A large Cryptosporidium parvum outbreak associated with a lamb-feeding event at a commercial farm in South Wales, March-April 2024: a retrospective cohort study.

Cryptosporidium parvum is a well-established cause of gastrointestinal illness in both humans and animals and often causes outbreaks at animal contact events, despite the availability of a code of practice that provides guidance on the safe management of these events. We describe a large C. parvum outbreak following a lamb-feeding event at a commercial farm in Wales in 2024, alongside findings from a cohort study to identify high-risk exposures. Sixty-seven cases were identified, 57 were laboratory-confirmed C. parvum, with similar genotypes. Environmental investigations found a lack of adherence to established guidance. The cohort study identified 168 individuals with cryptosporidiosis-like illness from 540 exposure questionnaires (distributed via email to 790 lead bookers). Cases were more likely to have had closer contact with lambs (odds ratio (OR) kissed lambs = 2.4, 95% confidence interval (95% CI): 1.2-4.8). A multivariable analysis found cases were more likely to be under 10 years (adjusted OR (aOR) = 4.5, 95% CI: 2.0-10.0) and have had visible faeces on their person (aOR = 3.6, 95% CI: 2.1-6.2). We provide evidence that close contact at lamb-feeding events presents an increased likelihood of illness, suggesting that farms should limit animal contact at these events and that revisions to established codes of practice may be necessary. Enhancing risk awareness among farmers and visitors is needed, particularly regarding children.