Abstract
Despite the public health importance of giardiasis in all of Europe, reliable data on the incidence and prevalence in Western Balkan Countries (Serbia, Bosnia and Herzegovina, Croatia, Montenegro and FYR Macedonia) are scarce, and the relative contribution of waterborne and food-borne, or person-to-person and/or animalto- person, transmission of human giardiasis is not yet clear. To provide baseline data for the estimation of the public health risk caused by Giardia, we here review the information available on the epidemiological characteristics of asymptomatic and symptomatic human infection in Serbia. Although asymptomatic cases of Giardia represent a major proportion of the total cases of infection, high rates of Giardia infection were found in both asymptomatic and symptomatic populations. No waterborne outbreaks of giardiasis have been reported, and it thus seems that giardiasis mostly occurs sporadically in our milieu. Under such circumstances, control measures to reduce the high prevalence of giardiasis in Serbia have focused on person-to-person transmission, encouraging proper hygiene, but for more targeted intervention measures, studies to identify other risk factors for asymptomatic and symptomatic infections are needed.
Highlights
Despite the public health importance of giardiasis in all of Europe, reliable data on the incidence and prevalence in Western Balkan Countries (Serbia, Bosnia and Herzegovina, Croatia, Montenegro and FYR Macedonia) are scarce, and the relative contribution of waterborne and food-borne, or person-to-person and/or animalto-person, transmission of human giardiasis is not yet clear
The results showed Giardia infection in all examined regions of Serbia, with an overall prevalence of 6.1 %, and highly significant (p = 0.001) differences among regions (3.2-14.2 %)
According to the data reported to the WHO, Serbia reported the greatest number of cases per 100,000 population for each of the four years of the reporting period compared to all other Western Balkan Countries (WBC) (WHO/Europe, CISID, 2005-2008) (Fig. 3)
Summary
Malgré l’importance en termes de santé publique de la giardiase humaine dans toute l’Europe, les données fiables sur son incidence et sa prévalence dans les pays de l’ouest des Balkans (Serbie, Bosnie-Herzégovine, Croatie, Monténégro et République de Macédoine) sont rares, et ses diverses modalités de transmission, via l’eau, les aliments, de l’animal à l’homme et de personne à personne ne sont pas encores claires. There are no published data for giardiasis for other WBC, which obviously implies lack of awareness of this infection in the Balkans High as it may seem, even the 6 % prevalence established in our studies is likely to be an underestimate, since the excretion of Giardia cysts is known to be intermittent, and examination of a single stool sample identifies no more than 75-85 % of all infected (Naik et al, 1978; Hiatt et al, 1995). According to the World Health Organization criteria (WHO, 1987) by which Giardia infection is considered sporadic at a prevalence below 1 %, endemic between 1-10 % and hyperendemic above 10 %, even 16 regions were endemic and four hyperendemic for giardiasis These findings are important as understanding the spatial distribution may help to develop programmes for giardiasis control that combine chemotherapy (NikoliĆ et al, 1995) and preventive measures. Fig. 1. – Asymptomatic human Giardia infection in Central Serbia: (A) map with prevalence (%) in 20 study regions and (B) distribution of prevalence in 115 settlements throughout Central Serbia
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