1887
  1. Home
  2. Eurosurveillance
  3. Volume 29, Issue 20, 16/May/2024
  4. Article
Surveillance Open Access
Like 0
Download

Abstract

Background

is a major cause of gastroenteritis globally, and is the most common food- and waterborne parasitic infection in Europe.

Aim

To describe the epidemiology of reported acute giardiasis cases in Germany and compare demographic and clinical characteristics between imported and autochthonous cases.

Methods

We conducted a descriptive analysis of giardiasis cases that fulfilled the national case definition and were reported between January 2002 and December 2021. We defined an imported case as having at least one place of exposure abroad in the 3–25 days before symptom onset. We analysed case numbers and incidence by age, sex, month reported and geographic region, both overall and stratified by autochthonous and imported cases.

Results

From 2002 to 2021, 72,318 giardiasis cases were reported in Germany, corresponding to a mean annual incidence of 4.4 per 100,000 population. Annual incidence gradually decreased since 2013, declining sharply during the COVID-19 pandemic in 2020–21. Of 69,345 cases reported between 2002 and 2019, 35% were imported. Incidence of autochthonous cases (overall yearly mean: 3.1/100,000) was highest in males and young children (< 5 years); imported cases were predominantly adults aged 20–39 years. We identified seasonal patterns for imported and autochthonous cases.

Conclusions

Giardiasis in Germany is typically assumed to be imported. Our data, however, underline the importance of autochthonous giardiasis. Travel advice might reduce imported infections, but prevention strategies for autochthonous infections are less clear. Dietary, behavioural and environmental risk factors need to be further investigated to enhance infection prevention measures for autochthonous giardiasis.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2024.29.20.2300509
2024-05-16
2024-06-17
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2024.29.20.2300509
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/29/20/eurosurv-29-20_4.html?itemId=/content/10.2807/1560-7917.ES.2024.29.20.2300509&mimeType=html&fmt=ahah

