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Different risk factors for infection with Giardia lamblia assemblages A and B in children attending day-care centres

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Giardia lamblia is a major cause of diarrhoea in children, especially those attending day-care centres (DCCs). Only Giardia assemblages A and B infect humans. Given the lack of assemblage-specific epidemiological data, we aimed to identify risk factors for infection by assemblages A and B in DCC attendees. During 2010–2013, 5,015 faecal samples from ≤4-year-old children attending 40 DCCs participating in laboratory surveillance in the Netherlands were tested for Giardia using RT-PCR. Giardia-positive samples were typed for identification of assemblages A and B. We compared child- and DCC-level characteristics of Giardia-positive children with those of Giardia-negative children using mixed-effects logistic regression. Overall, 226 samples (4.5 %) tested positive for Giardia, and assemblages were determined for 138 of them: 62 (45 %) were assemblage A and 76 (55 %) were B. The only risk factor for assemblage A infection was attending DCCs with indoor sandpits and cats during spring/summer (odds ratio [OR] 13.5; 95% CI 1.8–101.3). For assemblage B, risk factors were attending DCCs with dedicated diaper-changing (OR 3.6; 95% CI 1.7–7.6) and laundry (OR 2.3; 95% CI 1.1–4.9) areas. Preventing sick children from attending day-care and having cloth-towels at the DCC decreased the risk of assemblage B infection (OR 0.0; 95% CI 0.0–0.5 and OR 0.3; 95% CI 0.1–0.6 respectively). Risk factors for assemblages A and B infection in DCC-attending children were different, with assemblage B being mainly related to anthroponotic transmission, and assemblage A being related to zoonotic transmission. Given these differences, interventions to reduce the burden of childhood giardiasis cannot ignore those assemblage-specific preferred reservoirs and transmission routes.

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Correspondence to R. Pijnacker.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The Dutch Central Committee on Research involving Human Subjects in Utrecht, The Netherlands, gave permission to conduct this study (protocol number: 13-051/C). This study is conducted according to the principles of the Declaration of Helsinki.

Informed consent

Given that no subject-identifiable data were generated and the surveillance activities implied no risk or burden for any individuals, the committee judged that no specific ethical permission was required for individual consent. Although it was not required, an information form was attached that parents could return if they did not want to have their child participate in the study.

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Pijnacker, R., Mughini-Gras, L., Heusinkveld, M. et al. Different risk factors for infection with Giardia lamblia assemblages A and B in children attending day-care centres. Eur J Clin Microbiol Infect Dis 35, 2005–2013 (2016).

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