Abstract
To investigate risk factors for sporadic infection with Giardia lamblia acquired in the United Kingdom, we conducted a matched case-control study in southwest England in 1998 and 1999. Response rates to a postal questionnaire were 84% (232/276) for cases and 69% (574/828) for controls. In multivariable analysis, swallowing water while swimming (p<0.0001, odds ratio [OR] 6.2, 95% confidence intervals [CI] 2.3 to 16.6), recreational fresh water contact (p=0.001, OR 5.5, 95% CI 1.9 to 15.9), drinking treated tap water (p<0.0001, OR 1.3, 95% CI 1.1 to 1.5 for each additional glass per day), and eating lettuce (pç=0.01, OR 2.2, 95% CI 1.2 to 4.3) had positive and independent associations with infection. Although case-control studies are prone to bias and the risk of Giardia infection is minimized by water treatment processes, the possibility that treated tap water is a source of sporadic giardiasis warrants further investigation.
Highlights
To investigate risk factors for sporadic infection with Giardia lamblia acquired in the United Kingdom, we conducted a matched case-control study in southwest England in 1998 and 1999
Most information on risk factors for giardiasis has come from investigation of outbreaks
In the U.K., recreational exposure to fresh water and swimming pools has been identified as a possible risk factor [10,11,12], as well as travel to developing countries [11]
Summary
To investigate risk factors for sporadic infection with Giardia lamblia acquired in the United Kingdom, we conducted a matched case-control study in southwest England in 1998 and 1999. Case-control studies are prone to bias and the risk of Giardia infection is minimized by water treatment processes, the possibility that treated tap water is a source of sporadic giardiasis warrants further investigation. Water is the most frequently identified route of transmission [1,2], through drinking contaminated tap water [3,4] or recreational exposure in lakes, rivers, or swimming pools [5]. In the U.K., recreational exposure to fresh water and swimming pools has been identified as a possible risk factor [10,11,12], as well as travel to developing countries [11]. We set out to determine risk factors for giardiasis in residents of southwest England who had not recently traveled outside the U.K
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