6 January 2006

Dr Rachel Chalmers
Head, Cryptosporidium Reference Unit / Pennaeth Uned Cyfeiriad
Cryptosporidium
NPHS Microbiology Swansea / Microbioleg GICC Abertawe
Singleton Hospital/ Ysbyty Singleton
Sketty / Sgeti
Swansea / Abertawe
SA2 8QA

Dear Rachel,

Cryptosporidiosis

Thank you for contacting me in December about the guidance resources available to CCDCs and local authorities during outbreaks of cryptosporidiosis. As you know I am unconvinced that the outbreaks during last autumn in south England and north Wales reflect unique or novel circumstances that warrant a significant research programme and for this reason I don’t believe that there is a case for reforming the Expert Group.  However I do agree that the Health Protection Agency and the Inspectorate should work together to refresh and jointly reissue the protocols published in the 3^rd Report of the Expert Group chaired by Sir Ian Bouchier.

I suggest the way to take forward this work is to establish a programme of work under the overall guidance of the recently established HPA/DWI forum.  The Inspectorate is already in discussion with Gordon Nichols about funding a project to document knowledge regarding C.hominis and its relationship to the seasonal rise in cases of infection during the autumn period.  The Inspectorate has also undertaken to review the relevant parts of the Water Supply (Water Quality) Regulations and the water industry has already been required to take the first steps in this process (updating risk assessments and submitting this information to the Inspectorate).  As regards your concern about guidance on swimming pools, I should point out that this is not a matter for the Inspectorate (or Defra), however, we maintain observer status on the Pool Water Treatment Advisory Group and I understand they will shortly be publishing updated guidance documents for pool managers so we can consider how this might best be brought to the attention of local authorities and CCDC’s.

You have mentioned how health professionals rely heavily on protocols published in the 3^rd Report of the Expert Group during outbreak investigations and I would be happy to work with you to identify on how we might take this material, together with the Inspectorate’s guidance to the water industry and produce a practical document that could be published as a monograph and also used to support training events.   I feel certain that the industry would be happy to host a series of events of this nature, perhaps through their existing forums or as an activity supported by Water UK.  I will talk to Pamela Taylor about this.

As you may recall a similar and very effective series of seminars for Health Physicians and Environmental Health Officers was undertaken in the early 1990’s supported by a very useful monograph edited by Dr Ann Dawson and Dr Paul West covering all aspects of the microbiology of drinking water supplies including water related outbreaks. It is my view that we should be looking to a produce an updated edition of this document and to have it supported by the Chief Medical Officer(s) and by the Chief Inspector of Drinking Water jointly.  Furthermore, the monograph could address a much needed link across to “Report 71” which is now published in electronic format by the Environment Agency on behalf of the Standing Committee of Analysts and, as a consequence, the good advice it contains tends to be available to specialists, notably analysts in laboratories, and it no longer reaches the wider audience of engineers and managers in the health service, local authorities and water companies. 

Together with David Drury (Science and Strategy Manager, DWI) I will put in place arrangements to engage one of our consultants as a resource to work on the document if you are able to secure appropriate HPA and DoH support.  I will also be discussing this with the drinking water regulators for Scotland and Northern Ireland so the water and health stakeholders in the rest of the UK are able to contribute to the work.

I look forward to your response in the near future.

Yours sincerely,

Prof. Jeni Colbourne MBE
Chief Inspector of Drinking Water

Cc  Tony Howard, The National Public Health Service for Wales
Christine McCartney,Health Protection Agency
Gordon Nichols, Health Protection Agency
David Drury, Drinking Water Inspectorate