Giardiasis—Child Care and Schools

What is giardiasis?

Giardiasis is the most common intestinal infection caused by a parasite (Giardia duodenalis) in the United States and globally. This parasite is often found in streams, springs, ponds, lakes, and other natural bodies of water.

What are the signs or symptoms?

• Acute watery diarrhea.

• Excessive gas (flatulence).

• Distended and/or painful abdomen.

• Decreased appetite.

• Weight loss.

• Signs of dehydration, including dry mouth, no tears, or no urine for 8 hours.

• Many individuals are infected and infectious without signs or symptoms.

• Some individuals may have symptoms that last for weeks to months.

What are the incubation and contagious periods?

• Incubation period: 1 to 3 weeks

• Contagious period: Highly variable but can range from weeks to months and is most contagious during diarrhea phase

How is it spread?

• Fecal-oral route: Contact with feces from an infected person, typically when the person contaminates their fingers and touches an object another person then touches. Children who have contact with the contaminated surface may place their fingers into their own or another person's mouth.

• Ingestion of contaminated water (from people or animals) or food. Drinking water from an untreated source or playing or swimming in water contaminated with human or animal feces.

• Water tables and other water play have been associated with outbreaks of giardiasis in early childhood education (ECE) facilities.

How do you control it?

• Use good hand-hygiene technique at all the times listed in Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition, especially after toilet use or handling soiled diapers and before anything to do with food preparation or eating.

• Ensure proper surface disinfection that includes cleaning and rinsing of surfaces that may have become contaminated with stool (feces) with detergent and water and application of a US Environmental Protection Agency?registered disinfectant according to the instructions on the product label. For guidance on disinfectants, refer to Selection and Use of a Cleaning, Sanitizing, or Disinfecting Product in Chapter 8 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition.

• Use a combination of water disinfection and proper pool maintenance to reduce the risk of contamination. Children with symptoms should not use recreational water (eg, water tables, wading pools).

• Ensure thorough washing of raw fruits and vegetables.

• Ensure proper cooking and storage of food.

• Exclude infected staff members who handle food. See Safe Food Preparation and Service: Food Handlers in Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition.

• Exclude for specific types of symptoms (see the section Exclude from educational setting?).

Note: Giardia organisms are common in the stools of young children in ECE programs and schools. Treatment and exclusion of carriers (individuals who have the parasite but are not sick) are not effective for outbreak control.

What are the roles of the educator and the family?

• There are multiple causes of diarrhea. Until the cause of the diarrhea is identified, apply the recommendations for a child or staff member with diarrhea from any cause (see Diarrhea Quick Reference Sheet).

  • ? Report the condition to the staff member designated by the ECE program or school for decision-making and action related to care of ill children and staff members. That person, in turn, alerts possibly exposed family and staff members to watch for symptoms and notifies the Child Care Health Consultant.

  • ? Ensure staff members follow the control measures listed in the section How do you control it?

  • ? Do not allow a staff member with diarrhea to be involved with food handling or feeding of children.

  • ? Report outbreaks of diarrhea (more than 2 children and/or staff members in the group) to the Child Care Health Consultant, who may report to the local health department.

• If you know a child or staff member in the program has Giardia infection

  • ? Follow the advice of the child's or staff member's health professional.

  • ? Report the infection to the local health department. The health professional who makes the diagnosis may not report that the infected child is a participant in an ECE program or school, and this could lead to delay in controlling the spread.

  • ? Reeducate staff members about strict and frequent handwashing, diapering, toileting, food handling, and cleaning and disinfection procedures.

  • ? In an outbreak, follow the directions of the local health department.

• Administer medication as prescribed. Some infections are self-limited, and treatment is not required.

Exclude from educational setting?

Yes, if

• The local health department determines exclusion is needed to control an outbreak.

• Stool is not contained in the diaper for diapered children.

• Diarrhea is causing "accidents" for toilet-trained children.

• Stool is more watery and frequency exceeds 2 stools above normal for that child during the time the child is in the program because this may cause too much work for EC educators and make it difficult for them to maintain sanitary conditions.

• There is blood or mucus in stool.

• The stool is all black.

• The child has a dry mouth, no tears, or no urine output in 8 hours (suggesting the child's diarrhea may be causing dehydration).

• The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.

• The child meets other exclusion criteria (see Conditions Requiring Temporary Exclusion in Chapter 4 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition).

Note: For educators and children without symptoms (ie, recently recovered or exposed), testing stool cultures, treatment, and exclusion are not necessary.

Readmit to educational setting?

Yes, when all the following criteria are met:

• Once diapered children have their stool contained by the diaper (even if the stools remain loose) and when toilet-trained children do not have toileting accidents

• Once stool frequency is no more than 2 stools above normal for that child during the time the child is in the program, even if the stools remain loose

• When exclusion criteria are resolved, the child is able to participate, and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group

• Negative Giardia stool test results are not required for readmission to an educational setting