Department of Health

Health advisory

Status:
Active
Advisory number:
231220
Date issued:
19 Dec 2023
Issued by:
Dr Clare Looker, Chief Health Officer
Issued to:
Victorian public and health professionals

Key messages

  • There has been an increase in the number of cryptosporidiosis (crypto) cases in Victoria.
  • Some cases have become infected after using public swimming pools and public health investigations have found people are attending pools while they are infectious.
  • To avoid contaminating pool water which infects others, people with cryptosporidiosis or unknown cause of diarrhoea should not swim while they have diarrhoea and for two weeks after diarrhoea stops.
  • Health professionals should consider the possibility of cryptosporidiosis in people presenting with gastroenteritis, especially if they have recently used a public swimming pool.
  • If Cryptosporidium infection is suspected, ask about likely exposures, send a stool sample for Cryptosporidium testing and provide infection control and exclusion advice, including avoiding swimming until two weeks after diarrhoea stops.

What is the issue?

Cryptosporidiosis is a type of gastroenteritis (gastro) caused by the parasite Cryptosporidium.

There has been an increase in cryptosporidiosis cases in Victoria since the beginning of September 2023, with some cases linked to swimming in public pools. Several European countries and New Zealand have also reported a recent increase in the number of cases.

Cases of cryptosporidiosis generally increase during the warmer months when more people are swimming and using public pools. Cryptosporidium parasites are highly resistant to the levels of chlorine normally found in swimming pools.

Outbreaks associated with pools occur when people attend a pool with a cryptosporidium infection. Swimmers can become infected when they accidentally swallow pool water contaminated with the parasite.

Who is at risk?

All people can become infected. In Melbourne, the risk appears to be greatest for those exposed to swimming pools or for those who are household contacts of cases. Although most illness is mild and self-limiting, certain groups are more at risk of severe illness if infected, including younger children, pregnant women and people with weakened immune systems.

Symptoms and transmission

The most common symptoms of cryptosporidiosis are watery diarrhoea and stomach cramps which may last several weeks.

Other symptoms may include fever, nausea, vomiting, bloating and loss of appetite. Less commonly, Cryptosporidium infection can present as pneumonia, cholecystitis or pancreatitis. Some people who are infected may not show any symptoms.

Transmission of cryptosporidiosis occurs by the faecal-oral route (when the parasites are taken in by mouth). This can happen directly through eating contaminated food and water or, more commonly, from person to person or animal to person. Outbreaks can be linked to sources such as contaminated drinking water, swimming pools and petting infected animals.

The typical incubation period is around 1 to 12 days, with an average of 7 days. Cases are infectious while they excrete oocysts. An infected person typically excretes Cryptosporidium during the illness and for up to two weeks after the diarrhoea has stopped. For this reason, it is important that people with cryptosporidiosis do not swim for 14 days after diarrhoea ceases.

Recommendations

For the public

  • Do not swim if you have had cryptosporidiosis in the past 14 days.
  • Shower and wash with soap, especially the bottom, before swimming.
  • Avoid swallowing pool water.
  • Wash hands with soap after going to the toilet, changing a nappy, handling animals or before preparing food or drink.
  • Do not handle food or prepare food for others until at least 48 hours after diarrhoea has stopped.
  • Change nappies in nappy change areas only.
  • Keep children home from childcare or school until 24 hours free of symptoms.

If you think you or your child may have cryptosporidiosis, contact your doctor who will ask you for a stool (faeces or ‘poo’) sample for testing. If the results of the tests show that you have cryptosporidiosis, the doctor will be able to provide you with advice and will also notify the Department of Health.

For health professionals

  • Consider the possibility of cryptosporidiosis in people presenting with gastroenteritis, especially if they have recently used a public swimming pool in the past two weeks.
  • Send a stool sample requesting testing for Cryptosporidium, and any other relevant investigations for gastroenteritis.
  • Persons with Cryptosporidium infection should be advised not to swim for two weeks after symptoms have resolved.
  • Provide advice about the importance of hand hygiene measures and if relevant, advise exclusion from childcare settings until 24 hours free of symptoms.
  • Cryptosporidiosis is a routine notifiable condition under the Public Health and Wellbeing Regulations 2019 and requires written notification by medical providers and pathology services within five days of diagnosis.

Where to get help

Reviewed 19 January 2024

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