Archive for Saturday, January 24, 2004

CDC: Crypto response too slow

Summer outbreak’s speed required prompt actions, federal report says

January 24, 2004


The cryptosporidiosis outbreak last summer in Lawrence might have been slowed if health authorities had alerted the community sooner, a new federal report suggests.

The report also shows that as many as 600 people may have been infected, about five times more than previously reported.

"The speed of diffusion of an outbreak like the one (in Lawrence) requires prompt and swift actions," said the report from the federal Centers for Disease Control. The report was made public Friday by the Kansas Department of Health and Environment.

Alerting the public sooner and intervening more quickly "in similar outbreaks may prove advantageous" in preventing the spread of disease, the report's authors wrote.

But Douglas County and state authorities Friday said they took the correct action during the outbreak based on what they knew at the time.

"Keep in mind that cryptosporidium is a fairly new disease," said KDHE spokeswoman Sharon Watson. "It's fairly easy to look back and see how things may have been done differently once you have all the information."

She added: "There is no standard in place that says, if you have a cryptosporidiosis case in the community, you do A, B, C."

The first cases of the diarrhea-inducing parasite in Lawrence were diagnosed in July. Among the initial victims was at least one member of the Kansas University swim team.

The Lawrence-Douglas County Health Department came under fierce criticism because it didn't alert the broader public about the parasite until late August, when authorities closed swimming pools after 11 cases had been confirmed. The parasite is easily spread in pools and at day-care centers.

Eventually, 96 cases were confirmed in northeast Kansas -- 89 in Douglas County, the vast majority of those in Lawrence -- and more than 600 other probable, but unconfirmed, cases identified by community surveys. Only the confirmed cases were reported during the outbreak.

Many of those cases were connected to Lawrence pools and day-care centers.

The source of the outbreak was not determined, CDC officials wrote, but the genotype of the parasite found in stool samples is found only in human-to-human contact, not the animal-to-human contact that often starts a cryptosporidium outbreak.

CDC's investigators suggested that in future cryptosporidium cases, the community be alerted immediately:

  • When multiple, apparently unrelated cases are reported.
  • When diagnosis is confirmed of cryptosporidiosis in any patient who has been in a swimming pool during the infection period.

Either condition would have resulted in a public announcement weeks earlier than late August had the protocols been in place.

"We were working with limited data at the time, making decisions as data came in," Watson said. "Not everything pointed to a specific source at the time."

Traditional methods

Authorities said at the time they waited to alert the public because they weren't sure the cases were related. Lawrence-Douglas County Health Department Director Kay Kent said Friday her department followed "traditional" methods in waiting to make the announcement.

"I think the (CDC) report basically does say that there might be some difference in the future than what might be traditionally done," Kent said. "This is the first time the CDC has put that in writing, and I think that will be extremely helpful in the future."

And she pointed out that the Health Department followed many other recommendations in the CDC report during the outbreak.

Among them:

  • "Hyperchlorination" of pools linked to cryptosporidium.
  • Increased public education to discourage swimmers from entering pools until two weeks after a bout of diarrhea.
  • Waiting three weeks after the last laboratory-confirmed case before declaring the outbreak over.

Kent said she was proud of how her department handled the outbreak.

"I think really," she said, "the whole working together with local, state and federal worked very well."

video Preliminary CDC report (Word doc)Latest storiestext Two more crypto cases diagnosed in county (11-20-03)text Apartment pool tests positive for crypto (10-9-03)text County crypto cases to yield lessons, health official says (9-30-03)text Crypto outbreak spreads (9-20-03)text Letter gave early warning of crypto (9-16-03)text Most crypto cases at day cares (9-13-03)video 6News video: Douglas County Health Department actions backed by state health official (9-13-03)text Crypto investigation timeline (9-12-03)Archived storiestext City's parasite response under fire (9-12-03)text Toddler's crypto bug has mom seething (9-11-03)text News of crypto withheld 1 month (9-10-03)text Parasite continues to spread (9-06-03)text Crypto found at child center (9-5-03)text Cryptosporidium cases on hold at 22 in county (8-31-03)text Parasite outbreak strikes more victims (8-29-03)text Swimmers flock to pools opened after bacteria scare (8-25-03)text Outbreak closes city pools (8-23-03)Archived videovideo 6News video: Crypto outbreak offers experts insightstext 6News video: Reported crypto cases may be tip of iceberg (9-12-03)text 6News video: Crypto infection outbreak numbers updated (9-11-03)text 6News video: Authorities waited to warn public about parasite (9-10-03)text 6News video: Search for outbreak's cause continues (9-3-03)video 6News video: City plans to test water supply (8-30-03)video 6News video: Outbreak spurs search for parasite's source (8-29-03)video 6News video: Parasite discovered in city pools (8-23-03)Audio¢audio Lawrence-Douglas County Health Department Executive Director Kay Kent (9-5-03)¢audio Audio clips from city and county officialsDocumentsvideo City public health notice about Cryptosporidiumtext Letter to parents (pdf) (8-28-03)text Questionnaire for parents (pdf) (8-28-03)MoreCenters for Disease Control information

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