References

  1. Bouwknegt M, Devleesschauwer B, Graham H, Robertson LJ, van der Giessen JW, Euro-FBP workshop participants. Prioritisation of food-borne parasites in Europe, 2016. Euro Surveill. 2018;23(9):17-00161.  https://doi.org/10.2807/1560-7917.ES.2018.23.9.17-00161  PMID: 29510783 
  2. European Centre for Disease Prevention and Control (ECDC). Giardiasis (lambliasis). ECDC Annual Epidemiological Report for 2019. Stockholm: ECDC. 2022. Available from: https://www.ecdc.europa.eu/en/publications-data/giardiasis-lambliasis-annual-epidemiological-report-2019
  3. Krumrie S, Capewell P, Smith-Palmer A, Mellor D, Weir W, Alexander CL. A scoping review of risk factors and transmission routes associated with human giardiasis outbreaks in high-income settings. Curr Res Parasitol Vector Borne Dis. 2022;2:100084.  https://doi.org/10.1016/j.crpvbd.2022.100084  PMID: 36589877 
  4. European Centre for Disease Prevention and Control. Surveillance systems overview for 2019. Annual Epidemiological Report for 2019. Stockholm: ECDC; 2022. Available from: https://www.ecdc.europa.eu/en/publications-data/surveillance-systems-overview-2019
  5. Escobedo AA, Almirall P, Hanevik K, Cimerman S, Rodríguez-Morales AJ, Almanza C, et al. Giardiasis: a diagnosis that should be considered regardless of the setting. Epidemiol Infect. 2018;146(10):1216-8.  https://doi.org/10.1017/S0950268818001504  PMID: 29886858 
  6. Espelage W, an der Heiden M, Stark K, Alpers K. Characteristics and risk factors for symptomatic Giardia lamblia infections in Germany. BMC Public Health. 2010;10(1):41.  https://doi.org/10.1186/1471-2458-10-41  PMID: 20105338 
  7. Faensen D, Claus H, Benzler J, Ammon A, Pfoch T, Breuer T, et al. SurvNet@RKI - a multistate electronic reporting system for communicable diseases. Euro Surveill. 2006;11(4):7-8.  https://doi.org/10.2807/esm.11.04.00614-en  PMID: 29208145 
  8. Tennekes M. tmap: Thematic Maps in R. J Stat Softw. 2018;84(6):1-39.  https://doi.org/10.18637/jss.v084.i06 
  9. Robert Koch Institute (RKI). Infektionsepidemiologisches Jahrbuch meldepflichtiger Krankheiten für 2019. [Infectious disease epidemiological yearbook for 2019] Berlin: RKI; 2019. German. Available from: https://www.rki.de/DE/Content/Infekt/Jahrbuch/Jahrbuch_2019.html
  10. European Centre for Disease Prevention and Control (ECDC). Giardiasis (lambliasis). In: ECDC Annual Epidemiological Report for 2017. Stockholm: ECDC. 2019. Available from: https://www.ecdc.europa.eu/en/publications-data/giardiasis-lambliasis-annual-epidemiological-report-2017
  11. Coffey CM, Collier SA, Gleason ME, Yoder JS, Kirk MD, Richardson AM, et al. Evolving epidemiology of reported giardiasis cases in the United States, 1995-2016. Clin Infect Dis. 2021;72(5):764-70.  https://doi.org/10.1093/cid/ciaa128  PMID: 32047932 
  12. Sagebiel D, Weitzel T, Stark K, Leitmeyer K. Giardiasis in kindergartens: prevalence study in Berlin, Germany, 2006. Parasitol Res. 2009;105(3):681-7.  https://doi.org/10.1007/s00436-009-1438-5  PMID: 19404678 
  13. Gebel J, Teichert-Barthel U, Hornbach-Beckers S, Vogt A, Kehr B, Littmann M, et al. Hygiene-Tipps für Kids. [Hygiene tips for kids. Concept and examples of realisation]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2008;51(11):1304-13. German.  https://doi.org/10.1007/s00103-008-0697-0  PMID: 19043759 
  14. Heudorf U. Hygiene und Infektionsprävention in medizinischen Einrichtungen und in Kindergemeinschaftseinrichtungen - Gesetzliche Grundlagen, Überwachungspraxis und Erfahrungen der Gesundheitsämter. [Hygiene and infection prevention in medical institutions, kindergartens and schools - statutory basis, infection control practice and experiences of the public health services]. Gesundheitswesen. 2015;77(7):481-7. German. PMID: 26154256 
  15. Robert Koch Institut (RKI). Robert Koch-Institut: SurvStat@RKI 2.0. Berlin: RKI. [Accessed: 1 Mar 2022]. Available from: https://survstat.rki.de/Content/Query/Create.aspx
  16. Destatis (Federal Statistical Office of Germany). Pressemitteilung Nr. 451 vom 21. Oktober 2022 [Press release no. 451 from 21 October 2022]. Wiesbaden: Statistisches Bundesamt; 2022. Available from: https://www.destatis.de/DE/Presse/Pressemitteilungen/2022/10/PD22_451_225.html
  17. Yoder JS, Gargano JW, Wallace RM, Beach MJ, Centers for Disease Control and Prevention (CDC). Giardiasis surveillance--United States, 2009-2010. MMWR Surveill Summ. 2012;61(5):13-23. PMID: 22951494 
  18. Ferguson LC, Smith-Palmer A, Alexander CL. An update on the incidence of human giardiasis in Scotland, 2011-2018. Parasit Vectors. 2020;13(1):291.  https://doi.org/10.1186/s13071-020-04160-9  PMID: 32513243 
  19. Escobedo AA, Almirall P, Alfonso M, Cimerman S, Chacín-Bonilla L. Sexual transmission of giardiasis: a neglected route of spread? Acta Trop. 2014;132:106-11.  https://doi.org/10.1016/j.actatropica.2013.12.025  PMID: 24434784 
  20. Fernández-Huerta M, Zarzuela F, Barberá MJ, Arando M, Esperalba J, Rodríguez V, et al. Sexual transmission of intestinal parasites and other enteric pathogens among men who have sex with men presenting gastrointestinal symptoms in an STI unit in Barcelona, Spain: a cross-sectional study. Am J Trop Med Hyg. 2019;101(6):1388-91.  https://doi.org/10.4269/ajtmh.19-0312  PMID: 31549611 
