The Basics

Since late 2005, the AFA Air Safety, Health and Security Department has learned that several flight attendants across the country are suffering from gastro-intestinal diarrheal diseases possibly caused by microscopic parasites of the genus Cryptosporidium.

A fact sheet from the Centers for Disease Control and Prevention (CDC), which can be posted in crew rooms, states that the most common symptom of Cryptosporidiosis, or crypto, is watery diarrhea. Other symptoms include dehydration, weight loss, stomach cramps or pain, fever, nausea or vomiting. Also, some people with crypto will have no symptoms at all. Symptoms generally begin 2 to 10 days (average 7 days) after becoming infected with the parasite. In persons with healthy immune systems, symptoms usually last about 1 to 2 weeks. The symptoms may go in cycles in which you may seem to get better for a few days, then feel worse again before the illness ends.

People most likely to become infected with Cryptosporidium include parents of infected children, international travelers, swimmers who swallow water while swimming in swimming pools, lakes, rivers, ponds, and streams, people who drink from shallow, unprotected wells, and people who swallow water from contaminated sources. Contaminated water includes water that has not been boiled or filtered.

Although Crypto can infect all people, some groups are more likely to develop more serious illness, including:

§         Those with severely weakened immune systems should talk to their health care provider for additional guidance, and/or call the CDC AIDS HOTLINE toll-free at 1-800-342-2437, and/or go to the CDC fact sheet Preventing Cryptosporidiosis: A Guide for People with Compromised Immune Systems.

§         Young children and pregnant women may be more susceptible to the dehydration resulting from diarrhea and should drink plenty of fluids while ill.

Treatment for cryptosporidiosis includes a new drug, nitazoxanide, which has been approved for treatment of diarrhea caused by Cryptosporidium in people with healthy immune systems. Consult with a health care provider for more information. For diarrhea, drink plenty of fluids to prevent dehydration. People who are in poor health or who have a weakened immune system are at higher risk for more severe and more prolonged illness, and should see their health care provider for treatment strategies.

How to Avoid Cryptosporidiosis

To avoid becoming infected with Cryptosporidium, flight attendants should wash hands thoroughly with soap and water, after using the toilet and before handling or eating food. They should also avoid water that might be contaminated, should not swallow recreational water, should not drink untreated water from shallow wells, lakes, rivers, springs, ponds, and streams, and should not use untreated ice or drinking water when traveling in countries where the water supply might be unsafe. Also, do not rely on chemicals to disinfect water and kill Cryptosporidium. Because it has a thick outer shell, this particular parasite is highly resistant to disinfectants such as chlorine and iodine.

Also, avoid food that might be contaminated:

§         Wash and/or peel all raw vegetables and fruits before eating.

§         Use safe, uncontaminated water to wash all food that is to be eaten raw.

§         Avoid eating uncooked foods when traveling in countries with minimal water treatment and sanitation systems.

How to Avoid Spreading Cryptosporidiosis

Cryptosporidium can be very contagious - flight attendants diagnosed with Crypto should follow these guidelines to avoid spreading the disease to others:

§         Wash hands with soap and water after using the toilet, changing diapers, and before eating or preparing food.

§         Do not swim in recreational water (pools, hot tubs, lakes or rivers, the ocean, etc.) for at least 2 weeks after diarrhea stops. Cryptosporidium can be passed in stool and contaminate water for several weeks after symptoms have ended.

§         Avoid fecal exposure during sexual activity.

AFA activity and hot topics

To determine possible causes and the extent of this disease outbreak, we are encouraging symptomatic flight attendants to complete and return a short, two-page complaint form (MSWord or PDF format) and privacy policy disclosure form (MSWord or PDF format). The complaint form was adapted by AFA from questions included in a survey developed by the U.S. Environmental Protection Agency Airline Water Supplies program.  Flight attendants who have been diagnosed with crypto, or who have had watery diarrhea and suspect the cause may be work-related (i.e., contracted while working, traveling for work, or staying at hotels because of work), should print out and complete these forms, then return them to the Air Safety, Health and Security Department by fax, 202-434-1105, or by mail to AFA-CWA Air Safety, Health and Security Dept., 501 Third Street NW 2^nd Floor, Washington, DC 20001.

The information you provide will be used by AFA to support studies of gastrointestinal disease outbreaks linked to water quality or sanitation on board aircraft. They are also crucial in helping the AFA International Office make a case for stricter federal regulation of sanitation and water quality on board aircraft.