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BACKGROUND: On April 3, 2013, a Kansas county health department notified the Kansas Department of Health and Environment (KDHE) of two confirmed cases of cryptosporidiosis among persons who responded to a truck rollover accident during a snowstorm on March 10, 2013. The truck carried approximately 350 Holstein steer calves that were younger than ten days old. An outbreak investigation was conducted to determine the cause and scope of illness and to understand risk factors.
METHODS: KDHE conducted a retrospective cohort study. Persons who responded to the incident were identified and questionnaires were administered by phone. Exposure was defined as handling calves during this response. A case was defined as an accident responder who experienced diarrhea (3 or more loose stools in a 24-hour period) and one or more of the following: abdominal cramping, vomiting, or anorexia. Two stool specimens were submitted for laboratory testing.
RESULTS: Fifteen people responded to the accident; all were interviewed. Six (40%) respondents were ill and all met the case definition. All ill individuals were male and ranged in age from 17 to 34 years (median: 29 years). Five (83%) individuals sought medical care and two stool specimens tested positive for Cryptosporidium. The most common symptoms were diarrhea (100%), abdominal cramping (83%), anorexia (83%), and nausea (67%). The incubation period ranged from six to eight days (median seven days). Among those whose illness had resolved by the time of interview, duration ranged from seven to thirteen days (median: nine days). Respondents were law enforcement officers, towing and truck company employees, and volunteers. Live calves were herded and carried to cattle trailers, then transferred to a second truck for transport. Deceased calves were towed in the wrecked truck to the local sale barn and then were sent to be rendered. Individuals who carried calves were 3.0 times more likely to have become ill; those who reported coming into contact with calf feces were 4.5 times more likely to have become ill.
CONCLUSIONS: This cryptosporidiosis outbreak was associated with handling young calves during the response to a rollover accident. Cryptosporidium is a common cause of diarrhea in young calves especially within the first two weeks of life and transmission to humans has been documented. This unique outbreak highlights the need for prevention and control guidelines to prevent possible zoonotic disease transmission from animals to emergency responders.