  21. Herbinger KH, Alberer M, Berens-Riha N, Schunk M, Bretzel G, von Sonnenburg F, et al. Spectrum of imported infectious diseases: a comparative prevalence study of 16,817 German travelers and 977 immigrants from the tropics and subtropics. Am J Trop Med Hyg. 2016;94(4):757-66.  https://doi.org/10.4269/ajtmh.15-0731  PMID: 26903611 
  22. Vespestad MK, Mehmetoglu M. Gender differences in vacation behavior. Tour Rev Int. 2015;19(3):147-61.  https://doi.org/10.3727/154427215X14430967453670 
  23. Gallas-Lindemann C, Sotiriadou I, Plutzer J, Karanis P. Prevalence and distribution of Cryptosporidium and Giardia in wastewater and the surface, drinking and ground waters in the Lower Rhine, Germany. Epidemiol Infect. 2013;141(1):9-21.  https://doi.org/10.1017/S0950268812002026  PMID: 23010178 
  24. Naumova EN, Jagai JS, Matyas B, DeMaria A Jr, MacNeill IB, Griffiths JK. Seasonality in six enterically transmitted diseases and ambient temperature. Epidemiol Infect. 2007;135(2):281-92.  https://doi.org/10.1017/S0950268806006698  PMID: 17291363 
  25. Dietrich J, Hammerl JA, Johne A, Kappenstein O, Loeffler C, Nöckler K, et al. Impact of climate change on foodborne infections and intoxications. J Health Monit. 2023;8(Suppl 3):78-92. PMID: 37342431 
  26. Lal A, Baker MG, Hales S, French NP. Potential effects of global environmental changes on cryptosporidiosis and giardiasis transmission. Trends Parasitol. 2013;29(2):83-90.  https://doi.org/10.1016/j.pt.2012.10.005  PMID: 23219188 
  27. Woschke A, Faber M, Stark K, Holtfreter M, Mockenhaupt F, Richter J, et al. Suitability of current typing procedures to identify epidemiologically linked human Giardia duodenalis isolates. PLoS Negl Trop Dis. 2021;15(3):e0009277.  https://doi.org/10.1371/journal.pntd.0009277  PMID: 33764999 
  28. Ankarklev J, Lebbad M, Einarsson E, Franzén O, Ahola H, Troell K, et al. A novel high-resolution multilocus sequence typing of Giardia intestinalis Assemblage A isolates reveals zoonotic transmission, clonal outbreaks and recombination. Infect Genet Evol. 2018;60:7-16.  https://doi.org/10.1016/j.meegid.2018.02.012  PMID: 29438742 
  29. Klotz C, Sannella AR, Weisz F, Chaudhry U, Sroka J, Tůmová P, et al. Extensive testing of a multi-locus sequence typing scheme for Giardia duodenalis assemblage A confirms its good discriminatory power. Parasit Vectors. 2022;15(1):489.  https://doi.org/10.1186/s13071-022-05615-x  PMID: 36572928 
  30. Hommes F, Dörre A, Behnke SC, Stark K, Faber M. Travel-related giardiasis: incidence and time trends for various destination countries. J Travel Med. 2023;30(6):taad107.  https://doi.org/10.1093/jtm/taad107  PMID: 37561417 
  31. Ullrich A, Schranz M, Rexroth U, Hamouda O, Schaade L, Diercke M, et al. Impact of the COVID-19 pandemic and associated non-pharmaceutical interventions on other notifiable infectious diseases in Germany: An analysis of national surveillance data during week 1-2016 - week 32-2020. Lancet Reg Health Eur. 2021;6:100103.  https://doi.org/10.1016/j.lanepe.2021.100103  PMID: 34557831 
  32. European Centre for Disease Prevention and Control (ECDC). ECDC Surveillance Atlas. Stockholm: ECDC. [Accessed: 7 Sep 2023]. Available from: https://atlas.ecdc.europa.eu/public/index.aspx
  33. Robert Koch Institute (RKI). Falldefinitionen des Robert Koch-Instituts zur Übermittlung von Erkrankungs- oder Todesfällen und Nachweisen von Krankheitserregern. [The 2019 edition of case definitions for the surveillance of disease, mortality and detection of pathogens.] Berlin: RKI; 2019. German. Available from: https://www.rki.de/DE/Content/Infekt/IfSG/Falldefinition/falldefinition_node.html
Autochthonous and imported giardiasis cases: An analysis of two decades of national surveillance data, Germany, 2002 to 2021
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Franziska+Hommes&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hommes Franziska</a>, <a href="/search?value1=Achim+D%C3%B6rre&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Dörre Achim</a>, <a href="/search?value1=Susanne+C+Behnke&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Behnke Susanne C</a>, <a href="/search?value1=Klaus+Stark&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Stark Klaus</a>, <a href="/search?value1=Mirko+Faber&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Faber Mirko</a></span>. Autochthonous and imported giardiasis cases: An analysis of two decades of national surveillance data, Germany, 2002 to 2021. <a href="/content/ecdc">Euro Surveill.</a> 2024;29(20):pii=2300509. <a href="https://doi.org/10.2807/1560-7917.ES.2024.29.20.2300509" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2024.29.20.2300509</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 21 Sept 2023;&nbsp;&nbsp; <span class="generated">Accepted</span>: 18 Feb 2024 </span> </p>
/content/10.2807/1560-7917.ES.2024.29.20.2300509
/content/10.2807/1560-7917.ES.2024.29.20.2300509
Loading

Data & Media loading...

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error