DOI QR코드

DOI QR Code

Epidemiological Characteristics of the First Water-Borne Outbreak of Cryptosporidiosis in Seoul, Korea

  • Moon, Shinje (Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention) ;
  • Kwak, Wooseok (Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention) ;
  • Lee, Sangwon (Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention) ;
  • Kim, Won (Division of Health Policy, Seoul Metropolitan Government) ;
  • Oh, Jaeyeon (Healthcare Department of Dongdaemun-gu Public Health Center) ;
  • Youn, Seung-Ki (Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention)
  • Received : 2012.08.07
  • Accepted : 2013.05.14
  • Published : 2013.07.10

Abstract

The first case of human cryptosporidiosis was reported in Korea in 1995; however, an outbreak of Cryptosporidium has not been reported in Korea until now. This paper describes the first outbreak of cryptosporidiosis in Korea. On May 24, 2012, a local public health center filed a report on 126 residents with gastrointestinal symptoms in an old apartment complex in Seoul. Epidemiological investigations were implemented on 125 of the 126 patients. The patients were reported continuously over a period of 22 days. Diarrhea was the most common clinical symptom, and lasted for 5 days on average. The tap water was the only common exposure of the patients. During the environmental investigation it was discovered that the water and septic tanks were situated closely and that the waste water pipes were corroded where they passed over the water pipes. Cryptosporidium parvum was detected in 3 of the 7 stool specimens by PCR-RFLP. A number of Cryptosporidium oocysts were also detected in the water specimens from the water tank. In conclusion, Cryptosporidium parvum was the key causal pathogen of this outbreak. It is presumed that the tap water was contaminated by a sewage leak from the aged pipelines.

