Drinking Water Transmission of Giardiasis in the United States

Abstract

For about a century after Giardia was named by Lambl in 1859, the occurrence of the organism in humans was not widely considered significant in explaining the etiology of disease. This organism is now recognized as a cause of disease that ranges from mild to severe and debilitating gastroenteritis. Beginning in 1965, drinking water became increasingly implicated as an important route of transmission. An outbreak occurred in a Colorado ski resort in that year. A survey of visitors to the resort revealed that 123 persons experienced acute enteritis, possibly giardiasis. Sewage contamination of the well water supply was thought to be the source of the organism. Further evidence for waterborne transmission of Giardia came in 1975 with the first isolation of the organism from a water supply implicated in an outbreak. A cyst was isolated from the water supply during an extended outbreak that resulted in 359 confirmed cases over a 7 month period. Subsequent outbreaks have clearly established the role of water in Giardia transmission. From 1965 through 1984, 90 waterborne outbreaks with 23 776 cases of giardiasis were reported in the United States. This report discusses the etiologic agent and examines drinking water outbreak occurrence and control.