Published Date: 2001-10-06 23:50:00
Subject: PRO/AH/EDR> Cryptosporidiosis - Germany
Archive Number: 20011006.2421

CRYPTOSPORIDIOSIS - GERMANY
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Date: 4 Oct 2001 15:42:37 +0100
From: ProMED-mail <promed@promedmail.org>
Source: Eurosurveillance Weekly, 4 Oct 2001 [Edited]

Outbreak of Cryptosporidiosis in German armed forces
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At the beginning of August 2001, after a 5 day field exercise, about 200
out of 450 soldiers in Germany's armed forces became ill with acute
gastroenteritis, peaking after about a week (1). The incubation period was
assumed to be within a range of 2 to 10 days, and duration of the illness
was between several days and 2 weeks.
The recruits were stationed in barracks with a permanent kitchen catered
for by a cook. The meals were transported into the field in insulating
containers or eaten in the barracks. Drinks included mainly bottled mineral
water, juice concentrate diluted with tap water, and tea. The menu included
various hot and cold meals and leafy and mixed salads. During the exercise
the weather was very hot and no rain fell. Sheep graze regularly on the field.
Analyses of stool specimens helped to rule out bacterial pathogens, such as
_Salmonella_, _Yersinia_, _Shigella_, [pathogenic] _Escherichia coli_, or
_Bacillus cereus_ only a few days into the investigation. Cryptosporidia
were found. In 15 of 217 the stool specimens requested after from recovered
and still ill participants in the exercise, and _Cryptosporidium_ enzyme
linked immunosorbent assay found _Cryptosporidium_ antigen. These findings
were confirmed by immunofluorescence assay and microscopy.
The low number of positives may be due to the fact that the specimens were
taken only 2 to 3 weeks after onset of illness. Most people did not have
gastrointestinal complaints any more and therefore would not have excreted
oocysts. Analysis of food samples did not show any fecal or bacterial
contamination. No investigation for _Cryptosporidium_ was performed because
at this point no parasites were taken into consideration.
The result of the microbiological analysis of the drinking water on the
site was inconclusive. A second analysis of the reservoir for drinking
water and the kitchen water supply for cryptosporidia (filtration of 300
litres) and of 5 liters of mineral water imported from Italy yielded no
results, as did an examination of sheep droppings.
Reference:
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RKI. Gruppenerkrankung in Baden-Württemberg: Verdacht auf Kryptosporidiose.
Epidemiologisches Bulletin 2001; 39:298-9.
<http://www.rki.de/INFEKT/EPIBULL/EPI.HTM>
Reported by Stefan Brockmann <brockmann@gla.bwl.de>, Caroline Dreweck,
Christiane Wagner-Wiening, Peter Kimmig, Landesgesundheitsamt (State Health
Office) Baden-Wurttemberg; Dieter Schmid (Truppenarzt); Silke Richter,
Herbert Mertel, Wehrbereichskommando, Abteilung Sanund Gesundheitswesen;
Ralf Hagen, Zentrales Institut des Sanitätsdienstes der Bundeswehr München;
Helga Glaser, Gesundheitsamt Sigmaringen; Karl Dietrich, Gesundheitsamt
Reutlingen; and Wolfgang Kiehl <KiehlW@rki.de>, Robert Koch Institut,
Berlin, Germany. Translated and adapted from reference 1 by Birte
Twisselmann <btwisselmann@phls.org.uk>, Eurosurveillance editorial office.
--
ProMED-mail
<promed@promed.org>
[Infection with _Cryptosporidium_ has been found in Germany before.
Infection with _Cryptosporidium_ typically comes from insufficiently
purified surface water. Despite thorough investigation the source of this
outbreak the source was not identified. - Mod.EP]
......................................es/ep/ds
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