Download Example of letter to GPs/Hospital Trusts/NHS Direct

Public Health Wales Microbiology Division
Guidance for the investigation of
Cryptosporidium linked to swimming pools
Guidance for the investigation of Cryptosporidium
linked to swimming pools
Appendix 4: Example of letter to GPs/Hospital Trusts/ etc
Agencies: Public Health Wales, Public Health England, Local Authorities,
the Chartered Institute of Environmental Health, the Pool Water Treatment
Advisory Group and the Chartered Institute for the Management of Sport
and Physical Activity.
Author and original affiliation: Rachel Chalmers, Head of UK
Cryptosporidium Reference Unit, Public Health Wales.
Rosemary McCann, Consultant in Communicable Disease Control, Greater
Manchester Health Protection Unit.
Gwen Lowe, Consultant in Communicable Disease Control, Health
Protection Team, Public Health Wales.
Ash Modi, Specialist Registrar in Public Health, Greater Manchester Health
Protection Unit.
Rhianwen Stiff, Specialist Registrar in Public Health, Public Health Wales
Catherine Quigley, Regional Epidemiologist, Regional Epidemiology Unit,
HPA North West.
Paul Cleary, Regional Epidemiologist, Regional Epidemiology Unit, HPA
North West.
Ayo Oyinloye, Specialist Registrar in Public Health, Cheshire & Merseyside
Health Protection Unit.
Peter Lamb, Environmental Health, Trafford Council.
Craig Sewell, Environmental Health, Merthyr Tydfil County Borough
Council.
Sarah Jones, Health improvement, Cardiff City Council, Health
Improvement.
Mark Elliott, Chair, All Wales Communicable Disease Technical Panel
Julie Barratt, Director, CIEH Wales.
Janice Calvert, Chair, Pool Water Treatment Advisory Group.
Ralph Riley, Institute of Sport and Recreational Management .
Gordon Nichols, Consultant Epidemiologist, Health Protection Agency,
Centre for Infections.
Clare Elliott, Scientific web editor, Public Health Wales.
Approved by: HPA GI
programme board
Approval date 24/01/11
Page: 1 of 3
Date issued: 18 July 2016
Document Version: CRUGUID102 app4 v.3
If printed, this document is only valid for today 30 April 2017 unless authorised as a controlled
copy
Public Health Wales Microbiology Division
Date of issue: 18 July 2016
Guidance for the investigation of
Cryptosporidium linked to swimming pools
Document Version:
CRUGUID 102 appendix 4 v.3
Publication/ Distribution:

Public (Internet: Cryptosporidium Reference Unit website)

Links from Public Health Wales (Intranet) , Health Protection Agency
(Internet) and websites of Partner Organisations
Review Date: 18 July 2019
Purpose of Document:
This is Appendix 4 of a document that has been drawn up by a task and
finish group to provide guidance to public health professionals on the
prevention and investigation of cases of cryptosporidiosis linked to
swimming pools in England and Wales.
This guidance concentrates on conventional swimming pools i.e.
rectangular, indoor pools used by people of all ages and with no extra
features. Although the recommendations hold good for most pools, they
may need to be varied to apply to non-conventional or specialist pools.
It is intended for use alongside the Pool Water Treatment Advisory
Group’s (PWTAG) publication Swimming Pool Water Treatment and Quality
Standards for Pools and Spas, Second Edition 2009 (ISBN 0951700766)
www.pwtag.org (PWTAG 2009). Updates on the second edition are
available on the PWTAG website www.pwtag.org
A separate document is available on controlling infection risk in spa pools,
although these are rarely linked to Cryptosporidium because head
immersion is rare: Management of spa pools: controlling the risk of
infection. Health Protection Agency 2006 (ISBN 0901144800)
www.hpa.org.uk/publications/2006/spa_pools/default.htm
Summary of document:
This Appendix is an example of a letter that may be used to alert GPs and
relevant colleagues of a cluster of cryptosporidiosis cases and to ask for
consideration of Cryptosporidium among differential diagnosis, provide
hygiene advice and advise cases not to use swimming pools for 2 weeks
after cessation of symptoms.
Work Plan reference: Cryptosporidium Reference Unit 2010/11
Page: 2 of 3
Date issued: 18 July 2016
Document Version: CRUGUID102 app4 v.3
If printed, this document is only valid for today 30 April 2017 unless authorised as a controlled
copy
Public Health Wales Microbiology Division
Guidance for the investigation of
Cryptosporidium linked to swimming pools
[Date]
Dear Colleague,
We are investigating a cluster of cases of cryptosporidiosis which may
be linked with swimming at [NAME OF PREMISES]. This is against a
background of a [RISE/FALL] in cases of Cryptosporidium generally across
[GEOGRAPHICAL AREA / PCT / HEALTH BOARD] at present.
The common presenting symptoms of cryptosporidiosis are:
- diarrhoea. This is usually watery in nature; it may contain mucus,
but rarely contains blood; it is often profuse, but may wax and
wane.
- nausea, vomiting and anorexia often precede diarrhoea
- cramping abdominal pain.
Other symptoms occur such as:
- weight loss
- headache
- myalgia
- low grade fever.
People usually develop symptoms between 3 to 12 days after exposure to
the parasite. Most cases occur around 5 to 7 days after exposure.
Cryptosporidiosis is very easily spread. Individuals are infectious from
the start of symptoms, and may continue to be infectious for many weeks
after symptoms have resolved. Outside of the body, the oocysts can
remain infective for between many months in a moist environment.
If you see anyone with watery diarrhoea, and a history of having swam at
[NAME OF PREMISES], please consider cryptosporidiosis among your
differential diagnosis. Please give the family advice on frequent
handwashing with soap and water after using the toilet, changing nappies
and before preparing and eating food, not sharing towels and other basic
hygiene advice. Please advise them they should not swim with symptoms
or for two weeks afterwards.
We would be grateful if you would arrange for a stool sample to be sent on
such patients, and for you to notify the Health Protection Team on
[TELEPHONE NUMBER].
Yours faithfully,
Consultant in Communicable Disease Control
Page: 3 of 3
Date issued: 18 July 2016
Document Version: CRUGUID102 app4 v.3
If printed, this document is only valid for today 30 April 2017 unless authorised as a controlled
copy