The cryptosporidium outbreak is growing larger each day, health officials said Friday, with homes, day-care centers and restaurants particularly vulnerable to contamination.

“We know when an intestinal parasite like this gets into day-care facilities, it’s very difficult to bring under control,” said Kay Kent, executive director of the Lawrence-Douglas County Health Department. “We also know that day-care children actually go between day cares, they’re not just in one day care, so it can be easily transmitted.”

The number of confirmed cryptosporidium cases in Lawrence reached 46 Friday, two weeks after health officials first announced the outbreak. No one has been hospitalized, Kent said.

Kent said a communitywide survey would begin next week, with health officials questioning both healthy and sick people about their activities in recent weeks: food and drink consumption, swimming activities, travel, animal contact and contact with other people.

But it will be months before that investigation narrows the source or sources of the illness, Kent said. Officials expect “multiple sources” are involved in the spread, possibly including swimming pools and person-to-person contact.

That spread can be halted, Kent said, if — and only if — Lawrence residents aggressively maintain good hygiene. Hand-washing is critical after bathroom use, before food preparation and whenever dealing with children.

“I know from being in public health for a long time that seems like a simple and simplistic solution,” Kent said. “But it is the most effective against this disease.”

No names

Cryptosporidium is a microscopic parasite that causes diarrhea, loose or watery stool, stomach cramps, upset stomach and a slight fever. It can be fatal to patients with weakened immune systems, such as the young, elderly or people with HIV. More than two-thirds of those who contract cryptosporidiosis are children.

¢ Lawrence-Douglas County Health Department Executive Director Kay Kent¢ Crypto found at child center¢ 6News video: Search for outbreak’s cause continues¢ Cryptosporidium cases on hold at 22 in county (8-31-03)¢ 6News video: City plans to test water supply (8-30-03)¢ Audio clips from city and county officials¢ Parasite outbreak strikes more victims (8-29-03)¢ 6News video: Outbreak spurs search for parasite’s source (8-29-03)¢ Letter to parents (pdf)¢ Questionnaire for parents (pdf)¢ Swimmers flock to pools opened after bacteria scare (8-25-03)¢ Outbreak closes city pools (8-23-03)¢ 6News video: Parasite discovered in city pools¢Centers for Disease Control information

There is no treatment for the disease. Those who contract the parasite but are otherwise healthy normally recover within two or three weeks.

The parasite is easily passed in swimming pools, because it is able to survive outside the body for long periods of time and is resistant to levels of chlorine typically found in pools. Several pools in the city were temporarily closed two weeks ago after the initial outbreak was uncovered.

Kent said Friday that all adult-care and assisted-living facilities in Douglas County had been contacted, but none reported an increased number of diarrhea cases. She did not know if anyone with a weak immune system had contracted the parasite.

Geri Summers, executive director of the Douglas County AIDS Project, said none of her agency’s clients had reported symptoms.

“I think that we’ve been lucky, in the sense there hasn’t been any of our consumers who have come across it,” she said. “It’s something that’s difficult to get rid of when you’re immuno-suppressed. Thank God we don’t have it.”

Kent said earlier in the week that health officials had visited Raintree Montessori School and Children’s Learning Center in connection with the outbreak investigation. Friday, she said she would no longer name facilities, nor say if the outbreak had spread to other day-care centers, even while repeating emphatic concerns about the risks day-care centers face.

“What we believe is that all of our day cares are at risk,” she said, “and we are going to treat and respond as if all of the day cares are at risk.”

And though officials stressed the need for restaurant workers to be careful with hygiene, Kansas Department of Health and Environment spokesman Sharon Watson would not say if any food service employees in Lawrence were among the 46 confirmed cases. The public would be notified, she said, if there was a risk associated with a particular restaurant.

“We don’t make it a practice to identify specific facilities, because of the risk of that then leading to the identification of a person who has that illness,” Watson said.

Stretching resources

Health officials continued to repeat Friday their belief that the city water supply was not the source of the outbreak — in part because the parasite has taken time to spread. Authorities now believe the first local case popped up in mid-June.

“We would have expected a sharp increase in the number of people with the same date of illness onset,” Kent said.

Chris Stewart, the city’s water director, said testing of the water supply was under way to allay public concerns. Samples still were being taken Friday, he said; results of those tests should be available next week.

Kent said 40 of her department’s 42 employees had taken part in the investigation. Four researches from the federal Centers for Disease Control have joined the case, as has one person from the Kansas Department of Health and Environment.

“I think we know if this were much larger, we would have to ask for additional resources, additional people helping us,” she said.

She said it would be “difficult” to calculate how many people the outbreak might ultimately affect.

“In looking at other outbreaks that have happened across the country, there are not a lot that are similar to this,” she said.

A 1993 cryptosporidium outbreak in Milwaukee’s water supply killed more than 100 people and sickened about 400,000.

“When you look at the Milwaukee outbreak, it was a common source; it was the public water supply,” Kent said. “We don’t believe that to be the case here.

“Some other outbreaks have been just swimming pools. We don’t believe that to be the case here. We believe we have multiple sources.”