In order to monitor epidemiological trends, Cryptosporidium-positive samples (n=4509) from diarrhoeic patients were typed. Compared to the previous 4 years, the proportion of Cryptosporidium hominis cases in 2004-2006 increased to 57·3%, while 38·5% were C. parvum. The remaining 4·2% cases included mixed C. parvum and C. hominis infections, C. meleagridis, C. felis, C. ubiquitum and a novel genotype. When the typing results were combined with enhanced surveillance data to monitor risk exposures, C. hominis was linked to urban dwelling, previous diarrhoea in the household, any travel especially abroad, and using a swimming or paddling pool. C. parvum was linked to having a private water supply, contact with surface water, visiting or living on a farm, and contact with farm animal faeces. The proportion of laboratory-confirmed indigenous cases acquired from direct contact with farm animals was estimated to be 25% for C. parvum and 10% of all reported Cryptosporidium cases.

Summary The protozoan parasite Cryptosporidium infects all classes of vertebrates. Of the major human pathogenic species, Cryptosporidium parvum and Cryptosporidium hominis predominate in the UK. Cryptosporidium hominis is a human‐adapted species, while C. parvum has many animal hosts and is particularly common in preweaned farmed ruminants. Evaluation of zoonotic risks has been provided mainly by descriptive and analytical epidemiological studies and enhanced recently by genetic typing of isolates. The robust nature of the transmissive oocyst stage, multiple transmission routes, lack of antiparasitic treatment options and vaccines, and resistance to chlorine disinfection present challenges for control. Subtyping C. parvum isolates has been used to link human cases and suspected sources of infection in sporadic cases and outbreaks. Although it is possible that all C. parvum isolates are potentially zoonotic, populations with and without farm animal linkage have been identified. New zoonotic risks have emerged in at least one outbreak, caused by the Cryptosporidium sp. rabbit genotype. This re‐enforces the need to characterize infecting and contaminating isolates to ensure appropriate interventions. This study describes the risks of zoonotic cryptosporidiosis by detailing the hosts providing a potential reservoir, the risks of transmission to humans, outbreaks in animal‐associated settings and guidance for control with special emphasis on the UK.

An average of 70 samples were collected from 80 dairy farms in England and Wales, from cattle, co-grazed sheep, wildlife and farm wastes, to investigate prevalence, potential sources and transmission routes of Cryptosporidium. At least one positive sample was detected on 74 of the farms (92.5%) by IFAT microscopy. The prevalence in cattle was 10.2% (95% CI 9.4-11.1%), with greater prevalences detected in calf samples, especially from those under 1 month (45.1%). Young calves were also more likely to be shedding Cryptosporidium parvum and larger concentrations of oocysts, whereas older calves and adult cattle were more likely to be shedding Cryptosporidium bovis and Cryptosporidium andersoni, respectively. The C. parvum subtypes detected were predominantly from types commonly identified in UK cattle (67% were either IIaA15G2R1 or IIaA17G1R1). A novel subtype, IIaA17G1R2, was identified from one cattle sample. The prevalence in co-grazed sheep was low (4%). Birds and rodents may represent significant reservoirs of Cryptosporidium due to high prevalence, large oocyst concentrations, and the detection of a C. parvum subtype known to be present in human populations, identified in samples from these wildlife. Cryptosporidium were detected in dirty water and manure, and also from pasture samples where slurry had been spread. On 64% of the farms, identical Cryptosporidium species were detected (mainly C. parvum or C. bovis) from different cattle groups on the farms, although no direct or indirect contact between the groups were recorded, apart from sharing staff. The same Cryptosporidium species were found in cattle, farm wastes and bird samples on the same farms, but rarely, or not at all, present in sheep or rodent samples. The matching of species/subtypes was also related to the proximity of the different sample sources which may indicate a potential transmission route.

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