O0129 Cryptosporidiosis outbreak in Amazonia, French Guiana, 2018 Estelle Menu*1,2, Emilie Mosnier3, Loic Favennec4,5, Stephane Valot6, Arnaud Cotrel7, Frédéric Dalle6, Damien Costa4,5, Denis Blanchet1,8, Stéphane Ranque2, Damien Brélivet9, Magalie Demar1,8, Franck De Laval7,10,11

1 Laboratoire de Parasitologie-Mycologie, Centre hospitalier Andrée Rosemon, Cayenne, French Guiana, 2 Aix Marseille Université, IRD, AP-HM, SSA, VITROME, Marseille, France, 3 Pôle des Centres Délocalisés de Prévention et de Soins, Centre hospitalier Andrée Rosemon, Cayenne, French Guiana, 4 Laboratoire de Parasitologie-Mycologie, CHU Rouen, Rouen, France, 5 EA ESCAPE 7510, University of Medicine Pharmacy , Rouen, France, 6 Laboratoire de Parasitologie-Mycologie, CHU Dijon, Dijon, France, 7 French Armed Forces Health Service in French Guiana, French Armed Forces Health Service in French Guiana, Cayenne, France, 8 Ecosystèmes amazoniens et Pathologie Tropicale, Université de Guyane, Cayenne, French Guiana, 9 Water, sanitation monitoring unit, Agence Régionale de la Santé de la Guyane, Cayenne, French Guiana, 10 Centre d’épidémiologie et de santé publique des armées, SSA, Service de Santé des Armées, CESPA, Marseille, France, 11 Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France Background: Even if cryptosporidiosis transmission exists in South America, data are sparse and mode of contamination is not well understood. In March 2018, 51 cases of cryptosporidiosis were reported in Maripasoula, a village located in a remote forest area along the border between Surinam and French Guiana. Materials/methods: In order to understand and identify the origin of the epidemic, we performed epidemiological, microbiological and environmental investigations. From January 1 and May 31, 2018, in Maripasoula, a confirmed case was defined as diarrhea AND Cryptosporidium-positive stool test; a possible case was diarrhea in close contact with a confirmed case. In addition a retrospective cohort study was carried out in a military sub-group involved in the epidemic to identify risk factors for cryptosporidiosis. Results: The outbreak investigation identified 16 confirmed cases: ten civilian and six military. Among the civilian, there were nine children, with an average of age of 15.3 months, and one adult. The sex ratio was 7/3 (M/F). One child required a hospitalization for rehydration. Forty-one military cases were suspected with an average of age of 30, six military cases were confirmed. No other common risk factor apart from tap water consumption was reported in all cases (OR= 3.6; 95CI= [0.4-32.7]). All 16 Cryptosporidium stools were PCR positive; the sequencing of gp60 gene found only one cryptosporidium hominis subtype Ib A10 G2. Investigation of drinking water found Cryptosporidium parvum subtype IId A19 G2 and negligent water sanitary was described. Conclusions: These results were in favor of a clonal waterborne cryptosporidiosis outbreak, and consolidated results from the former outbreak described in 2016. Water was pumped from the river then treated via decantation, sand filtration and chlorination, which was ineffective to prevent cryptosporidiosis. Water quality is a major public health problem in Amazonian French Guiana. To control the risk of recurrent outbreaks, Cryptosporidium monitoring (diarrhea stool routine examination, water turbidity) should be enhanced.

C:\Users\a133930\Documents\graph .png Figure. Epidemic curve. Green: civilians’ cases; Blue: soldiers’ cases; C: confirmed case.

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