First Cryptosporidium outbreak in Hungary, linked to a treated recreational water venue in 2015
J Plutzer1, K Kelen2, E Varga3
1Department of Water Hygiene, National Public Health Institute, Budapest, Hungary.
Abstract:
In June 2015, an outbreak of cryptosporidiosis with 35 cases (23 probable and 12 laboratory-confirmed) occurred among 191 attendees of a residential rehabilitation holiday for paediatric organ transplant patients (n = 49) and their families at a hotel in Somogy county, Hungary. The overall attack rate was 18%. Most of the cases were transplanted children who experienced severe acute disease and required adjustment to their tacrolimus immunosuppression. A retrospective case-control study suggested an association between recreational water exposures and illness: cases were seven times more likely than controls to have swum in the children's pool (odds ratio 7.17; 95% confidence interval 2.9-17.2; P < 0.0001) and five times more likely to have used the jetted whirlpool (odds ratio 5.25; 95% confidence interval 2.1-13.1; P < 0.0001). This was the first outbreak of cryptosporidiosis in Hungary and it is especially unfortunate that it affected vulnerable children who experienced severe symptoms. Cryptosporidium presents specific infection control difficulties in treated recreational water venues; the link to a whirlpool is unusual and highlights the importance of the age-appropriate use of these facilities and reminding users not to immerse their heads or swallow the water. Cryptosporidiosis is more commonly linked to children' pools where improved bather hygiene and promoting exclusion of diarrhoea cases could help to avoid similar outbreaks.
Insights
A 2015 cryptosporidiosis outbreak in Hungary affected vulnerable pediatric organ transplant patients. Recreational water exposure, particularly in the children's pool and whirlpool, was linked to illness, highlighting infection control challenges.
Area of Science:
- Infectious Diseases
- Public Health
- Epidemiology
Background:
- An outbreak of cryptosporidiosis occurred in Hungary in June 2015.
- The outbreak affected attendees of a residential rehabilitation holiday, including pediatric organ transplant patients and their families.
- This was the first reported cryptosporidiosis outbreak in Hungary.
Purpose of the Study:
- To investigate the cause and identify risk factors associated with the cryptosporidiosis outbreak.
- To understand the specific challenges of Cryptosporidium control in recreational water venues.
- To provide recommendations for preventing future outbreaks, especially among vulnerable populations.
Main Methods:
- A retrospective case-control study was conducted among 191 attendees.
- Data on recreational water exposure and illness were collected.
- Statistical analysis, including odds ratios and confidence intervals, was used to assess associations.
Main Results:
- 35 cases of cryptosporidiosis were identified (23 probable, 12 confirmed) with an 18% overall attack rate.
- Cases were significantly more likely to have used the children's pool (OR 7.17) and the jetted whirlpool (OR 5.25).
- Transplanted children experienced severe illness, requiring adjustments to immunosuppression therapy.
Conclusions:
- Recreational water exposure, especially in pools and whirlpools, was strongly associated with the cryptosporidiosis outbreak.
- Cryptosporidium poses unique infection control challenges in treated water venues.
- Recommendations include age-appropriate use of facilities, avoiding water ingestion, and improved bather hygiene to prevent future outbreaks.
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