CRYPTO study 2013-2016 - Amazon S3 · 2015. 11. 10. · Pos % Pos % Pos % Pos % Pos % Pos % Pos %...
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CRYPTO study 2013-2016
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CRYPTO study 2013-2016 | 15-09-2015
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Cryptosporidium: achtergrond informatie
● Verwekker waterdunne diarree
– Verschil in chronische sequela tussen types: C.hominis meer extra intestinale klachten (oa. gewrichtsklachten; beide relapses na aanvankelijk opknappen.)
● Therapie : geen effectieve therapie
● Risicogroep: immuungestoorden : hiv/aids; transplantatie/prednison hoge dosis
● Seizoen: najaar en kleinere voorjaarspiek
● Leeftijd: vooral jonge kinderen:
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Cryptosporidium: in NL
● In NIVEL en SENSOR studie: ca. 2% van de cases; bijna niets in controles ( populatie en GP patiënten 1996-1998; microscopie)
● Weinig in eXplosie studie en KIZSS (Kinderdagverblijf 2010-2013 ( PCR))
● In Geops (ziekenhuisopnames GE): opvallend vaak (>7 %) maar vaak dubbelinfecties (PCR)
● GCC studie (GP patienten 4 labs, case controle; PCR)
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Dutch case control study GP population
organism Case Control
< 5yr 5-20 21-50 >50 < 5yr 5-20 21-50 >50
n= 152 313 557 493 104 200 445 428
Pos % Pos % Pos % Pos % Pos % Pos % Pos % Pos %
Giardia 14 9.2 24 7.7 24 4.3 23 4.7 4 3.8 15 7.2 10 2.2 4 0.9
Crypto 12 7.9 9 2.9 21 3.8 4 0.8 5 4.8 2 0.4 2 0.4 1 0.2
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Bruijnesteijn van Coppenraet LE ea Case-control comparison of bacterial and protozoan microorganisms associated with gastroenteritis: application of molecular detection. Clin Microbiol Infect. 2015 Jun;21(6):. 7 592.e9-592.e19. Epub 2015
Table 4: Positivity for all targets by age category
Age difference detection Cryptosporidium in controls ; 50 yrs cases : 0.8 %; controls 0.2%
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GCC study results parasites
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50 yrs
Cryptosporidium % pos per age group
cases
controls
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Cryptosporidium: DALYs and Cost of illness
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DALY’s Crypto: 72 DALYS per jaar; 3.1 DALYS per 1000 cases ( Giardia 127, Toxoplasma 3570, Campylobacter 3633) M.-J.J. Mangen et al. Cost-of-illness and disease burden Ranking of food-related pathogens in the Netherlands in 2011. International Journal of Food Microbiology 196 (2015) 84–93
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ISIS lab surveillance 2001-2007
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1-4 5-8 9-12 13-16 17-20 21-24 25-28 29-32 33-36 37-40 41-44 45-48 49-52
Week
Aan
tal g
evallen
/ 1
0.0
00.0
00 in
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2001 2002 2003 2004 2005 2006 2007 Cryptosporidium spp.
Incidentie van Cryptosporidium spp gerapporteerd door ISIS, 2001-2007.
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ISIS lab surveillance 2001-2007
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200
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0 1-4 5-11 12-17 18-34 35-64 64+
Leeftijd
Aan
tal g
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/ 1
0.0
00.0
00 in
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Mannen Vrouwen Cryptosporidium spp.
Leeftijds- en geslachts-specifieke incidenties voor Cryptosporidium spp gerapporteerd door ISIS, 2001-2007
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1 5 9 13 17 21 25 29 33 37 41 45 49 1 5 9 13 17 21 25 29 33 37 41 45 49 1 5 9 13 17 21 25 29 33 37 41 45
Week
Nb
2010 2011 2012
Number of Cryptosporidium positive faecal samples by week of confirmation in 4 laboratories*, Netherlands, January 2010 to November 2012
Weeks 36-38: 180 cases 20 in 2010 29 in 2011
Weeks 31-45: 472 cases
108 in 2010 92 in 2011
*CBSL (Hilversum), Haarlem, Saltro (Utrecht) and Labmicta (Enschede)
Nelly Fournet et all Euro Surveill. 2013
80 % C. hominis type IbA10G2 (dominant strain)
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Sporadic Cryptosporidium - study design
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Regional GP Laboratories
GP Case patient
Patient visits GP with GI symptoms
GP sends sample to laboratory
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2
RIVM (Epi&lab)
Laboratory sends B envelope to GP
GP forward A envelope to patient
Laboratory sends the sample for futher speciation/typing
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Patient returns questionnaire
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Cases are approached by email for follow up study of symptoms
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Study objectives
• To describe the epidemiology of sporadic cryptosporidiosis in the Netherlands.
• To identify risk factors for sporadic cryptosporidiosis in the Netherlands in order to acquire information for control strategies.
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Case and control definitions
Case definition
• Gastrointestinal illness between April 2 2013 to April 1 2016 and
laboratory confirmation (Cryptosporidium spp.)
Control recruitment
• 5 controls/ case prospectively selected from population register
• ‘Frequency matched’ according to age and area of residence of
cases
• Excluded if diarrhoea 2-4 weeks before
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Data collection methods
Questionnaire with 200 items
• Symptoms
• Personal hygiene
• Day care attendance
• Travel
• Housing conditions
• Swimming
• Water consumption
• Outdoor activities
• Food history
• Animal contact (pets, farm animals)
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Laboratory and statistical methods
Microbiological
• Cryptosporidium specification by real-time PCR.
