Skip to main content Accessibility help
×
Home

Outbreak of giardiasis associated with a community drinking-water source

  • E. R. DALY (a1), S. J. ROY (a2), D. D. BLANEY (a1) (a3), J. S. MANNING (a1), V. R. HILL (a3), L. XIAO (a3) and J. W. STULL (a1) (a4)...

Summary

Giardiasis is a common waterborne gastrointestinal illness. In 2007, a community giardiasis outbreak occurred in New Hampshire, USA. We conducted a cohort study to identify risk factors for giardiasis, and stool and environmental samples were analysed. Consuming tap water was significantly associated with illness (risk ratio 4·7, 95% confidence interval 1·5–14·4). Drinking-water samples were coliform-contaminated and a suspect Giardia cyst was identified in a home water filter. One well was coliform-contaminated, and testing indicated that it was potentially under the influence of surface water. The well was located 12·5 m from a Giardia-contaminated brook, although the genotype differed from clinical specimens. Local water regulations require well placement at least 15 m from surface water. This outbreak, which caused illness in 31 persons, represents the largest community drinking-water-associated giardiasis outbreak in the USA in 10 years. Adherence to well placement regulations might have prevented this outbreak.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Outbreak of giardiasis associated with a community drinking-water source
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Outbreak of giardiasis associated with a community drinking-water source
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Outbreak of giardiasis associated with a community drinking-water source
      Available formats
      ×

Copyright

Corresponding author

*Author for correspondence: E. R. Daly, MPH, Communicable Disease Surveillance Section, New Hampshire Department of Health and Human Services, 29 Hazen Drive, Concord, NH 03301-6504, USA. (Email: erdaly@dhhs.state.nh.us)

