title: Waterborne transmission of protozoan parasites: Review of worldwide outbreaks - An update 2011-2016.
abstract: This review provides a comprehensive update of worldwide waterborne parasitic protozoan outbreaks that occurred with reports published since previous reviews largely between January 2011 and December 2016. At least 381 outbreaks attributed to waterborne transmission of parasitic protozoa were documented during this time period. The nearly half (49%) of reports occurred in New Zealand, 41% of the outbreaks in North America and 9% in Europe. The most common etiological agent was Cryptosporidium spp., reported in 63% (239) of the outbreaks, while Giardia spp. was mentioned in 37% (142). No outbreaks attributed to other parasitic protozoa were reported. The distribution of reported outbreaks does not correspond to more broadly available epidemiological data or general knowledge of water and environmental conditions in the reporting countries. Noticeably, developing countries that are probably most affected by such waterborne disease outbreaks still lack reliable surveillance systems, and an international standardization of surveillance and reporting systems has yet to be established.
authors.affiliation: State Key Laboratory of Plateau Ecology and Agriculture, Center for Biomedicine and Infectious Diseases, Academy of Animal Science and Veterinary Medicine, Qinghai University, Xining, Qinghai 810016, PR China; National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8555, Japan.
authors.forename: Artemis
authors.initials: A
authors.lastname: Efstratiou
authors.affiliation: State Key Laboratory of Plateau Ecology and Agriculture, Center for Biomedicine and Infectious Diseases, Academy of Animal Science and Veterinary Medicine, Qinghai University, Xining, Qinghai 810016, PR China; Civil, Mining, & Environmental Engineering, University of Wollongong, Wollongong, NSW 2522, Australia.
authors.forename: Jerry E
authors.initials: JE
authors.lastname: Ongerth
authors.affiliation: State Key Laboratory of Plateau Ecology and Agriculture, Center for Biomedicine and Infectious Diseases, Academy of Animal Science and Veterinary Medicine, Qinghai University, Xining, Qinghai 810016, PR China. Electronic address: panagiotis.karanis@uk-koeln.de.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Karanis
mesh_terms: D000818:Animals; D004196:Disease Outbreaks; D010271:Parasites; D014871:Water Microbiology; D014876:Water Pollution; D014881:Water Supply
keywords: Contamination; Cryptosporidium; Diarrhea; Giardia; Protozoan parasites; Public health surveillance systems; Waterborne disease outbreak (WBDO); Worldwide review