{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T14:40:50Z","timestamp":1776436850919,"version":"3.51.2"},"reference-count":26,"publisher":"IWA Publishing","issue":"5","content-domain":{"domain":["iwaponline.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>We investigated sick leave from work, studies, preschool, and kindergarten occurring between 1 November 2010 and 31 January 2011 and associated with a waterborne outbreak of diarrhea caused by Cryptosporidium hominis in late November 2010 in \u00d6stersund, Sweden with 45.2% of 60,000 residents being symptomatic. A questionnaire defining acute watery diarrhoea and\/or \u22653 diarrhea episodes\/day as cryptosporidiosis was sent to 1,508 residents in late January 2011 (response rate 69.2%). Among adults aged 18\u201360 years, 24.0% took sick leave for a mean of 4.6 (SD \u00b1 4.0) days due to cryptosporidiosis, and an additional 10.6% were absent from work a mean of 4.0 (\u00b12.2) days to care for symptomatic children. Among children (aged \u226417 years), 35.0% stayed home sick from kindergarten\/preschool or school\/university for a mean of 5.2 (\u00b13.8) days resulting in 5.1 (\u00b14.4) days of absence from work per sick child shared between parents\/guardians. The estimated total number of sick leave days was 50,000 for adults and 20,700 for children, with an estimated direct cost of \u20ac7 million for employers. The potential impact on society of sick leave caused by waterborne diseases must be considered in decisions regarding the quality of drinking water.<\/jats:p>","DOI":"10.2166\/wh.2017.311","type":"journal-article","created":{"date-parts":[[2017,3,21]],"date-time":"2017-03-21T00:10:20Z","timestamp":1490055020000},"page":"704-710","update-policy":"https:\/\/doi.org\/10.2166\/iwapcrossmarkpolicypage","source":"Crossref","is-referenced-by-count":11,"title":["Sick leave due to diarrhea caused by contamination of drinking water supply with Cryptosporidium hominis in Sweden: a retrospective study"],"prefix":"10.2166","volume":"16","author":[{"given":"Frida","family":"Ridderstedt","sequence":"first","affiliation":[{"name":"Uppsala University, Uppsala, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Micael","family":"Widerstr\u00f6m","sequence":"first","affiliation":[{"name":"Department of Clinical Microbiology, Unit of Communicable Disease Control and Prevention \u2013 \u00d6stersund, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johan","family":"Lindh","sequence":"first","affiliation":[{"name":"Department of Cell and Molecular Biology, BMC, Uppsala University, Uppsala, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikael","family":"Lilja","sequence":"first","affiliation":[{"name":"Department of Public Health and Clinical Medicine, Unit of Clinical Research Center \u2013 \u00d6stersund, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"945","published-online":{"date-parts":[[2017,3,20]]},"reference":[{"issue":"2","key":"2020032616094056700_JWH-D-16-00311C1","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1017\/S0950268813001088","article-title":"Syndromic surveillance for local outbreak detection and awareness: evaluating outbreak signals of acute gastroenteritis in telephone triage, web-based queries and over-the-counter pharmacy sales","volume":"142","year":"2014","journal-title":"Epidemiol. Infect."},{"issue":"20","key":"2020032616094056700_JWH-D-16-00311C2","doi-asserted-by":"crossref","first-page":"6603","DOI":"10.1016\/j.watres.2011.10.013","article-title":"Waterborne transmission of protozoan parasites: review of worldwide outbreaks \u2013 an update 2004\u20132010","volume":"45","year":"2011","journal-title":"Water Res."},{"issue":"1","key":"2020032616094056700_JWH-D-16-00311C3","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1128\/CMR.00076-12","article-title":"Cryptosporidium pathogenicity and virulence","volume":"26","year":"2013","journal-title":"Clin. Microbiol. Rev."},{"issue":"3","key":"2020032616094056700_JWH-D-16-00311C4","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1111\/j.1365-2672.2006.03193.x","article-title":"Presence of Giardia cysts and Cryptosporidium oocysts in drinking water supplies in northern Spain","volume":"102","year":"2007","journal-title":"J. Appl. Microbiol."},{"issue":"1","key":"2020032616094056700_JWH-D-16-00311C5","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.exppara.2009.02.003","article-title":"Minireview: clinical cryptosporidiosis","volume":"124","year":"2010","journal-title":"Exp. Parasitol."