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Cryptosporidiosis is the most common parasitic enteric disease in the United States and causes human and animal illness. Outbreaks have been associated with contaminated water, unpasteurized milk, and animal contact. We investigated a cryptosporidiosis outbreak among persons from 5 states who participated in a mission trip to Tennessee, July 16-19.
METHODS:
Investigators contacted trip organizers to review trip activities. Department of Health staff contacted trip participants using an online survey and phone interviews to conduct case finding and assess exposures. A case was defined as a trip participant reporting ≥ 3 loose stools in 24 hours beginning on or after July 19th. The owner of Farm C was interviewed regarding volunteer activities, animal health, and farm management.
RESULTS:
Organizers described 13 participant activities. Thirteen (14%) participants volunteered at Farm C. Of 95 trip participants, 72 (76%) completed the survey. Volunteering at Farm C was significantly associated with illness (Relative risk: 81; 95% Confidence Interval: 5 – 1305). Eight (62%) of 13 Farm C volunteers met the case definition. Reported symptoms included diarrhea (8, 100%), abdominal cramps (6, 75%), fatigue (6, 75%), nausea (6, 75%), fever (4, 50%), vomiting (4, 50%), and bloody stool (2, 25%). Onset dates ranged from July 19 to July 24. Two cases were laboratory-confirmed Cryptosporidium infections. Among Farm C volunteers, activity-specific attack rates were: 100%, bathing calves; 86%, bottle-feeding calves; 80%, cleaning the barn; and 67%, building pens. Volunteers reported that calves were ill with diarrhea and that hand washing facilities were not readily accessible. The owner reported recently purchasing calves from a local sale barn.
CONCLUSIONS:
Although calves were not available for testing, cryptosporidiosis is a common infection in calves. We concluded that transmission occurred via contact with ill calves compounded by inadequate hand washing facilities. Recommendations to ill persons included consulting a medical provider and notifying the provider of the possibility of cryptosporidiosis to facilitate appropriate testing and nitazoxanide treatment. Upon notification of the outbreak, organizers stopped sending volunteers to Farm C. CDC recommendations regarding measures to prevent illness associated with animals in public settings were provided to trip organizers and Farm C.