Waterborne cryptosporidiosis threat addressed.

and further research is needed to find cost-effective ways to control the spread of vancomycin resistance, HICPAC strongly encourages hospitals to develop their own institution-specific plans, which should stress the following elements: 1) prudent vancomy-cin use by clinicians, 2) education of hospital staff regarding vancomycin resistance, 3) early detection and prompt reporting of vancomycin resistance in enterococci and other gram-positive microorganisms by the hospital microbiology laboratory, and 4) immediate implementation of appropriate infection-control measures to prevent person-to-person transmission of VRE. The recommendations were developed by HICPAC's Subcommittee on the Prevention and Control of Antimicrobial-Resistant Microorganisms in Hospitals and subject-matter experts and representatives of the American Hospital Association, Waterborne Cryptosporidiosis Threat Addressed Cryptosporidium parvum was first recognized as a cause of human illness in 1976. From 1976 to 1982, the disease was reported rarely in the United States, primarily among the immunocompromised. In 1982, the number of reported cases began to increase dramatically along with the number of HIV-infected persons; outbreaks among immunocompetent populations also were reported. Recent municipal water-borne outbreaks of cryptosporidiosis in Texas (1984), Georgia (1987), and Oregon (1992), and a massive outbreak in Wisconsin in 1993 that affected more than 400,000 persons have raised awareness about the waterborne transmission of cryptosporidiosis. Since 1993, several smaller cryptosporidiosis outbreaks were reported in the United States: two were related to drinking water, six were linked to recreational water, and one was foodborne. Cryptosporidiosis is caused by ingestion of the environmentally tough oocysts of the protozoan parasite C. parvum, an intracellular organism that can replicate in the gut epithelial cells of most mammals. Its oocyst is extremely resistant to chlorine, which is commonly used to treat municipal water. In healthy persons, the disease lasts 1 to 2 weeks and can have considerable economic impact through absenteeism of those affected. In the immunocom-promised, the disease is often severe, lifelong, and life-threatening. No effective therapy is available. The magnitude of the 1993 Wisconsin outbreak and its association with a municipal water plant operating within existing state and federal regulations underlined the need for improved surveillance and coordination among public health agencies and spurred efforts for regulatory standards for Crypto-sporidium in drinking water. During 1995-1996, the U.S. Environmental Protection Agency (EPA) intends to implement the Information Collection Rule, which requires utilities that serve populations of 100,000 or more and use surface water (lakes, rivers, streams) to test that water routinely for Crypto-sporidium oocysts. If oocysts …