},{"issue":"4","key":"2020032616094056700_JWH-D-16-00311C6","doi-asserted-by":"crossref","first-page":"426","DOI":"10.3201\/eid0904.020417","article-title":"Cost of illness in the 1993 waterborne Cryptosporidium outbreak, Milwaukee, Wisconsin","volume":"9","year":"2003","journal-title":"Emerg. Infect. Dis."},{"issue":"19","key":"2020032616094056700_JWH-D-16-00311C7","doi-asserted-by":"crossref","first-page":"5799","DOI":"10.1128\/AEM.00870-13","article-title":"Occurrence of waterborne pathogens and Escherichia coli at offshore drinking water intakes in Lake Ontario","volume":"79","year":"2013","journal-title":"Appl. Environ. Microbial."},{"issue":"21","key":"2020032616094056700_JWH-D-16-00311C8","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1056\/NEJM198905253202103","article-title":"Large community outbreak of cryptosporidiosis due to contamination of a filtered public water supply","volume":"320","year":"1989","journal-title":"N. Engl. J. Med."},{"issue":"3","key":"2020032616094056700_JWH-D-16-00311C9","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1017\/S0950268802006805","article-title":"A community survey of self-reported gastroenteritis undertaken during an outbreak of cryptosporidiosis strongly associated with drinking water after much press interest","volume":"128","year":"2002","journal-title":"Epidemiol. Infect."},{"issue":"4","key":"2020032616094056700_JWH-D-16-00311C10","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1086\/422649","article-title":"Health sequelae of human cryptosporidiosis in immunocompetent patients","volume":"39","year":"2004","journal-title":"Clin. Infect. Dis."},{"issue":"9888","key":"2020032616094056700_JWH-D-16-00311C11","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/S0140-6736(13)60844-2","article-title":"Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study","volume":"382","year":"2013","journal-title":"Lancet"},{"key":"2020032616094056700_JWH-D-16-00311C12","unstructured":"Lindberg\n            A.\n          , LusuaJ. & NevhageB.2011Cryptosporidium i \u00d6stersund vintern 2010\/2011 \u2013 Konsekvenser och kostnader av ett stort vattenburet sjukdomsutbrott (Cryptosoridium in \u00d6stersund winter 2010\/2011 \u2013 consequenses and costs from a large waterborne outbrake).Totalf\u00f6rsvarets Forskningsinstitut, Sweden. Report number FOI-R-3376-SE."},{"issue":"3","key":"2020032616094056700_JWH-D-16-00311C13","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1056\/NEJM199407213310304","article-title":"A massive outbreak in Milwaukee of Cryptosporidium infection transmitted through the public water supply","volume":"331","year":"1994","journal-title":"N. Engl. J. Med."},{"issue":"1","key":"2020032616094056700_JWH-D-16-00311C14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2166\/wh.2015.131","article-title":"Removal of Cryptosporidium by wastewater treatment processes: a review","volume":"14","year":"2016","journal-title":"J. Water Health"},{"issue":"4","key":"2020032616094056700_JWH-D-16-00311C15","doi-asserted-by":"crossref","first-page":"573","DOI":"10.2166\/wh.2007.007","article-title":"First investigations into the prevalence of Cryptosporidium and Giardia spp. in Hungarian drinking water","volume":"5","year":"2007","journal-title":"J. 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Public Health"},{"key":"2020032616094056700_JWH-D-16-00311C20","unstructured":"Smittskyddsinstitutet\n          2011\n          Cryptosporidium i \u00d6stersund - Smittskyddsinstitutets arbete med det dricksvattenburna utbrottet i \u00d6stersund 2010\u20132011 (How the Swedish Institute for Communicable Disease Control worked with the waterborne outbreak in \u00d6stersund 2010\u20132011)\n          .\n          Smittskyddsinstitutet, Sweden. Report number 2011-15-4."},{"key":"2020032616094056700_JWH-D-16-00311C21","author":"Statistics Sweden","year":"2015"},{"key":"2020032616094056700_JWH-D-16-00311C22","author":"Statistics Sweden","year":"2016"},{"key":"2020032616094056700_JWH-D-16-00311C23","author":"Swedish Pension Agency","year":"2016"},{"key":"2020032616094056700_JWH-D-16-00311C24","author":"Swedish Social Insurance Agency","year":"2016"},{"issue":"4","key":"2020032616094056700_JWH-D-16-00311C25","doi-asserted-by":"crossref","first-page":"581","DOI":"10.3201\/eid2004.121415","article-title":"A large outbreak of Cryptosporidium hominis infection in Sweden transmitted through the public water supply","volume":"20","year":"2014","journal-title":"Emerg. Infect. 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