title: Case-Control Study of Risk Factors for Sporadic Giardiasis and Parasite Assemblages in North West England.
abstract: Giardia duodenalis is a major cause of infectious gastroenteritis worldwide, and it is diversified into eight genetic assemblages (A to H), which are distinguishable only by molecular typing. There is some evidence that the assemblages infecting humans (assemblages A and B) may have different transmission routes, but systematically acquired data, combining epidemiological and molecular findings, are required. We undertook a case-control study with Giardia genotyping in North West England, to determine general and parasite assemblage-specific risk factors. For people without a history of foreign travel, swimming in swimming pools and changing diapers were the most important risk factors for the disease. People infected with assemblage B reported a greater number of symptoms and higher frequencies of vomiting, abdominal pain, swollen stomach, and loss of appetite, compared with people infected with assemblage A. More importantly, keeping a dog was associated only with assemblage A infections, suggesting the presence of a potential zoonotic reservoir for this assemblage. This is the first case-control study to combine epidemiological data with Giardia genotyping, and it shows the importance of integrating these two levels of information for better understanding of the epidemiology of this pathogen.
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Corrado
authors.initials: C
authors.lastname: Minetti
authors.affiliation: Public Health England Cumbria and Lancashire Centre, Chorley, United Kingdom kenneth.lamden@sky.com.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Lamden
authors.affiliation: Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom.
authors.forename: Caroline
authors.initials: C
authors.lastname: Durband
authors.affiliation: Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Cheesbrough
authors.affiliation: Public Health England Cumbria and Lancashire Centre, Chorley, United Kingdom.
authors.forename: Katherine
authors.initials: K
authors.lastname: Platt
authors.affiliation: Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom.
authors.forename: Andre
authors.initials: A
authors.lastname: Charlett
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: O'Brien
authors.affiliation: Public Health England Food, Water, and Environmental Microbiology Laboratory, Preston, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Fox
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Wastling
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004285:Dogs; D004739:England / Q000453:epidemiology; D005260:Female; D005838:Genotype; D060005:Genotyping Techniques; D005872:Giardia / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D005873:Giardiasis / Q000453:epidemiology* / Q000469:parasitology / Q000473:pathology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult; D015047:Zoonoses / Q000453:epidemiology / Q000469:parasitology