The epidemiology of cryptosporidiosis in New Zealand, 1997-2006

Aims New Zealand has a high incidence of cryptosporidiosis compared to other developed countries. This study aimed to describe the epidemiology of this disease in detail and to identify potential risk factors.

Methods We analysed anonymous cryptosporidiosis notification (1997–2006) and hospitalisation data (1996–2006). Cases were designated as “urban” or “rural” and assigned a deprivation level based on their home address. Association between disease rates and animal density was studied using a simple linear regression model, at the territorial authority level.

Results Over the 10-year period 1997–2006, the average annual rate of notified cryptosporidiosis was 22.0 cases per 100,000 population. The number of hospitalisations was equivalent to 3.6% of the notified cases. There was only 1 reported fatality. The annual incidence of infection appeared fairly stable, but showed marked seasonality with a peak rate in spring (September–November in New Zealand). The highest rates were among Europeans, children 0–9 years of age, and those living in low deprivation areas. Notification rates showed large geographic variations, with rates in rural areas 2.8 times higher than in urban areas, and with rural areas also experiencing the most pronounced spring peak. At the territorial authority (TA) level, rates were also correlated with farm animal density.

Conclusions Most transmission of Cryptosporidium in New Zealand appears to be zoonotic: from farm animals to humans. Prevention should focus on reducing transmission in rural setting, though more research is needed to identify which strategies are likely to be most effective in that environment.

A tale of two parasites : the comparative epidemiology of cryptosporidiosis and giardiasis

New Zealand has a higher reported incidence of cryptosporidiosis and giardiasis than most other developed countries. This study aimed to describe and compare the epidemiology of these infections in New Zealand, to better understand their impact on public health and to gain insight into their probable modes of transmission. We analysed cryptosporidiosis and giardiasis notification data for a 10-year period (1997–2006). Highest rates for both diseases were in Europeans, children aged 0–5 years, and those living in low-deprivation areas. Cryptosporidiosis distribution was consistent with mainly farm animal (zoonotic) reservoirs. There was a dose–response relationship with increasing grades of rurality, marked spring seasonality, and positive correlation with farm animal density. Giardiasis distribution was consistent with predominantly human (anthroponotic) reservoirs, with an important contribution from overseas travel. Further research should focus on methods to reduce transmission of Cryptosporidium in rural areas and on reducing anthroponotic transmission of Giardia.

The impact of climate variability and change on cryptosporidiosis and giardiasis rates in New Zealand

Aim: To investigate the spatial relationship between climate variability and cryptosporidiosis and giardiasis notifications in New Zealand between 1997 and 2006.

Methods: Negative binomial regression was used to analyse spatial relationships between cryptosporidiosis and giardiasis notifications in New Zealand between 1997 and 2006, and climatological average rainfall and temperature at the Census Area Unit (CAU) level. The quality of domestic water supplies, urban-rural status and deprivation were included as covariates.

Main results: Giardiasis: There was a positive association between rainfall and giardiasis and between temperature and giardiasis.

Cryptosporidiosis: There was a positive association between rainfall and cryptosporidiosis and a negative association between temperature and cryptosporidiosis. The effect of rainfall was modified by the quality of the domestic water supply.

Conclusions: These findings suggest that climate variability affects protozoan disease rates in New Zealand. However, predicting the effect of climate change from this study is difficult, as these results suggest that the projected increases in temperature and rainfall may have opposing effects on cryptosporidiosis rates. Nevertheless, water supply quality appeared to modify the impact of increased rainfall on cryptosporidiosis rates. This finding suggests that improving water supply quality in New Zealand could reduce vulnerability to the impact of climate change on protozoan diseases.

Ecosystems and human well-being : health synthesis

This report synthesizes the findings from the Millennium Ecosystem Assessment's (MA) global and sub-global assessments of how ecosystem changes do, or could, affect human health and well-being. Main topics covered are: Food, fresh water, timber, fibre, and fuel, nutrient and waste management, pollution, processing and detoxification, cultural, spiritual and recreational services, climate regulation, and extreme weather events.