NATIONAL SURVEILLANCE CONFERENCE

CSTE POSITION STATEMENT 1994-NSC-06

COMMITTEE: Executive Committee

TITLE: National Surveillance for Cryptosporidiosis

ISSUE: 

BACKGROUND/JUSTIFICATION: Cryptosporidium parvum is an increasing important cause of waterborne disease outbreaks and severe diarrheal illness in immunocompromised persons. The Environmental Protection Agency (EPA) plans to mandate testing of public water supplies for Cryptosporidium in 1995 under the Information Collection Rule (ICR0). Such testing will undoubtedly lead to frequent occurrences of oocyst being found in finished waters. Public health agencies, water utilities, regulators of water supplies, and local governments will need to respond to these findings. In part because surveillance for Cryptosporidium has only recently been implemented in a few states, little is known regarding the occurrence of Cryptosporidiosis in many communities.

POSITION TO BE ADOPTED: CSTE recommends:

1) Cryptosporidiosis infection should be added to the list of conditions under national surveillance in the National Public Health Surveillance System (NPHSS) for a period of three years to conclude at the time of the CSTE annual meeting in the year 1998.

2) States and territories are encouraged to institute surveillance for cryptosporidiosis by legally mandated notification from laboratories and, if applicable, health care providers (e.g., physicians, hospitals). States and territories should forward core surveillance data elements to CDC via NETSS for the purposes of national surveillance. As resources permit, additional clinical and epidemiologic information should be gathered on cryptosporidiosis cases.

3) CSTE, CDC, states and territories should work to provide surveillance information about cryptosporidiosis to health care providers and to develop and implement prevention and control strategies.

4) Any computer software developed by CDC to support this surveillance system should be able to provide data files in a format that is fully compatible with existing NETSS and PHLIS file formats.

5) Surveillance data on cryptosporidiosis should be published on a regular basis in the MMWR.


GOALS FOR SURVEILLANCE: Cryptosporidium parum is an important emerging pathogen in the United States. It is an increasing important cause of drinking and recreational waterborne disease outbreaks. Infection may cause severe diarrheal illness in immunocompromised persons, and no consistently effective treatment is available. Prevention and control options are currently limited by a lack of data on the epidemiologic features of this infection. Surveillance for cryptosporidiosis can help define the epidemiologic features and identify cases for more thorough investigation (e.g., case-control studies).

In addition, the EPA plans to mandate testing of public water supplies for Cryptosporidium in 1995, which will undoubtedly lead to the frequent detection of oocysts in finished waters. Public health agencies, water utilities,. Regulators of water supplies, and local governments will need to respond to these findings. Surveillance of cryptosporidiosis in humans can provide information that may be useful to communities in formulating such a response.

METHODS FOR SURVEILLANCE: Clinician and laboratory reporting.

CASE DEFINITION:

Cryptosporidiosis

Clinical description

An illness caused by the protozoan Cryptosporidium parvum and characterized by diarrhea, abdominal cramps, loss of appetite, low-grade fever, nausea, and vomiting. Infected persons may asymptomatic. The disease can be prolonged and life-threatening in severely immunocompromised person.

Laboratory criteria for diagnosis

Demonstration of Cryptosporidium oocysts in stool, or

Demonstration of Cryptosporidium in intestinal fluid or small bowel biopsy specimens, or

Demonstration of Cryptosporidium antigen in stool by a specific immunodiagnostic test such as enzyme-linked immunosorbent assay (ELISA).

Case Classification

Confirmed, symptomatic: a laboratory-confirmed case associated with one or more of the symptoms described above 

Confirmed, asymptomatic: a laboratory-confirmed case associated with none of the above symptoms


DATA TO BE COLLECTED: NETSS Core Data

PERIOD OF SURVEILLANCE: Three years

CONSULTATION WITH OTHER ORGANIZATIONS: CDC, ASTPHLD, ASTHO, NASPHV

CONTACT: CSTE: Michael T. Osterholm, Ph.D., M.P.H.
State Epidemiologist and Chief,
Acute Disease Epidemiology Section
Minnesota Department of Health
717 Delaware Street, SE
P.O. Box 9441
Minneapolis, MN 55440-9441
612-623-5414
612-623-5743 fax

CDC: David Addis, M.D., M.P.H.
Division of Parasitic Diseases, MS F22
National Center for Infectious Diseases
Centers for Disease Control and Prevention
1600 Clifton Road, NE
Atlanta, GA 30333
404-488-7770