Keywords

References

  1. Chalmers RM, Davies AP. Minireview: clinical cryptosporidiosis. Exp Parasitol 2010; 124: 138-46. https://doi.org/10.1016/j.exppara.2009.02.003
  2. Cama VA, Bern C, Roberts J, Cabrera L, Sterling CR, Ortega Y, Gilman RH, Xiao L. Cryptosporidium species and subtypes and clinical manifestations in children, Peru. Emerg Infect Dis 2008; 14: 1567-74. https://doi.org/10.3201/eid1410.071273
  3. Yoder JS, Harral C, Beach MJ; Centers for Disease Control and Prevention (CDC). Cryptosporidiosis surveillance - United States, 2006-2008. MMWR Surveill Summ 2010; 59: 1-14.
  4. Takagi M, Toriumi H, Endo T, Yamamoto N, Kuroki T. An outbreak of cryptosporidiosis associated with swimming pools. Kansenshogaku Zasshi 2008; 82: 14-9. https://doi.org/10.11150/kansenshogakuzasshi1970.82.14
  5. Baldursson S, Karanis P. Waterborne transmission of protozoan parasites: review of worldwide outbreaks - an update 2004-2010. Water Res 2011; 45: 6603-14. https://doi.org/10.1016/j.watres.2011.10.013
  6. Kang YK, Lee HK, Kim SW, Chi JG. Cryptosporidiosis in a leukemia child with severe diarrhea. Seoul J Med 1995; 36: 29-34.
  7. Seo M, Huh S, Chai JY, Yu JR. An epidemiological survey on Cryptosporidium parvum infection of inhabitants in Chorwon-gun, Kangwon-do. Korean J Parasitol 2001; 39: 201-3. https://doi.org/10.3347/kjp.2001.39.2.201
  8. Chai JY, Lee SH, Guk SM, Lee SH. An epidemiological survey of Cryptosporidium parvum infection in randomly selected inhabitants of Seoul and Chollanam-do. Korean J Parasitol 1996; 34: 113-9. https://doi.org/10.3347/kjp.1996.34.2.113
  9. Yu JR, Lee JK, Seo M, Kim SI, Sohn WM, Huh S, Choi HY, Kim TS. Prevalence of cryptosporidiosis among the villagers and domestic animals in several rural areas of Korea. Korean J Parasitol 2004; 42: 1-6. https://doi.org/10.3347/kjp.2004.42.1.1
  10. Park JH, Guk SM, Han ET, Shin EH, Kim JL, Chil JY. Genotype analysis of Cryptosporidium spp. prevalent in a rural village in Hwasun-gun, Republic of Korea. Korean J Parasitol 2006; 44: 27-33. https://doi.org/10.3347/kjp.2006.44.1.27
  11. Park JH, Kim HJ, Guk SM, Shin EH, Kim JL, Rim HJ, Lee SH, Chai JY. A survey of cryptosporidiosis among 2,541 residents of 25 coastal islands in Jeollanam-do (Province), Republic of Korea. Korean J Parasitol 2006; 44: 367-72. https://doi.org/10.3347/kjp.2006.44.4.367
  12. Korea Centers for Disease Control and Prevention. Epidemiologic investigation guideline for food and waterborne diseases 2012. Cheongwon: Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, 2012.
  13. Lee SH, Joung M, Yoon S, Choi K, Park WY, Yu JR. Multiplex PCR detection of waterborne intestinal protozoa; Microsporidia, Cyclospora and Cryptosporidium. Korean J Parasitol 2010; 48: 297-301. https://doi.org/10.3347/kjp.2010.48.4.297
  14. Ramirez NE, Ward LA, Sreevatsan S. A review of the biology and epidemiology of cryptosporidiosis in humans and animals. Microbes Infect 2004; 6: 773-85. https://doi.org/10.1016/j.micinf.2004.02.021
  15. Garcia LS, Bruckner DA, Brewer TC, Shimizu RY. Techniques for the recovery and identification of Cryptosporidium oocysts from stool specimens. J Clin Microbiol 1983; 18: 185-90.
  16. Nielsen CK, Ward LA. Enhanced detection of Cryptosporidium parvum in the acid-fast stain. J Vet Diagn Invest 1999; 11: 567-9. https://doi.org/10.1177/104063879901100621
  17. Chan R, Chen J, York MK, Setijono N, Kaplan RL, Graham F, Tanowitz HB. Evaluation of a combination rapid immunoassay for detection of Giardia and Cryptosporidium antigens. J Clin Microbiol 2000; 38: 393-4.
  18. Sulaiman IM, Xiao L, Lal AA. Evaluation of Cryptosporidium pavum genotyping techniques. Appl Environ Microbiol 1999; 65: 4431-5.
  19. Sharp SE, Suarez CA, Duran Y, Poppiti RJ. Evaluation of the Triage Micro Parasite Panel for detection of Giardia lamblia, Entamoeba histolytica/Entamoeba dispar, and Cryptosporidium parvum in patient stool specimens. J Clin Microbiol 2001; 39: 332-4. https://doi.org/10.1128/JCM.39.1.332-334.2001
  20. Elwin K, Chalmers RM, Roberts R, Guy EC, Casemore DP. Modification of a rapid method for the identification of gene-specific polymorphisms in Cryptosporidium parvum and its application to clinical and epidemiological investigations. Appl Environ Microbiol 2001; 67: 5581-4. https://doi.org/10.1128/AEM.67.12.5581-5584.2001
  21. Korea Centers for Disease Control and Prevention. Epidemiologic investigation guideline for food and waterborne diseases 2013 revised ed. Cheongwon: Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, 2013.
  22. Lynch M, Painter J, Woodruff R, Braden C; Centers for Disease Control and Prevention. Surveillance for foodborne-disease outbreaks: United States, 1998-2002. MMWR Surveill Summ 2006; 55: 1-42.
  23. Huang DB, White AC. An updated review on Cryptosporidium and Giardia. Gastroenterol Clin North Am 2006; 35: 291-314. https://doi.org/10.1016/j.gtc.2006.03.006
  24. Mac Kenzie WR, Hoxie NJ, Proctor ME, Gradus MS, Blair KA, Peterson DE, Kazmierczak JJ, Addiss DG, Fox KR, Rose JB, et al. A massive outbreak in Milwaukee of cryptosporidium infection transmitted through the public water supply. N Engl J Med 1994; 331: 161-7. https://doi.org/10.1056/NEJM199407213310304
  25. MacKenzie WR, Schell WL, Blair KA, Addiss DG, Peterson DE, Hoxie NJ, Kazmierczak JJ, Davis JP. Massive outbreak of waterborne cryptosporidium infection in Milwaukee, Wisconsin: recurrence of illness and risk of secondary transmission. Clin Infect Dis 1995; 21: 57-62. https://doi.org/10.1093/clinids/21.1.57
  26. Newman RD, Sears CL, Moore SR, Nataro JP, Wuhib T, Agnew DA, Guerrant RL, Lima AA. Longitudinal study of Cryptosporidium infection in children in northeastern Brazil. J infect Dis 1999; 180: 167-75. https://doi.org/10.1086/314820
  27. DuPont HL, Chappell CL, Sterling CR, Okhuysen PC, Rose JB, Jakubowski W. The infectivity of Cryptosporidium parvum in healthy volunteers. N Engl J Med 1995; 332: 855-9. https://doi.org/10.1056/NEJM199503303321304
  28. Lee MY, Cho EJ, Lee JH, Han SH, Park YS. A survey of Cryptosporidium oocysts in water supplies during a 10-year period (2000-2009) in Seoul. Korean J Parasitol 2010; 48: 219-24. https://doi.org/10.3347/kjp.2010.48.3.219