References

Hide All
1.Kappus, KD, et al. Intestinal parasitism in the United States: update on a continuing problem. American Journal of Tropical Medicine and Hygiene 1994; 50: 705713.
2.Centers for Disease Control and Prevention. Giardiasis surveillance – United States, 2003–2005. Morbidity and Mortality Weekly Report 2007; 56: 1118.
3.Birkhead, G, Vogt, RL. Epidemiologic surveillance for endemic Giardia lamblia infection in Vermont: the roles of waterborne and person-to-person transmission. American Journal of Epidemiology 1989; 129: 762768.
4.Isaac-Renton, JL, Philion, JJ. Factors associated with acquiring giardiasis in British Columbia residents. Canadian Journal of Public Health 1992; 83: 155158.
5.Gagnon, F, et al. Risk of giardiasis associated with water supply in an endemic context. International Journal of Environmental Health Research 2006; 16: 349359.
6.Chute, CG, Smith, RP, Baron, JA. Risk factors for endemic giardiasis. American Journal of Public Health 1987; 77: 585587.
7.Hoque, ME, et al. Children at risk of giardiasis in Auckland: a case-control analysis. Epidemiology and Infection 2003; 131: 655662.
8.Stuart, JM, et al. Risk factors for sporadic giardiasis: a case-control study in southwestern England. Emerging Infectious Diseases 2003; 9: 229233.
9.Centers for Disease Control and Prevention. Surveillance for waterborne-disease outbreaks – United States, 1997–1998. Morbidity and Mortality Weekly Report 2000; 49: 145.
10.Centers for Disease Control and Prevention. Surveillance for waterborne-disease outbreaks- United States, 1999–2000. Morbidity and Mortality Weekly Report 2002; 51: 128.
11.Centers for Disease Control and Prevention. Surveillance for waterborne disease and outbreaks associated with drinking water and water not intended for drinking – United States, 2001–2002. Morbidity and Mortality Weekly Report 2004; 53: 2345.
12.Centers for Disease Control and Prevention. Surveillance for waterborne disease and outbreaks associated with drinking water and water not intended for drinking – United States, 2003–2004. Morbidity and Mortality Weekly Report 2006; 55: 3158.
13.Centers for Disease Control and Prevention. Surveillance for waterborne disease and outbreaks associated with drinking water and water not intended for drinking – United States, 2005–2006. Morbidity and Mortality Weekly Report 2008; 57: 3962.
14.Sulaiman, IM, et al. Triosephosphate isomerase gene characterization and potential zoonotic transmission of multispecies Giardia duodenalis. Emerging Infectious Diseases 2003; 9: 14441452.
15.Environmental Protection Agency. Method 1623: Cryptosporidium and Giardia in water by filtration/IMS/FA. Washington, DC, USA: Office of Water, 2005; EPA 815-R-05-002.
16.Environmental Protection Agency. Consensus method for determining ground water is under the direct influence of surface water using microscopic particulate analysis (MPA). Washington, DC, USA: Office of Water, 1992; EPA Report Number 910/9-92-029.
17.Hill, VR, et al. Multi-state evaluation of an ultrafiltration-based procedure for simultaneous recovery of enteric microbes in 100-L tap water samples. Applied and Environmental Microbiology 2007; 73: 42184225.
18.NH Code of Administrative Rules. PART Env-Dw 301 Small production wells for small community water systems. Env-Dw 301 #9007 effective 10-19-07 (http://des.nh.gov/organization/commissioner/legal/rules/). Accessed 8 October 2008.
19.Navin, TR, et al. Case-control study of waterborne giardiasis in Reno, Nevada. American Journal of Epidemiology 1985; 122: 269275.
20.Sulaiman, IM, et al. Distribution of Giardia duodenalis genotypes and subgenotypes in raw urban wastewater in Milwaukee, Wisconsin. Applied and Environmental Microbiology 2004; 70: 37763780.
21.Robertson, LJ, et al. Application of genotyping during an extensive outbreak of waterborne giardiasis in Bergen, Norway, during autumn and winter 2004. Applied Environmental Microbiology 2006; 72: 22122217.
22.Thompson, RCA, Palmer, CS, O'Handley, R. The public health and clinical significance of Giardia and Cryptosporidium in domestic animals. Veterinary Journal 2008; 177: 1825.
23.Fayer, R, et al. Prevalence of Microsporidia, Cryptosporida spp., and Giardia spp. in beavers (Castor canadensis) in Massachusetts. Journal of Zoo and Wildlife Medicine 2006; 37: 492497.
24.Dykes, AC, et al. Municipal waterborne giardiasis: an epidemiologic investigation. Beavers implicated as a possible reservoir. Annals of Internal Medicine 1980; 92: 165170.
25.Lopez, CE, et al. Waterborne giardiasis: a community wide outbreak of disease and a high rate of asymptomatic infection. American Journal of Epidemiology 1980; 112: 495507.
26.Teodorovic, S, Braverman, JM, Elmendorf, HG. Unusually low levels of genetic variation among Giardia lamblia isolates. Eukaryotic Cell 2007; 6: 14211430.
27.Dixon, BR, et al. Giardia duodenalis and Cryptosporidium spp. in the intestinal contents of ringed seals (Phoca hispida) and bearded seals (Erignathus barbatus) in Nunavik, Quebec, Canada. Journal of Parasitology 2008; 94: 11611163.
28.Foronda, P, et al. Identification of genotypes of Giardia intestinalis of human isolates in Egypt. Parasitology Research 2008; 103: 11771181.
29.Caccio, SM, Ryan, U. Molecular epidemiology of giardiasis. Molecular and Biochemical Parasitology 2008; 160: 7580.
30.Keeley, A, Faulkner, BR. Influence of land use and watershed characteristics on protozoa contamination in a potential drinking water resources reservoir. Water Research 2008; 42: 28032813.
31.LeChevallier, MW, Norton, WD, Lee, RG. Occurrence of Giardia and Cryptosporidium spp. in surface water supplies [published erratum appears in Applied and Environmental Microbiology 1992; 58: 780]. Applied and Environmental Microbiology 1991; 57: 26102616.
32.Ryu, H, Abbaszadegan, M. Long-term study of Cryptosporidium and Giardia occurrence and quantitative microbial risk assessment in surface waters of Arizona in the USA. Journal of Water Health 2008; 6: 263273.
33.Wallis, PM, et al. Prevalence of Giardia cysts and Cryptosporidium oocysts and characterization of Giardia spp. isolated from drinking water in Canada. Applied and Environmental Microbiology 1996; 62: 27892797.
34.Dunlap, BG, Thies, ML. Giardia in beaver (Castor canadensis) and nutria (Myocastor coypus) from east Texas. Journal of Parasitology 2002; 88: 12541258.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed