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Volume 23, Number 10—October 2017
Research

Economic Assessment of Waterborne Outbreak of Cryptosporidiosis

Aksana Chyzheuskaya, Martin Cormican, Raghavendra Srivinas, Diarmuid O’Donovan, Martina Prendergast, Cathal O’Donoghue, and Dearbháile MorrisComments to Author 
Author affiliations: National University of Ireland Galway, Galway, Ireland (A. Chyzheuskaya, M. Cormican, R. Srivinas, D. O’Donovan, M. Prendergast, D. Morris); Health Service Executive, Galway (M. Cormican, D. O’Donovan); Teagasc, Athenry, Ireland (C. O’Donoghue)

Main Article

Table 1

Description of costs included in economic assessment of waterborne outbreak of cryptosporidiosis, Galway, Ireland, 2007*

Characteristic Value and assumption Source
Private sector
No. households 45,160 (17)
Cost of extra bottled water 48% reported buying bottled water; 80% increased bottled water use from 3.2 L to 16 L/wk; 20% increased use from 3.2 L to 20 L/wk; €0.50/L HSE, 2007; estimated bottled water retail price
Cost of boiling water Use of boiled water/household: drinking >12%, 2.1L/adult/d, 1 L/child/d; cooking >30%, 2 L/household/d; dishwashing >43%, 10 L/household/d; hygiene >14% 250 mL/person/d; €0.01/L (15)
Sick persons
No. reported 242 HSE, 2007
No. not reported 498, 71% not reported (16); HSE, 2007
GP visits €50/visit, 1 GP visit/confirmed case; all reported patients consulted GP; GMS cost €50.46 (assumed to be €50) HSE primary care reimbursement service, 2008
Self-medication €9.26 for antidiarrheal medication; €6.99 for ORS (1 pack); 30% self-medication for reported; 17.6% self-medication for not reported Pharmacy prices; (7)
Loss of income €122.85/d; 5 d of work missed (all nonhospitalized reported patients and 17.4% of not reported patients); 10 d of work missed for hospitalized patients Central Statistics Office, 2007; HSE, 2007
Loss of income for caregivers €122.85/day; children <15 and persons >65 years of age (n = 195); 1 caregiver took 5 d off from work; average 10 d off from work for hospitalized patients Central Statistics Office, 2007; (4); HSE, 2007
Cost of missing college/school Reported: €69.20/student/d; 5 d missed (10 d for hospitalized patients); not reported: 19% took time off from school/college; average 5 d missed, €69.20/student/d Central Statistics Office, 2007; (16); HSE, 2007
Cost to businesses
Productivity loss €134/person/d; average 5 d; 10 d for hospitalized persons and caregivers Health and Safety Times, 2011
Hotels, B and Bs, hostels
Extra water 4.2 L/room/d; 2.1 L/person/day (18)
Cancellations 13% cancelation rate; 57% occupancy rate IPSOS Mori survey
Other assumptions No. businesses: 70 hotels, 134 B and B, and 18 hostels; no. rooms: 79/hotel, 5/B and B, and 134/hostel; price: €66 hotels, €65 B and B, and €17 hostels
Care industry†
Bottled water 2.1 L/person/d (18)
Boiled water 1.5 L/person/d
Other factors 18 nursing homes in boil water–alert area; average no. residents 41, total no. residents for analysis 742; 168 nurseries/day care centers and 19 child minders; assume 3 children/child minder; average 29 children/nursey or day care center; no. children in nurseries or day care centers 4,929
Public sector costs, €
Galway City Council 3,388,840.33 Galway City Council
Galway County Council 2,472,837 Galway County Council
EPA 20,000 EPA
HSE
Emergency department cost 100; 1.3% of reported patients visited ED           HSE, (14)
5,810 extra species detection tests 46.06 University Hospital Galway (no. laboratory tests); commercial service provider (cost)
3,000 extra fecal culture tests 59.58 University Hospital Galway (no. laboratory tests); commercial service provider (cost)
Hospital admissions 753/person/d; 35% admitted to hospital for 10 d HSE, 2007
Response team (representatives from all public sector categories)
Opportunity cost of labor 356/consultant/meeting; 16 persons; 28 meetings IPS

*B and Bs, bed and breakfast; ED, emergency department; EPA, Environmental Protection Agency of Ireland; GMS, general medical scheme; GP, general practitioner; HSE, Health Service Executive; IPS, Institute of Public Administration; ORS, oral rehydration solution.
†Nursing homes, nurseries, and day care centers.

