Changing approaches to the study of Giardia epidemiology: 1681-2000

Since the first description of Giardia by Antony van Leeuwenhoek in 1681, this parasite has proved to be enigmatic with a much more complicated epidemiology than originally envisaged. Even the nomenclature of this organism is confused. Despite numerous community prevalence studies, it was not until 1970 that the first proven report of waterborne transmission occurred. In 1981 the first common source outbreak due to contaminated food was recorded. It is also now recognized that venereal transmission occurs, especially among homosexual males. The faecal-oral route still remains the most important mode of infection despite the elucidation of these other methods of transmission. Recent developments in molecular biology especially DNA 'fingerprinting' and karyotyping which allow individual strain identification are being used to answer key epidemiological questions; for example are there truly pathogenic strains of Giardia, does drug resistance develop in vivo and is giardiasis a zoonotic disease? These and other molecular biological approaches will form the basis of research into the epidemiology of giardiasis and other intestinal protozoal infections until the end of the century and are certain to hold many surprises.