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Prolonged outbreak of giardiasis with two modes of transmission

Published online by Cambridge University Press:  29 March 2006

D. E. KATZ
Affiliation:
Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA, USA
D. HEISEY-GROVE
Affiliation:
Bureau of Communicable Disease Control, Massachusetts Department of Public Health, MA, USA
M. BEACH
Affiliation:
Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
R. C. DICKER
Affiliation:
Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA, USA
B. T. MATYAS
Affiliation:
Bureau of Communicable Disease Control, Massachusetts Department of Public Health, MA, USA
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Abstract

Large outbreaks of giardiasis caused by person-to-person transmission, or a combination of transmission routes, have not previously been reported. A large, prolonged giardiasis outbreak affected families belonging to a country club in a suburb of Boston, Massachusetts, during June–December 2003. We conducted a retrospective cohort study to determine the source of this outbreak. Giardiasis-compatible illness was experienced by 149 (25%) respondents to a questionnaire, and was laboratory confirmed in 97 (65%) of these cases. Of the 30 primary cases, exposure to the children's pool at the country club was significantly associated with illness (risk ratio 3·3, 95% confidence interval 1·7–6·5). In addition, 105 secondary cases probably resulted from person-to-person spread; 14 cases did not report an onset date. This outbreak illustrates the potential for Giardia to spread through multiple modes of transmission, with a common-source outbreak caused by exposure to a contaminated water source resulting in subsequent prolonged propagation through person-to-person transmission in the community. This capacity for a common-source outbreak to continue propagation through secondary person-to-person spread has been reported with Shigella and Cryptosporidium and may also be a feature of other enteric pathogens having low infectious doses.

Type
Research Article
Copyright
2006 Cambridge University Press

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