Water Health Educator
Water Health Educator
Promoting advocacy for access to clean water
Disease Focus: Giardiasis
Giardiasis Brief
by Lindsay Boyce
Giardia is a parasite that causes the diarrheal disease Gardiasis. It is frequently found on surfaces, in soil, food or water that had been contaminated by fecal material. The structure of Giardia allows it to live for long periods outside of a host. The most common mode of transmission is through drinking contaminated water.
Giardiasis is the most frequently diagnosed intestinal disease. Symptoms can last from 1 to 2 weeks or sometimes longer; frequent symptoms include, diarrhea, gas, greasy stool, stomach and abdominal cramps, upset stomach and nausea, as well as dehydration. Less common symptoms may include itch skin or hives, and swelling of the eyes and joints.
Diagnosis is usually done through the collection of stool samples. Treatment is provided by several drugs, these include metronidazole, tinidazole, and nitazoxanide.
Prevention is easy and simple. Good hygiene practices are important for the prevention of Giardiasis. The most common prevention technique is washing hands before preparing food, after using the bathroom, after touching and animal, and before and after treating a cut or wound.
Overall, much like other diseases prevention is the easiest way to protect from the contraction of Gidariasis. Common good hygiene rules are the best way to protect your self from contracting Giardiasis.
Giardiasis:
A Recreational Water Illness
By Jason Zheng
As the hot beaming sun and humidity strive among us during the summer months, many people would go to beaches to cool down, however those to choose to remain close to home, opt for public pools. Though attending public pools has certain requirements, such as showering after using the restroom and practice proper hygienic. However a study shows that 1 in 5 Americans use pools as a restroom, while 7 in 10 do not shower before or after being in a pool.
These poor practices can contribute to gastroenteritis outbreaks. One of the many disease, giardia or giardiasis is a germ can live up to 45 minutes in contaminated water because of its tough outer shell, even if the water is properly chlorinated. In 2013, 23 cases of giardiasis has been reported at the Navy MTFs.
To prevent these illnesses, the Center of Disease Control have established protocols that would maintain a safe and healthy swimming environment. These protocols are primarily used to establish awareness and proper practices for swimmers and disinfectors of pools (e.g. establishing proper pH and chlorine levels to pools and hot tubs). The Navy and Marine Corps Public Health Center also established their own protocols on clearing a fecal infested pool.
Where there are no human occupancy in swimming pools and public waters, animals may populated the area. Thus animal fecal waste and bacteria can also strive in public waters and marine water, being equivalent on harming humans.
Virginia like all states have their own regulations to follow when it comes to disposing pool water. First the water needs to be covered and second the normal waiting period would be at least seven days for the chlorine and bromine to evaporate, as well having a pH between 6 and 8. Improper disposal of pool water may contribute to the decline of marine life because pool water is drained directly into a pond, lake, stream, and/or sewage.
Giardiasis is a disease by human and/or animal contribution. However, while we cannot fully control the latter, we can control the former to prevent the spread of giardiasis.
Giardiasis in the United Kingdom
By Nora Rideg
Giardiasis in the UK is primarily caused by ingesting cysts of Giardia duodenalis, which are shed by infected hosts and contaminate the environment. Transmission occurs through ingestion of contaminated water, food, or direct contact with infected individuals, leading to various symptoms ranging from mild to severe. Outbreaks in the UK can result from drinking untreated water, consuming contaminated food, or person-to-person contact in communal settings like daycare centers and nursing homes. Recreational water sources, such as lakes and swimming pools, can also be sources of infection if sanitation is not properly maintained.
According to a report by Health Protection Scotland, an estimated 3,500 cases of giardiasis occur annually in the UK, with an incidence rate of 5.5 cases per 100,000 population in 2005. The number of Giardia infections reported annually in Scotland has decreased consistently between 1988 and 1998; in 2003 only 192 infections were reported. The number of Giardia reports in England and Wales has shown a steady increase since 2013. In 2017, the Southwest of England reported the highest number of Giardia laboratory cases, totaling 1,116 reports, equating to a rate of 20.1 reports per 100,000 population, the highest in England and Wales.
Farm animals serve as reservoirs for human Giardia infections due to their widespread presence and potential for contaminating the environment with infectious cysts. Farming practices that allow livestock direct access to water sources facilitate the spread of infective cysts downstream, significantly impacting environmental contamination in areas with large numbers of livestock, such as the Scottish Highlands. Studies have shown that cattle, sheep, goats, and pigs, often carry Giardia duodenalis, leading to co-infections that complicates disease epidemiology. While direct links between exposure to farm animals and increased giardiasis risk vary, some studies suggest associations, particularly with pigs, dogs, and cats. Recent reviews have shown Giardia infection rates in dogs and cats in the UK ranging from 8.4% to 21.0%, with cats generally exhibiting lower prevalence rates around 5.3%.
Vulnerable populations, including young children, immunocompromised individuals, and those in areas with inadequate water and sanitation infrastructure, are particularly affected by giardiasis. In Scotland, between 2011 and 2018, there were 1,631 reported cases of giardiasis, with an average of 204 cases annually. Young children (0-4 years old) are heightened risk, with incidence rates of 5.4 per 100,000 in males and 3.7 per 100,000 in females, due to their developing immune systems and higher exposure to contaminated environments. Adults aged 20-49 years also show high susceptibility, with peak incidences of 7.7 per 100,000 in males aged 20-24 years and 5.5 per 100,000 in females aged 35-39 years, often due to travel, occupational hazards, and certain sexual practices. Immunocompromised individuals face a higher risk of severe and prolonged illness. While giardiasis is not usually life-threatening, it can cause significant discomfort like diarrheal diseases and dehydration.
To address giardiasis, improving sanitation, ensuring clean water access, and enhancing surveillance and diagnostic practices are crucial. Public health education and targeted interventions for vulnerable populations are also essential to reduce the disease burden and improve health outcomes. Maintaining high water quality standards, promoting proper hygiene practices, and employing advanced diagnostic techniques, including molecular methods, can effectively identify and control infections. Educational campaigns, especially in rural areas with private water supplies, further contribute to reducing the incidence and impact of giardiasis in the UK. Several organizations work together to mitigate giardiasis, including Public Health England (PHE) and The National Health Service (NHS) to monitors, control and provide diagnostic testing and treatment for giardiasis.
References:
Feng, Y., & Xiao, L. (2011). Zoonotic Potential and Molecular Epidemiology of Giardia Species and Giardiasis. Clinical Microbiology Reviews, 24(1), 110–140. https://doi.org/10.1128/cmr.00033-10
Ferguson, L.C., Smith-Palmer, A. & Alexander, C.L. An update on the incidence of human giardiasis in Scotland, 2011–2018. Parasites Vectors 13, 291 (2020). https://doi.org/10.1186/s13071-020-04160-9
Horton, B., Bridle, H., Alexander, C. L., & Katzer, F. (2019). Giardia duodenalis in the UK: current knowledge of risk factors and public health implications. Parasitology, 146(4), 413–424. doi:10.1017/S0031182018001683
Public Health England. (2019, May 30). Giardia data 2008 to 2017. GOV.UK. https://www.gov.uk/government/publications/giardia-national-laboratory-data/giardia-data-2008-to-2017