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The Number of Reported Crypto Cases and Outbreaks is Increasing

Crypto, that chlorine-resistant problem the recreational water sector has been dealing with since 1988, is setting itself up to be an even bigger challenge in the future. Since 2005, individual Crypto infections have increased substantially with an increase of 41% in 2005 and 24% in 2006 (Figure 1). Reported cases for 2007 have already exceeded the total for 2006. This trend is also reflected by the number of outbreaks reported to the Centers for Disease Control and Prevention (Figure 2). From 1995 to 2004 there were an average of five disinfected venue-associated Crypto outbreaks a year. However, the number jumped to 22 in 2006 and to 29 in 2007.

Why is this happening? A combination of factors may be contributing to this trend. To begin with, in late 2004 the first drug for treating adults with Crypto was approved. The availability of this new drug likely increased the chance that healthcare providers will now test for Crypto if they have a patient with diarrhea. Second, when Crypto is diagnosed, swimmers, healthcare providers, and health departments are now thinking about the last swimming visit instead of the last meal. Third, when Crypto tracking systems pick up these new cases, health departments investigate and find outbreaks. Finally, Crypto does appear to be spreading more through different parts of the country. The key point is that this trend is likely to continue in the future so the risk of outbreaks being detected will increase.

What can IAAPA members and others do to respond to this risk management problem? Get informed and then get involved! Build a relationship with your health department and ask to be part of a health alert network to receive news about outbreaks so you can prepare for them. Train your staff so they are aware of Crypto, recreational water illnesses (RWIs), and your response plan. Operate at 110% with regular system checks with the latest technology and practices in place. Remember that typical levels of chlorine in a pool and normal pool filtration are not effective against Crypto. Be part of the effort to develop a national Model Aquatic Health Code. Technical Committees are now being formed for this collaboration between state, local, and federal public health officials and the aquatics sector (visit http://www.cdc.gov/healthyswimming/model_code.htm). Finally, let’s accept that this problem cannot be solved without fully engaging the public. All parties involved must work together to bring the public on board with the basics of healthy swimming behaviors (e.g., don’t swim when ill with diarrhea, don’t swallow the water, practice good hygiene). Start by making RWI Prevention Week 2008 (May 19-May 25) a launch pad for your communication campaign to combat Crypto. Visit the Healthy Swimming website for further information (http://www.cdc.gov/healthyswimming) on how to make 2008 a Healthy Swimming season.