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Risk factors for sporadic Giardia infection in the USA: a case-control study in Colorado and Minnesota

  • H. E. Reses (a1), J. W. Gargano (a1), J. L. Liang (a1), A. Cronquist (a2), K. Smith (a3), S. A. Collier (a1), S. L. Roy (a1), J. Vanden Eng (a1), A. Bogard (a3), B. Lee (a3), M. C. Hlavsa (a1), E. S. Rosenberg (a4), K. E. Fullerton (a1), M. J. Beach (a1) and J. S. Yoder (a1)...

Abstract

Giardia duodenalis is the most common intestinal parasite of humans in the USA, but the risk factors for sporadic (non-outbreak) giardiasis are not well described. The Centers for Disease Control and Prevention and the Colorado and Minnesota public health departments conducted a case-control study to assess risk factors for sporadic giardiasis in the USA. Cases (N = 199) were patients with non-outbreak-associated laboratory-confirmed Giardia infection in Colorado and Minnesota, and controls (N = 381) were matched by age and site. Identified risk factors included international travel (aOR = 13.9; 95% CI 4.9–39.8), drinking water from a river, lake, stream, or spring (aOR = 6.5; 95% CI 2.0–20.6), swimming in a natural body of water (aOR = 3.3; 95% CI 1.5–7.0), male–male sexual behaviour (aOR = 45.7; 95% CI 5.8–362.0), having contact with children in diapers (aOR = 1.6; 95% CI 1.01–2.6), taking antibiotics (aOR = 2.5; 95% CI 1.2–5.0) and having a chronic gastrointestinal condition (aOR = 1.8; 95% CI 1.1–3.0). Eating raw produce was inversely associated with infection (aOR = 0.2; 95% CI 0.1–0.7). Our results highlight the diversity of risk factors for sporadic giardiasis and the importance of non-international-travel-associated risk factors, particularly those involving person-to-person transmission. Prevention measures should focus on reducing risks associated with diaper handling, sexual contact, swimming in untreated water, and drinking untreated water.

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Copyright

Corresponding author

Author for correspondence: H. E. Reses, E-mail: hreses@cdc.gov

References

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