2016 Crypto Outbreak & Response. Adam Holbrook, RS, REHS, NSPFI Sarah Badenhop, RS, NSPFI

Transcription

1 2016 Crypto Outbreak & Response Adam Holbrook, RS, REHS, NSPFI Sarah Badenhop, RS, NSPFI

2 Outline Cryptosporidium and Cpryptosoridosis How to Kill Crypto in Your Pool Crypto Outbreak in Central Ohio Public Awareness Campaign CPH Video Series for Operator Training

3 Cryptosporidium photo source:

4 Cryptosporidium AKA Crypto Protozoan parasite Has a hard outer shell Resistant to chlorine at normal operating range Shed in feces of infected animal 10,000,000 to 100,000,000 Crypto germs in single bowel movement Swallowing as few as 10 Crypto germs can cause infection

5 Cryptosporidium life cycle photo source: pathogen.html

6 Cryptosporidium Crypto is spread by fecal-oral route of transmission: Swallowing contaminated recreational water (treated and untreated waters) Swallowing contaminated food or water Undercooked food or unpasteurized raw apple cider or milk that is contaminated Touching mouth with contaminated hands

7 Cryptosporidosis Symptoms of infection: Watery diarrhea Stomach cramps or pain Dehydration Nausea Vomiting Fever Weight loss Begin 2 to 10 days after infection Lasts about 1 to 2 weeks Some will have no symptoms Some will come and go for up to 30 days

8 Cryptosporidosis Detection Fecal sample Specific request for testing Turnaround is 3-7 days Reported to Local Health Department Treatment Most recover without Prevent dehydration Nitazoxanide is available Consult healthcare provider before taking anti-diarrheal medication

9 Cryptosporidosis General prevention guidelines: Good hand hygiene 20 seconds with soap and warm water After using restroom, changing diapers, handling raw foods, before preparing food, etc. Alcohol-based hand sanitizers are NOT effective against Crypto Exclude children with diarrhea from childcare centers until symptoms stop 3% hydrogen peroxide on contaminated surfaces

10 Cryptosporidosis Prevention in Recreational Waters Begins with swimmer awareness: Stay out of the water if you have diarrhea Shower before getting into the water Don t pee or poop in the water Don t swallow the water Don t swim for 2 weeks after symptoms of diarrhea stop

11 Cryptosporidosis Prevention in Recreational Waters Roles of the operator: Educate swimmers and patrons Insist on showers before swimming Hourly breaks to encourage bathroom use Diapers changed in designated area that is not poolside

12 Cryptosporidosis Prevention in Recreational Waters Educating patrons Signage CDC Health Promotion Materials s/index.html Orientation

13 CDC Health Promotion Materials

14 Filter Micron Removal 50 40

15 How to Kill Crypto In Your Pool UV and Ozone Supplemental disinfectants Effective only at the point where water passes through unit Must be properly sized and maintained to deliver effective dose

16 How to Kill Crypto in Your Pool CDC Fecal Incident Response Guidelines

17 How to Kill Crypto in Your Pool No Stabilizer (CYA) in Water Stabilizer (CYA) in Water

18 Response with No Stabilizer (CYA) Maintain a ph of 7.5 or less

19 Response with Stabilizer (CYA) Use a non-stabilized shock Maintain a ph of 7.5 or less

20 Response when using Bromine No specified guidance or sufficient research for Bromine treatment for crypto or fecal incident 1) Measure disinfectant using DPD chlorine test kit 2) Add this number to the minimum chlorine level specified in guidance document & this is your hyperchlorination goal. a) (Ex. Initial reading from step one = 4ppm; = 24ppm; raise the chlorine level to 24ppm) 3) Use a non-stabilized chlorine disinfectant to raise the chlorine level to your hyperchlorination goal. 4) Maintain chlorine at this level with a ph at 7.5 or lower for the specified time frame 5) Return pool to required operating parameters prior to opening

21 How is Health Dept. Notified of Cases of Crypto? Ohio Disease Reporting System (ODRS) State and Local Public Health Practitioners report infectious diseases Infectious Disease Reporting System (IDRS) Joint Reporting for CPH & FCPH Local Healthcare Providers Reporting Reports received are entered into ODRS

22 Crypto Outbreak in Central Ohio

23 Crypto Outbreak in Central Ohio

24 Crypto Outbreak in Central Ohio

25 Environmental Health Response Epi & Nursing Staff Gathered Information Surveyed individuals infected or persons close to them EH Staff Contacted Facilities Notified that someone infected reported they swam at facility Followed up to see what facility did Records

26 Notice to all Facilities Sent out on August 18, 2016 Everbridge s

27 Ongoing Public Awareness Campaign

28 Ongoing Public Awareness Campaign

29 Ongoing Public Awareness Campaign

30 Ongoing Public Awareness Campaign

31 Resources Centers for Disease Control and Prevention National Swimming Pool Foundation Columbus Public Health

32 Contamination Video

33 Free Education

34 Thank you. Any Questions? Adam Holbrook, RS, REHS, NSPFI Public Health Sanitarian Program Coordinator NSPF Instructor Phone: (614) Sarah Badenhop, RS, NSPFI Public Health Sanitarian Program Coordinator NSPF Instructor Phone: (614)