.[310]

WaterborneFL (USA)38 park visitorsAdults and childrenContamination of a water fountainCryptosporidium spp.[260]

1998

WaterborneSpain21ChildrenContamination of tap waterCryptosporidium spp.[253]

FoodborneDC (USA)88 students and employeesYoung adults and adultsContamination of food by a food handler in a cafeteriaCryptosporidium spp.[311]

1In presence of two or more cases of similar infection, with a common exposure in the community not related to waterborne or foodborne diasese, the term of community disease was used.
2Number and category of people with symptom referable to cryptosporidiosis.
3This outbreak was characterised by a Cryptosporidium infection in 9 of the 11 children, a coinfection of Giardia and Cryptosporidium in 2 of the 11 children and a concomitant infection of other 38 additional children by only Giardia oocysts triggered by the same likely source.
4Median age.
5Outbreak characterised by a concomitant waterborne Cyclospora outbreak.
6Outbreak characterised by a concomitant waterborne Giardia outbreak.
7Outbreak characterised by a concomitant foodborne E. coli O111 outbreak.
8Outbreak characterised by a concomitant waterborne Norovirus outbreak.