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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