Background

Cyclosporiasis is an intestinal infection caused by a pathogenic protozoan Cyclospora cayetanensis, It is a single cell parasite that is spread by feces or feces-contaminated food and water. The most common symptom is watery diarrhea. Other symptoms may include nausea, loss of appetite, resulting in weight loss, cramping, bloating and fatigue.

This study was a public health report from the North York Public Health Department describing a 1996 outbreak of Cyclosporiasis.

Methodology

The investigation was started by a report for a local physician who treated three family members with diarrhea. The offending organism was identified in stool samples. All three had attended a catered luncheon at a religious institution 11 days earlier. The hostess of the luncheon had contacted 15 guest and learned that many had a similar illness. All of the guests had attended only this luncheon in common. The caterer had prepared the cooked food in an off-sight kitchen. The fresh food was prepared at the institution’s kitchen. There had been a report of the filtration system failure at the mikveh causing the rain water to become brackish around the time of the luncheon. The authors hypothesized that the guest became ill through exposure to the mikveh water.

Methods

Everyone attending the luncheon was interviewed regarding symptoms, food and beverage consumption and demographic data. This included 49 guest, 2 relatives and the 4 catering staff. Everyone was asked to supply a stool sample. The authors also attempted to identify all people who used the mikveh during the month prior to the luncheon or two weeks following the luncheon. Employees of the institution and the attached school were also interviewed. Attendance records were examined to look at patterns of student absenteeism in the time period in question. Hosts of other events who worked with the same caterers were contacted and asked about guest illnesses. The environment was investigated. Samples were taken from the kitchen faucets and water traps, the mikveh, the rainwater collection system, the street water main, the institutional plumbing, and the caterer’s kitchen. Food items served at the luncheon were traced back with the health of public health inspectors.

Results

35 of 49 71%) guests became ill. All age groups (4-76 years) were affected. No one needed to be hospitalized. Incubation for symptoms was 6-13 days after the luncheon. 4 additional people became ill. Two people who ate food that was brought home from the luncheon and 2 of the catering staff. The food source was traced back the strawberry flan that was garnished with fresh berries washed in the kitchen.

Cross contamination was found between the mikveh filtration system and the institutions hot water line.

Discussion

The cluster of food-borne Cyclosporiasis was related to the mikveh filtration system causing contamination of the potable hot water line. It appears to be a human error caused by a plumbing error.

Potential Infections

There are a wide variety of illnesses associated with public swimming pools. Mikveh is different from public pools but theoretically health threats could be similar.

A review of the recent medical literature on swimming pools generated the following list of illnesses.

Adenovirus infections
Cryptosporidiosis
Echovirus infection
Enterovirus infection
Escherichia coli infection
Fungal infections of the feet
Giardia infection
Group A Coxsackie virus
Nonovirus illness
Norwalk gastroenteritis
Ocular and respiratory illnesses
Pseudomonas aeruginosa skin infections

Historical Literature

Weekly Bulletin of the New York Departmentof Health. American Journal of Public Health. (1914) July; 4 (7): 620-626

On page 622 there is a brief report on the sanitation of the ceremonial baths of the Jewish synagogues. A bacteriologic evaluation of the pools conducted by Dr. Manheimer of Colombia University showed there to be a “serious menace” to the health of the people using the baths.

THOMAS SCHLICH; Medicalization and Secularization: the Jewish Ritual Bath as a Problem of Hygiene (Germany 1820s–1840s), Social History of Medicine, Volume 8, Issue 3, 1 December 1995, Pages 423–442, https://doi.org/10.1093/shm/8.3.423

Abstract Summary

In the 1820s and 1840s the Jewish Ritual bath in Germany was criticized on the basis of medical arguments. Associated with this critique were demands for a change in the traditional Jewish way of life in general, especially as concerning the Jewish religion. The new role assigned to religion can be seen as part of a process of ‘secularization’. The criticism of the ritual bath was justified by medical arguments and entailed a demand for an extension of the medical sphere of competence, and thus formed part of a development described as ‘medicalization’. An historical investigation of the debate on the Jewish ritual bath illuminates the way in which medicalization and secularization were different aspects of the same process of the attribution of complementary circumscribed spheres of medicine and religion.