Public health priority: Routine.
PHU response time: Respond to confirmed cases within 1 day of notification for clusters, discretionary for others. Enter confirmed cases on NCIMS within 3 working days.
Case management: Exclude from childcare centres until diarrhoea resolves. Identify and control source of cluster.
Contact management: Not applicable.
A confirmed case requires laboratory definitive evidence.
Detection of Giardia lamblia.
Laboratory diagnosis of giardiasis usually involves isolation of Giardia lamblia cysts or trophozoites from stool samples, samples of duodenal contents or occasionally a small intestinal biopsy. NAT or antigen detection kits for faeces are available. Giardia lamblia is also known as Giardia duodenalis and Giardia intestinalis.
Giardiasis is to be notified by laboratories on diagnosis (ideal reporting by routine mail).
Only confirmed cases should be entered onto NCIMS.
The flagellate protozoan Giardia duodenalis.
Giardiasis is transmitted by the faecal oral route:
The typical incubation period is usually 3 to 25 days or longer; the median is 7 to 10 days. Giardia is infectious for the duration of excretion of the organism, which may be months.
Giardiasis is frequently asymptomatic, but may present as acute or chronic diarrhoea, steatorrhoea, bloating, abdominal cramps, fatigue and malnutrition.
Within 1 working day of notification of a cluster of confirmed cases begin follow-up investigation. Cases that do not form part of a cluster are followed up at the discretion of the local PHU Director.
Within 3 working days of notification enter confirmed cases on NCIMS.
The response to a notification will normally be carried out in collaboration with the case's health carers. But regardless of who does the follow-up, PHU staff should ensure that action has been taken to:
Refer to Therapeutic Guidelines: Antibiotic.
The case or relevant care-giver should be informed about the nature of the infection and the mode of transmission. Emphasise the importance of hygienic practices, particularly hand washing before eating and preparing food and after going to the toilet.
Children with diarrhoea should not attend childcare for 24 hours after diarrhoea has ceased.
Where a water-borne source is suspected, collect samples for analysis, and discuss with the Water Unit.
When a cluster has been identified in a childcare centre, the director of the facility should be asked to telephone the PHU immediately if new cases of diarrhoea are reported. The facility should be telephoned or visited at least once a week for 2 weeks after onset of the last case to verify that surveillance and appropriate preventive measures are being carried out.
Where an ongoing source of infection is suspected, discuss further public health actions with the Communicable Diseases Branch.