Even More Cases Get Reported

As you continue investigating the cases, the number of new reported cases is rapidly increasing.

In October, 40 cases are reported. You are now spending hundreds of hours investigating the cases, and continue to work closely with MDPH and other Dunnit LBOH personnel.

  • MDPH is able to get assistance from the CDC and an epidemic intelligence service (EIS) officer is assigned to the assist in the investigation
  • There is no doubt that this is an outbreak

Because Giardiasis is spread by the fecal-oral route, the DBOH has begun collaborating with local hospitals, daycare centers, town recreational and school departments, and healthcare providers to increase awareness of proper handwashing and other methods to prevent the spread of disease.

  • You also collaborate with MDPH and a local laboratory to encourage suspected cases and contacts to get tested for Giardia.

Open the Giardiasis chapter of the Guide, then use Section 4 (Controlling Further Spread) to answer the following questions

 

During the investigation, many sources of exposure are considered, including local restaurants, daycare centers, municipal drinking water, and a country club. As the investigation progresses, a common link appears to be a private country club in Dunnit. Many of the cases are members or were guests of the country club.

golf course The country club includes an 18-hole golf course, basketball and tennis courts, a clubhouse, a restaurant, an outdoor adult swimming pool and wading pool, a pool area snack bar, and pool area restrooms with showers and a diaper changing station.

Further investigation narrows the link to the pools at the country club, which closed for the season on September 5. The snack bar and restrooms also closed for the season on that date.

Many residents are anxious to know the cause of the outbreak. Some are attempting to assign blame to the municipal water supply. However, the municipal water supply is regularly tested for Giardia and has had no positive results. Additionally, the distribution of cases is centered in one geographic area of town, while the water supply is regional (providing water to many towns, with none of them reporting cases of Giardiasis).

On November 7, the Dunnit LBOH issues an advisory, in consultation with MDPH. It explains:

  • There is a cluster of Giardiasis cases in Dunnit
  • The Dunnit LBOH is collaborating with MDPH and CDC
  • Signs and symptoms of Giardiasis
  • What to do if symptoms appear
  • There was no link to the municipal water supply
  • How to get more information

The advisory does not mention the link to the pools at the country club because the investigation is still ongoing. While it does appear that the initial cases were linked to those pools, many new cases were reported after the pools were closed (well beyond the exposure period). It is clear that something else is causing the continued spread of the disease.

In November, another 50 new cases are reported.

Is this an unexpected increase?

No. Due to all of the case investigation and follow up work by the DBOH, residents are aware of the outbreak and many are getting laboratory testing if they have GI symptoms.

The Dunnit LBOH is continuing their collaboration with local hospitals, daycares, and healthcare providers to increase awareness and testing. Proper handwashing to prevent fecal-oral spread is a focus of health education efforts.