Main Article

References
  1. Dietz  V, Vugia  D, Nelson  R, Wicklund  J, Nadle  J, McCombs  KG, et al. Active, multisite, laboratory-based surveillance for Cryptosporidium parvum. Am J Trop Med Hyg. 2000;62:36872. DOIPubMedGoogle Scholar
  2. Mead  PS, Slutsker  L, Dietz  V, McCaig  LF, Bresee  JS, Shapiro  C, et al. Food-related illness and death in the United States. Emerg Infect Dis. 1999;5:60725. DOIPubMedGoogle Scholar
  3. Vijgen  SM, Mangen  MJ, Ortbeek  LM, van Duijnhoven  YT, Havelaar  AH. Disease burden and related costs of cryptosporidiosis and giardiasis in the Netherlands. RIVM report 330081001, 2007 [cited 2016 Aug 9]. http://www.researchgate.net/publication/27453554_Disease_burden_and_related_costs_of_cryptosporidiosis_and_giardiasis_in_the_Netherlands
  4. Garvey  P, McKeown  P. Epidemiology of cryptosporidiosis in Ireland, 2007. Health Protection Surveillance Centre. Annual report 2007. 2008 [cited 2016 Aug 9]. http://www.hpsc.ie/A-Z/Gastroenteric/Cryptosporidiosis/Publications/EpidemiologyofCryptosporidiosisinIrelandAnnualReports/File,3475,en.pdf
  5. Health Protection Surveillance Centre. HPSC annual epidemiological reports on cryptosporidiosis in Ireland [Cited 2016 Aug 9]. http://www.hpsc.ie/A-Z/Gastroenteric/Cryptosporidiosis/Publications/EpidemiologyofCryptosporidiosisinIrelandAnualReports/
  6. Callaghan  M, Cormican  M, Prendergast  M, Pelly  H, Cloughley  R, Hanahoe  B, et al. Temporal and spatial distribution of human cryptosporidiosis in the west of Ireland 2004-2007. Int J Health Geogr. 2009;8:64. DOIPubMedGoogle Scholar
  7. Corso  PS, Kramer  MH, Blair  KA, Addiss  DG, Davis  JP, Haddix  AC. Cost of illness in the 1993 waterborne Cryptosporidium outbreak, Milwaukee, Wisconsin. Emerg Infect Dis. 2003;9:42631. DOIPubMedGoogle Scholar
  8. Bridge  JW, Oliver  DM, Chadwick  D, Godfray  HC, Heathwaite  AL, Kay  D, et al. Engaging with the water sector for public health benefits: waterborne pathogens and diseases in developed countries. Bull World Health Organ. 2010;88:8735. DOIPubMedGoogle Scholar
  9. Jameson  PB, Hung  YT, Kuo  CY, Bosela  PA. Cryptosporidium outbreak (water treatment failure): North Battleford, Saskatchewan, spring, 2001. J Perform Constr Facil. 2008;22:3427. DOIGoogle Scholar
  10. Pelly  H, Cormican  M, O’Donovan  D, Chalmers  RM, Hanahoe  B, Cloughley  R, et al. A large outbreak of cryptosporidiosis in western Ireland linked to public water supply: a preliminary report. Euro Surveill. 2007;12:E070503.3.PubMedGoogle Scholar
  11. Halonen  JI, Kivimäki  M, Oksanen  T, Virtanen  P, Virtanen  MJ, Pentti  J, et al. Waterborne outbreak of gastroenteritis: effects on sick leaves and cost of lost workdays. PLoS One. 2012;7:e33307. DOIPubMedGoogle Scholar
  12. Hutton  G, Haller  L, Bartram  J. Global cost-benefit analysis of water supply and sanitation interventions. J Water Health. 2007;5:481502. DOIPubMedGoogle Scholar
  13. Safe Drinking Water Foundation. Cost-benefit analysis: treat the illness or treat the water? [cited 2016 Aug 9]. http://www.safewater.org/PDFS/resourcesknowthefacts/CostBenefit_Analysis_Treat.pdf
  14. Ailes  E, Budge  P, Shankar  M, Collier  S, Brinton  W, Cronquist  A, et al. Economic and health impacts associated with a Salmonella Typhimurium drinking water outbreak-Alamosa, CO, 2008. PLoS One. 2013;8:e57439. DOIPubMedGoogle Scholar
  15. Fitzgerald  M, Scallen  E, Collins  C, Crowley  D, Daly  L, Devine  M, et al. Results of the first population based telephone survey of acute gastroenteritis in Northern Ireland and the Republic of Ireland. Euro Surveill. 2004;8:2456.
  16. Safefood. Acute gastroenteritis in Ireland: a telephone survey. Research report September 2003 [cited 2016 Aug 9]. http://www.safefood.eu/SafeFood/media/SafeFoodLibrary/Documents/Publications/Research%20Reports/Acute_Gastroenteritis.pdf
  17. O’Donoghue  C, Ballas  D, Clarke  G, Hynes  S, Morrissey  K. Spatial microsimulation for rural policy analysis: Berlin: Springer; 2012.
  18. The Sphere Project. The sphere handbook: humanitarian charter and minimum standards in humanitarian response; 2011 [cited 2016 Aug 9] http://www.sphereproject.org/resources/?search=1&keywords=&language=English&category=22&subcat-22=23&subcat-29=0&subcat-31=0&subcat-35=0&subcat-49=0
  19. Garvey  M, Farrell  H, Cormican  M, Rowan  N. Investigations of the relationship between use of in vitro cell culture-quantitative PCR and a mouse-based bioassay for evaluating critical factors affecting the disinfection performance of pulsed UV light for treating Cryptosporidium parvum oocysts in saline. J Microbiol Methods. 2010;80:26773. DOIPubMedGoogle Scholar
  20. Zimmer  JL, Slawson  RM, Huck  PM. Inactivation and potential repair of Cryptosporidium parvum following low- and medium-pressure ultraviolet irradiation. Water Res. 2003;37:351723. DOIPubMedGoogle Scholar
  21. Widerström  M, Schönning  C, Lilja  M, Lebbad  M, Ljung  T, Allestam  G, et al. Large outbreak of Cryptosporidium hominis infection transmitted through the public water supply, Sweden. Emerg Infect Dis. 2014;20:5819. DOIPubMedGoogle Scholar

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