Transmission of Cryptosporidium Species Among Human and Animal Local Contact Networks in Sub-Saharan Africa: A Multicountry Study

Author:

Krumkamp Ralf12,Aldrich Cassandra123,Maiga-Ascofare Oumou124,Mbwana Joyce5,Rakotozandrindrainy Njari6,Borrmann Steffen78,Caccio Simone M9,Rakotozandrindrainy Raphael6,Adegnika Ayola Akim78,Lusingu John P A5,Amuasi John4,May Jürgen12,Eibach Daniel12,Stark Tony,Dekker Denise,Jaeger Anna,Hogan Benedikt,Lamshöft Maike,Thye Thorsten,Schuldt Kathrin,Winter Doris,Tannich Egbert,Rohmann Christina,Melhem Sophia,Boahen Kennedy Gyau,Akenten Charity Wiafe,Sarpong Nimako,Oppong Kwabena,Schares Gereon,Conraths Franz,Kremsner Peter G,Manouana Prince,Mbong Mirabeau,Byrne Natalie,Gesase Samwel,Minja Daniel T R,Sannella Anna Rosa,

Affiliation:

1. Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany

2. German Center for Infection Research, Hamburg-Lübeck-Borstel-Riems, Germany

3. Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany

4. Kumasi Centre for Collaborative Research in Tropical Medicine, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

5. National Institute for Medical Research, Tanga Research Centre, Tanga, United Republic of Tanzania

6. University of Antananarivo, Antananarivo, Madagascar

7. Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon

8. Institut für Tropenmedizin and German Center for Infection Research, partner site Tübingen, Universitätsklinikum, Tübingen, Germany

9. Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy

Abstract

Abstract Background Cryptosporidiosis has been identified as one of the major causes of diarrhea and diarrhea-associated deaths in young children in sub-Saharan Africa. This study traces back Cryptosporidium-positive children to their human and animal contacts to identify transmission networks. Methods Stool samples were collected from children < 5 years of age with diarrhea in Gabon, Ghana, Madagascar, and Tanzania. Cryptosporidium-positive and -negative initial cases (ICs) were followed to the community, where stool samples from households, neighbors, and animal contacts were obtained. Samples were screened for Cryptosporidium species by immunochromatographic tests and by sequencing the 18S ribosomal RNA gene and further subtyped at the 60 kDa glycoprotein gene (gp60). Transmission clusters were identified and risk ratios (RRs) calculated. Results Among 1363 pediatric ICs, 184 (13%) were diagnosed with Cryptosporidium species. One hundred eight contact networks were sampled from Cryptosporidium-positive and 68 from negative ICs. Identical gp60 subtypes were detected among 2 or more contacts in 39 (36%) of the networks from positive ICs and in 1 contact (1%) from negative ICs. In comparison to Cryptosporidium-negative ICs, positive ICs had an increased risk of having Cryptosporidium-positive household members (RR, 3.6 [95% confidence interval {CI}, 1.7–7.5]) or positive neighboring children (RR, 2.9 [95% CI, 1.6–5.1]), but no increased risk of having positive animals (RR, 1.2 [95% CI, .8–1.9]) in their contact network. Conclusions Cryptosporidiosis in rural sub-Saharan Africa is characterized by infection clusters among human contacts, to which zoonotic transmission appears to contribute only marginally.

Funder

German Research Foundation

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

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