Characteristics and risk factors for symptomatic Giardia lamblia infections in Germany
Creators: name: Espelage, Werner
name: Heiden, Matthias An Der
name: Stark, Klaus
name: Alpers, Katharina
Publisher: name: Robert Koch-Institut
Year: 2010
Subjects: subject: 80 and over
subject: Preschool
subject: Humans
subject: Female
subject: Germany/epidemiology
subject: Male
subject: Middle Aged
subject: Population Surveillance
subject: Risk Factors
subject: Travel/statistics &amp; numerical data
subject: Child
subject: Case-Control Studies
subject: Aged
subject: Infant
subject: Logistic Models
subject: * Adolescent
subject: Interviews as Topic
subject: Sex Factors
subject: Young Adult
subject: * AdultAged
subject: Food Parasitology
subject: Giardia lamblia
subject: Giardiasis/epidemiology
subject: Giardiasis/immunology
subject: Giardiasis/transmission
subject: Immunocompromised Host
subject: 610 Medizin

description: Background: In developed countries, giardiasis is considered a travel related disease. However, routine surveillance data from Germany indicate that &gt;50% of infections were acquired indigenously. We studied the epidemiological characteristics of symptomatic Giardia infections acquired in Germany and abroad, and verified the proportion of cases acquired in Germany in order to investigate risk factors for sporadic autochthonous Giardia infections. Methods: We identified Giardia cases notified by 41 local health authorities between February 2007 and January 2008 and interviewed them on their clinical symptoms, underlying morbidities, travel abroad and potential risk factors for the disease. We conducted a case-control-study including laboratory-confirmed (microscopy or antigen-test) autochthonous Giardia cases with clinical manifestations (diarrhoea, cramps, bloating) and randomly selected controls from the local population registry matched by county of residence and age-group (0-5, 6-19, ≥20 years). Secondary cases, controls with diarrhoea and persons who had travelled outside Germany in the three weeks prior to disease onset (exposure period) were excluded. We calculated adjusted odds ratios (aOR) with 95% confidence intervals (CI) using conditional logistic regression. Results: Of 273 interviewed cases, 131 (48%) had not travelled abroad during the defined exposure period. Of these 131, 85 (65%) were male, 68 (54%) were living in communities with &gt;100,000 inhabitants and 107 (83%) were aged 20 years or older. We included 120 cases and 240 controls in the case-control study. Cases were more likely to be male (aOR 2.5 CI 1.4-4.4), immunocompromised (aOR 15.3 CI 1.8-127) and daily consumers of green salad (aOR 2.9 CI 1.2-7.2). Contact with animals (pets/farm animals) and exposure to surface water (swimming/water sports) were not associated with symptomatic disease. Conclusions: A substantial proportion of Giardia lamblia cases in Germany are indigenously acquired. Symptomatic cases are significantly more likely to be immunocompromised than control persons from the general population. Physicians should consider Giardia infections among patients with no recent history of travel abroad, particularly if they have immune deficiencies. Green salads may be an important vehicle of infection. Information campaigns highlighting this food-borne risk should emphasise the risk to persons with immune deficiencies.