Statistical analysis
• Single variable and multivariable logistic regression
• Variables were included if P-value
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Deelnemende laboratoria
In totaal 17 labs ● 'S-GRAVENHAGE
● AMSTERDAM
● DELFT
● ENSCHEDE/HENGELO
● GRONINGEN
● HAARLEM
● HEERLEN
● HILVERSUM
● LEEUWARDEN
● MAASTRICHT
● NIJMEGEN
● ROTTERDAM
● TERNEUZEN
● TILBURG
● UTRECHT/SALTRO
● VELDHOVEN
● WOERDEN
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Figure 1: Number of Cryptosporidium cases by date of sample collection and participating laboratory, IDS database (n=1218*). *167 with missing date of sample collection
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April 2013-aug 2015 (week 34)
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Binnengekomen monsters 2015 bij RIVM-IDS (datum binnenkomst)
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jan feb mrt apr mei jun jul aug sep till
15/9)
number total received
number total received
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Typering 2013 en 2014
2013 2014
C. hominis 16 % 8 %
C. parvum 84 % 92 %
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C.parvum IIaA15G2R1 meest voorkomend C.hominis IbA10G2 niet het meest voorkomend
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Zomer 2013
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C. parvum
C. hominis
IIaA15G2R1
IIaA17G1R1
IIaA16G3R1
IIaA15G1R1
IIaA19G3R1
IIaA14G1R1
IIaA14G2R1
IIaA16G1R1
IIaA16G2R1
IIaA20G1R1
IIaA20G2R1
IIdA17G1
C. parvum
C. parvum
C. parvum
C. parvum
C. parvum
C. parvum
C. parvum
C. parvum
C. parvum
C. parvum
C. parvum
IIaA19G1R1
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C. hominis
C. hominis
C. hominis
C. hominis
C. hominis
IbA10G2
IbA9G3
IaA14
IeA11G3T3
IdA17
IdA25
Totaal 19 genotypes
C. parvum
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Resultaten typering 132 samples 2015
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0%
10%
20%
30%
40%
50%
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70%
80%
90%
100%
jan feb mrt apr mei jun jul aug sep
% C hominis
% C.parvum
Binnengekomen /getest
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Cryptosporidium study 2013 : by gender
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15
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25
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female
male
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Cryptosporidium study 2015 : by gender
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10
15
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2015w262015w272015w282015w292015w302015w312015w322015w332015w34
female
male
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Project review module, August 2014
Risk factors for sporadic cryptosporidiosis in the Netherlands: a mid-term analysis
of an ongoing case-control study
Laura Nic Lochlainn EPIET Fellow National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, the Netherlands [email protected]
//upload.wikimedia.org/wikipedia/en/5/5d/ECDC_logo.svgmailto:[email protected]
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Recruitment of participants April 2013- April 2014
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547 cases invited 2,350 controls invited
705 controls recruited
273 cases recruited
50% response
192 cases 587 controls 81 cases excluded due to travel
30% response
118 controls excluded due diarrhoea illness or travel
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Factors associated with crypotosporidiosis: multivariable analysis
(na 1 jaar, vooral C.parvum)
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Characteristics Odds ratio* 95% CI
Swam in a river or lake 4.9 2.0-12.0
Had contact with cattle 3.8 2.0-7.0
Ate barbequed foods 3.8 2.4-6.1
Shared house with a case 1.8 1.1-3.0
Played in a sandbox 0.4 0.2-0.7
*Multivariable logistic regression adjusted for age, gender, season and excluding those who travelled
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Characteristics of cases of cryptosporidiosis, the Netherlands, 2013-2014
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• 59% females (n=162)
• Median age of cases: 28 years (range 1-95)
0 50 100
Diarrhoea
Fatigue
Stomach pain
Loss of appetite
Weight loss
Headache
Vomiting
Dizziness
Joint pain
Proportion (%)
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Komende analyses
● Chronische sequela
– Vragenlijst 4 maanden na begin
– 274 personen die een vragenlijst hebben ingevuld
– Geen gegevens uit NL;
– Paul Hunter in UK: C.hominis meer extra intestinale klachten
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Acknowledgements
RIVM Epidemiology Dept – Jussi Sane – Barbara Schimmer – Wilfrid Van Pelt – Rody Zuidema – Susan Hahné – Laura Nic Lochlainn – Lennard Pisa – Sofie Mooij
RIVM Laboratory Dept
– Titia Kortbeek – Jeroen Roelfsema – Sietze Brandes – Nahid Nozari – Denise Hoek
● Deelnemende labs – 'S-GRAVENHAGE
– AMSTERDAM
– DELFT
– ENSCHEDE
– GRONINGEN
– HAARLEM
– HEERLEN
– HILVERSUM
– LEEUWARDEN
– MAASTRICHT
– NIJMEGEN
– ROTTERDAM
– TERNEUZEN
– TILBURG
– UTRECHT/SALTRO
– VELDHOVEN
– WOERDEN
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Algoritme
● Wordt Cryptosporidium altijd bepaald – ook als het niet specifiek wordt aangevraagd?
– Wanneer wel/wanneer niet?
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Vragen?
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