Cited by

  1. Cryptosporidiosis as threatening health problem: A review vol.3, pp.11, 2013, https://doi.org/10.1016/s2221-1691(13)60179-3
  2. Clinical Update on Parasitic Diseases vol.85, pp.5, 2013, https://doi.org/10.3904/kjm.2013.85.5.469
  3. An evaluation of the potential use of Cryptosporidium species as agents for deliberate release vol.160, pp.4, 2014, https://doi.org/10.1136/jramc-2013-000186
  4. Genotyping and subtyping Cryptosporidium parvum and Giardia duodenalis carried by flies on dairy farms in Henan, China vol.7, pp.1, 2013, https://doi.org/10.1186/1756-3305-7-190
  5. Cryptosporidiosis caused by Cryptosporidium parvum subtype IIdA15G1 at a dairy farm in Northwestern China vol.7, pp.1, 2013, https://doi.org/10.1186/s13071-014-0529-z
  6. Detection of Cryptosporidium parvum in Environmental Soil and Vegetables vol.29, pp.10, 2013, https://doi.org/10.3346/jkms.2014.29.10.1367
  7. 송아지에서 발생한 중증 크립토스포리듐 증 증례 vol.54, pp.4, 2014, https://doi.org/10.14405/kjvr.2014.54.4.257
  8. Multilocus typing of Cryptosporidium spp. in young calves with diarrhea in Korea vol.229, pp.None, 2013, https://doi.org/10.1016/j.vetpar.2016.09.019
  9. Transmission of waterborne parasites in the Association of Southeast Asian Nations (ASEAN): Overview and direction forward vol.8, pp.None, 2013, https://doi.org/10.1016/j.fawpar.2017.08.001
  10. Simultaneous Molecular Detection of Cryptosporidium and Cyclospora from Raw Vegetables in Korea vol.55, pp.2, 2013, https://doi.org/10.3347/kjp.2017.55.2.137
  11. Status of common parasitic diseases in Korea in 2019 vol.62, pp.8, 2013, https://doi.org/10.5124/jkma.2019.62.8.437
  12. Clinical and Laboratory Diagnosis of Cryptosporidiosis among Children with Acute Gastroenteritis at a Tertiary Hospital, Cairo, Egypt vol.67, pp.3, 2013, https://doi.org/10.1093/tropej/fmab064