{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T22:08:10Z","timestamp":1789164490188,"version":"build-2803163510"},"reference-count":46,"publisher":"Microbiology Society","issue":"6","license":[{"start":{"date-parts":[[2023,6,7]],"date-time":"2023-06-07T00:00:00Z","timestamp":1686096000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,7]]},"abstract":"<jats:p>\n                  <jats:bold>Introduction.<\/jats:bold> In England and Wales, cryptosporidiosis cases peak in spring and autumn, associated with zoonotic\/environmental exposures (<jats:italic>Cryptosporidium parvum,<\/jats:italic> spring\/autumn) and overseas travel\/water-based activities (<jats:italic>Cryptosporidium hominis,<\/jats:italic> autumn). Coronavirus disease 2019 (COVID-19) restrictions prevented social mixing, overseas travel and access to venues (swimming pools\/restaurants) for many months, potentially increasing environmental exposures as people sought alternative countryside activities.<\/jats:p>\n               <jats:p>\n                  <jats:bold>Hypothesis.<\/jats:bold> COVID-19 restrictions reduced incidence of <jats:italic>C. hominis<\/jats:italic> cases and potentially increased incidence of <jats:italic>C. parvum<\/jats:italic> cases.<\/jats:p>\n               <jats:p>\n                  <jats:bold>Aim.<\/jats:bold> To inform\/strengthen surveillance programmes, we investigated the impact of COVID-19 restrictions on the epidemiology of <jats:italic>C. hominis<\/jats:italic> and <jats:italic>C. parvum<\/jats:italic> cases.<\/jats:p>\n               <jats:p>\n                  <jats:bold>Methodology.<\/jats:bold> Cases were extracted from the Cryptosporidium Reference Unit (CRU) database (1 January 2015 to 31 December 2021). We defined two periods for pre- and post-COVID-19 restrictions implementation, corresponding to before and after the first UK-wide lockdown on 23 March 2020. We conducted a time series analysis, assessing differences in <jats:italic>C. parvum<\/jats:italic> and <jats:italic>C. hominis<\/jats:italic> incidence, trends and periodicity between these periods.<\/jats:p>\n               <jats:p>\n                  <jats:bold>Results.<\/jats:bold> There were 21\u202f304\u2009cases (<jats:italic>C. parvum<\/jats:italic>=12\u202f246; <jats:italic>C. hominis<\/jats:italic>=9058). Post-restrictions implementation incidence of <jats:italic>C. hominis<\/jats:italic> dropped by 97.5\u200a% (95\u200a% CI: 95.4\u201398.6\u200a%; <jats:italic>P<\/jats:italic>&lt;0.001). The decreasing incidence trend pre-restrictions was not observed post-restrictions implementation due to lack of cases. No periodicity change was observed post-restrictions implementation. There was a strong social gradient; there was a higher proportion of cases in deprived areas. For <jats:italic>C. parvum<\/jats:italic>, post-restrictions implementation incidence fell by 49.0\u200a% (95\u200a% CI: 38.4\u201358.3\u200a%; <jats:italic>P<\/jats:italic>&lt;0.001). There was no pre-restrictions incidence trend but an increasing incidence trend post-restrictions implementation. A periodicity change was observed post-restriction implementation, peaking 1\u2009week earlier in spring and 2\u2009weeks later in autumn. The social gradient was the inverse of that for <jats:italic>C. hominis<\/jats:italic>. Where recorded, 22\u200a% of <jats:italic>C. hominis<\/jats:italic> and 8\u200a% of <jats:italic>C. parvum<\/jats:italic> cases had travelled abroad.<\/jats:p>\n               <jats:p>\n                  <jats:bold>Conclusion.<\/jats:bold>\n                  <jats:italic>C. hominis<\/jats:italic> cases almost entirely ceased post-restrictions implementation, reinforcing that foreign travel seeds infections. <jats:italic>C. parvum<\/jats:italic> incidence fell sharply but recovered post-restrictions implementation, consistent with relaxation of restrictions. Future exceedance reporting for <jats:italic>C. hominis<\/jats:italic> should exclude the post-restriction implementation period but retain it for <jats:italic>C. parvum<\/jats:italic> (except the first 6\u2009weeks post-restrictions implementation). Infection prevention and control advice should be improved for people with gastrointestinal illness (GI) symptoms to ensure hand hygiene and swimming pool avoidance.<\/jats:p>","DOI":"10.1099\/jmm.0.001693","type":"journal-article","created":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T09:19:00Z","timestamp":1686215940000},"source":"Crossref","is-referenced-by-count":13,"title":["Impact of the COVID-19 restrictions on the epidemiology of Cryptosporidium spp. in England and Wales, 2015\u20132021: a time series analysis"],"prefix":"10.1099","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9175-8287","authenticated-orcid":false,"given":"James P.","family":"Adamson","sequence":"first","affiliation":[{"name":"UK Field Epidemiology Training Programme, UK Health Security Agency, London, UK"},{"name":"Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9309-7096","authenticated-orcid":false,"given":"Rachel M.","family":"Chalmers","sequence":"additional","affiliation":[{"name":"Swansea University Medical School, Swansea University, Swansea, UK"},{"name":"Cryptosporidium Reference Unit , Public Health Wales, Swansea, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2426-5893","authenticated-orcid":false,"given":"Daniel Rh.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1024-2276","authenticated-orcid":false,"given":"Kristin","family":"Elwin","sequence":"additional","affiliation":[{"name":"Cryptosporidium Reference Unit , Public Health Wales, Swansea, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6594-2408","authenticated-orcid":false,"given":"Guy","family":"Robinson","sequence":"additional","affiliation":[{"name":"Swansea University Medical School, Swansea University, Swansea, UK"},{"name":"Cryptosporidium Reference Unit , Public Health Wales, Swansea, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7764-554X","authenticated-orcid":false,"given":"Alicia","family":"Barrasa","sequence":"additional","affiliation":[{"name":"UK Field Epidemiology Training Programme, UK Health Security Agency, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"345","reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1186\/s13071-020-04308-7"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1016\/j.parint.2019.101979"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms8111665"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0195834"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.7150\/jca.42393"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.3201\/eid1107.040889"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268810001688"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-022-07086-y"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2012.11.023"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.15.1.145-154.2002"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30283-3"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.1186\/s13071-020-3906-9"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.1186\/s13071-019-3354-6"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES2013.18.35.20565"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.1016\/j.fawpar.2022.e00151"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-007-9179-1"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268809990197"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.1016\/j.vetpar.2004.09.002"},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.3201\/eid1007.030582"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268810001688"},{"key":"R21","article-title":"Overseas residents in the UK and UK residents abroad: 2020","author":"Osborn","year":"2021"},{"key":"R22","article-title":"Holiday-related search terms with the highest year-over-year growth following the COVID-19 lockdown in the United Kingdom (UK) in July 2020","year":"2021"},{"key":"R23","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-044067"},{"key":"R24","article-title":"People and Nature Survey: How has COVID-19 changed the way we engage with nature?","year":"2022"},{"key":"R25","article-title":"How has lockdown changed our relationship with nature? 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