Giardiasis outbreaks in the United States, 1971–2011

Adam, E. A.; Yoder, Jonathan S.; Gould, L. Hannah; Hlavsa, Michele C.; Gargano, Julia W.

doi:10.1017/s0950268815003040

Cited by 89 publications

(70 citation statements)

References 37 publications

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“…Giardia parasite transmission occurs through ingestion of fecally contaminated food or water, or through person-to-person contact [6, 7]. Symptoms include prolonged diarrhea, abdominal pain, malabsorption, bloating, dehydration, and weight loss.…”

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confidence: 99%

Giardiasis Diagnosis and Treatment Practices Among Commercially Insured Persons in the United States

Beer

Collier

et al. 2017

Clinical Infectious Diseases

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Background Giardiasis, the most common enteric parasitic infection in the United States, causes an estimated 1.2 million episodes of illness annually. Published clinical recommendations include readily available Giardia-specific diagnostic testing and antiparasitic drugs. We investigated sequences of giardiasis diagnostic and treatment events using MarketScan, a large health insurance claims database. Methods We created a longitudinal cohort of 2995 persons diagnosed with giardiasis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 007.1) from 2006 to 2010, and analyzed claims occurring 90 days before to 90 days after initial diagnosis. We evaluated differences in number and sequence of visits, diagnostic tests, and prescriptions by age group (children 1–17 years, adults 18–64 years) using χ2 tests and data visualization software. Results Among 2995 patients (212 433 claims), 18% had a Giardia-specific test followed by or concurrent with an effective antiparasitic drug, without ineffective antibiotics. Almost two-thirds of patients had an antiparasitic and 27% had an antibiotic during the study window. Compared with children, adults more often had ≥3 visits before diagnosis (19% vs 15%; P = .02). Adults were also less likely to have a Giardia-specific diagnostic test (48% vs 58%; P < .001) and more likely to have an antibiotic prescription (28% vs 25%; P = .04). When Giardia-specific tests and antiparasitic and antibiotic prescriptions were examined, pediatric clinical event sequences most frequently began with a Giardia-specific test, whereas adult sequences most frequently began with an antiparasitic prescription. Conclusions Giardiasis care infrequently follows all aspects of clinical recommendations. Multiple differences between pediatric and adult care, despite age-agnostic recommendations, suggest opportunities for provider education or tailored guidance.

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confidence: 99%

Giardiasis Diagnosis and Treatment Practices Among Commercially Insured Persons in the United States

Beer

Collier

et al. 2017

Clinical Infectious Diseases

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“…Furthermore, animal contact has been implicated in three reported giardiasis outbreaks in a review of Giardia sp. outbreaks in the USA (1971-2011), associated with rabbits at a petting zoo, cattle at a farm and a pet reptile at a long-term care facility [84].…”

Section: Discussionmentioning

confidence: 99%

Estimates of the burden of illness for eight enteric pathogens associated with animal contact in Canada

et al. 2017

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SUMMARYEnteric pathogens are commonly known to be transmitted through food or water; however, contact with animals is another important transmission route. This study estimated the annual burden of illness attributable to animal contact for eight enteric pathogens in Canada. Using data from a Canadian expert elicitation on transmission routes, the proportion of enteric illnesses attributable to animal contact was estimated for each pathogen to estimate the annual number of illnesses, hospitalizations and deaths in Canada. For each estimate, a mean and probability intervals were generated. Of all illnesses caused by these eight pathogens, 16% were estimated attributable to animal contact. This estimate translates to 86 000 (31 000-166 000) illnesses, 488 (186-890) hospitalizations and 12 (2-28) deaths annually for the eight pathogens combined. Campylobacter spp. is the leading cause of illnesses annually, with an estimated 38 000 (14 000-71 000) illnesses occurring each year, followed by non-typhoidal Salmonella spp. (17 000, 6000-32 000). The majority of hospitalizations were attributable to non-typhoidal Salmonella spp. (36%) and Campylobacter spp. (31%). Non-typhoidal Salmonella spp. (28%) and Listeria monocytogenes (31%) were responsible for the majority of the estimated deaths. These results identify farm animal and pet/pet food exposure as key pathways of transmission for several pathogens. The estimated burden of illness associated with animal contact is substantial.

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“…In the US, in the period from 1971 to 2011, 242 outbreaks of giardiasis were reported to the Centers for Disease Control and Prevention (Adam et al, 2016). These outbreaks affected ~41,000 persons, and resulted from waterborne (74.8%), foodborne (15.7%), person-to-person (2.5%), and animal contact (1.2%) transmission.…”

Section: Transmission Routesmentioning

confidence: 99%