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Early outbreak detection by linking health advice line calls to water distribution areas retrospectively demonstrated in a large waterborne outbreak of cryptosporidiosis in Sweden
Publ Hlth Agcy Sweden, Dept Monitoring & Evaluat, S-17183 Solna, Sweden..ORCID iD: 0000-0002-5560-865X
Publ Hlth Agcy Sweden, Dept Microbiol, Solna, Sweden..
Publ Hlth Agcy Sweden, Dept Monitoring & Evaluat, S-17183 Solna, Sweden..
Publ Hlth Agcy Sweden, Dept Monitoring & Evaluat, S-17183 Solna, Sweden..
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2017 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, article id 328Article in journal (Refereed) Published
Abstract [en]

Background: In the winter and spring of 2011 a large outbreak of cryptosporidiosis occurred in Skelleftea municipality, Sweden. This study summarizes the outbreak investigation in terms of outbreak size, duration, clinical characteristics, possible source(s) and the potential for earlier detection using calls to a health advice line. Methods: The investigation included two epidemiological questionnaires and microbial analysis of samples from patients, water and other environmental sources. In addition, a retrospective study based on phone calls to a health advice line was performed by comparing patterns of phone calls between different water distribution areas. Results: Our analyses showed that approximately 18,500 individuals were affected by a waterborne outbreak of cryptosporidiosis in Skelleftea in 2011. This makes it the second largest outbreak of cryptosporidiosis in Europe to date. Cryptosporidium hominis oocysts of subtype IbA10G2 were found in patient and sewage samples, but not in raw water or in drinking water, and the initial contamination source could not be determined. The outbreak went unnoticed to authorities for several months. The analysis of the calls to the health advice line provides strong indications early in the outbreak that it was linked to a particular water treatment plant. Conclusions: We conclude that an earlier detection of the outbreak by linking calls to a health advice line to water distribution areas could have limited the outbreak substantially.

Place, publisher, year, edition, pages
BioMed Central, 2017. Vol. 17, article id 328
Keywords [en]
Early outbreak detection, Cryptosporidiosis, Syndromic surveillance, Cryptosporidium hominis
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-323653DOI: 10.1186/s12889-017-4233-8ISI: 000400812800003PubMedID: 28420373OAI: oai:DiVA.org:uu-323653DiVA, id: diva2:1115086
Available from: 2017-06-26 Created: 2017-06-26 Last updated: 2017-11-29Bibliographically approved

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