The Centers for Disease Control and Prevention (CDC) and the National Swimming Pool Foundation (NSPF) have established a Cryptosporidium (Crypto) Outbreak Alert System to help aquatic facilities protect their patrons from recreational water illness. During the past two decades, Crypto has become recognized as one of the most common causes of waterborne disease (recreational water and drinking water) in the
Readers should visit www.nspf.org/Cryptotoolkit.html and sign up to make sure they receive Alerts. They can also download and review the Toolkit of available materials, to prepare to prevent or limit outbreaks.
The system is relatively simple. It focuses on building awareness of the risk and revealing prevention strategies. When CDC becomes aware of a large cryptosporidiosis outbreak with the potential for having a regional impact, CDC will contact NSPF who will broadcast a regional email. Each Alert will include the general location of the outbreak and a link to the Crypto Toolkit. Toolkits are posted both at the CDC and NSPF websites.
Though containment is critical, prevention is paramount; the Alerts focus on both. Each Alert will include the general location of the outbreak and a link to the Toolkit. The Toolkit includes posters and brochures that facilities can print for free to educate consumers about not swimming when they have diarrhea. In addition, there are documents to educate facility personnel about Crypto and how to treat water that may be contaminated.
The NSPF Toolkit also includes an additional benefit: videos to help educate recreational facility management. Viewing these video seminars is a great way to get the latest updates from experts in this field. The seminars were presented at the 2007 World Aquatic Health Conference (WAHC). In the first video, Dr. Michael Beach of the CDC presents a synopsis of several outbreaks and key challenges and prevention strategies. The second video features Dr. James Amburgey from the
It is important that more rigorous prevention strategies be implemented with Crypto because it is resistant to chlorine and survives for days without special treatments. Even well-maintained, treated aquatic venues (pools, water parks, interactive spray grounds) can spread Crypto. Therefore, it is very important for pool operators, public health officials and the public to work together to keep Crypto out of the water. The Toolkit includes 12 steps that facility management can implement to prevent outbreaks.
Previous outbreak investigations have shown that when a pool is contaminated and the pool is closed, patrons will go to other facilities and unknowingly contaminate them too. The result is the outbreak spreads when pools are closed and consumers are not educated. Crypto is spread from diarrhea of ill people. Thus, it is important to educate patrons and employees to stay out of the water if they have diarrhea.
Recreational facility management can mount a proactive effort by reviewing the Toolkit and implementing preventative strategies. Policies should be developed and enforced relative to individuals and groups who use the pool. It is important that lifeguards are not punished for admitting to supervisors they have diarrhea. Alternative jobs should be assigned so the guard does not enter and contaminate the water. Swim coaches need to also prevent team members from training and competing in the water when they have had diarrhea. Similar education should apply to day-care, other groups and individuals who use the pool or water features.
Cryptosporidiosis is a gastrointestinal illness which causes diarrhea, stomach aches, vomiting, dehydration and other symptoms. Most people who have healthy immune systems will recover without treatment. Symptoms can be particularly severe with young children, the elderly and people who are immune-compromised. Unfortunately, many aquatics managers are not aware of Cryptosporidiosis outbreaks when they occur in their community and what to do if it happens in their pool. This new Alert system is designed to increase communication between the aquatics industry and public health and decrease the knowledge gap on how to fight Crypto.
Based on Cryptos resistance to chlorine, it is not surprising that the number and severity of documented outbreaks have been increasing for over a decade. It is widely acknowledged that many outbreaks are not identified, reported, or investigated. Beginning this year, state health departments will use a more convenient electronic reporting system to notify the CDC of outbreaks under investigation. When other reporting systems, like food, have been converted from paper to electronic systems, the number of documented outbreaks has increased. Thus, 2008 is likely to see an increase in documented outbreaks unless effective prevention strategies are implemented.
According to the CDC, in 2007, there were at least 18 documented Cryptosporidiosis outbreaks related to treated aquatics venues, the largest one in
The NSPF encourages facility operators and service companies to start a dialogue with their public health officials about the Crypto risk in their area. When public health officials and facility operators and managers partner to educate the public, a larger audience can be reached. NSPF is excited to help convey these important prevention messages.
Facilities should consider other measures to reduce outbreak risks at their facility. Studies have shown using supplemental disinfection, such as in-line ultraviolet radiation and ozone, can reduce the transmission of Crypto. Keep in mind that due to dilution, not all water passes through the system. Additional strategies to reduce risk include periodic hyperchlorination and improving water circulation throughout the pool, increasing turn over rates, and/or using flocculants or water clarifiers. Chlorine dioxide is also effective at inactivating Crypto. It can be used in some countries, but is not registered for this particular use in the
Many unanswered questions remain on Crypto. To help answer some of them, NSPF has an active research grant program. This program is funded with proceeds of NSPF educational programs like the Certified Pool/Spa Operator (CPO) certification program. When facilities train their management and staff with NSPF courses, about a third of the proceeds go to fund grants.
To sign up to receive Outbreak Alert Notifications or read more information on the Alert system and the Toolkit contents, visit www.nspf.org/cryptotoolkit.html.
For more information about healthy swimming visit your states website (http://www.cdc.gov/healthyswimming/state.htm) or CDCs Healthy Swimming website (www.cdc.gov/healthyswimming).
The National Swimming Pool Foundation (NSPF) is a non-profit organization founded in 1965, giving back about one-third of all revenue in grants to prevent illness, injury, and drowning and to demonstrate the benefits of aquatic activity. NSPF partners with Human Kinetics to publish the International Journal of Aquatic Research and Education (IJARE), the quarterly peer-reviewed source for aquatic research and educational information, available in print and electronic format. The NSPF funds grants to help reduce risk at aquatic facilities and is the largest funding source for grants to study aquatic health benefits in swimming pools and hot tubs.
