Risk assessment of Giardia in rivers of southern China based on continuous monitoring

The occurrence and risks of Giardia in China have been unclear to date, which has made it difficult to properly manage source water as well as to create reasonable drinking water standards. The levels of Giardia in river networks of several cities in Zhejiang Province, China were found to be in the range of 0-5 oocysts/10 L in the rainy season in 2008. The mortality due to Giardia infection for people in this region was calculated to be from 0 to 1.95 × 10^-8 persons using a conditional probability equation. Based on multiple unboiled water intake routes, the disability-adjusted life years (DALYs) due to Giardia infection for people who consumed conventionally treated water was 0.625 (95% CI: 0.137-2.05) per 10⁵ persons, with the symptom of hospitalization making the highest contribution to total DALYs (0.56 per 10⁵ persons; 95% CI: 0.122-1.84). The DALYs decreased to 0.425 (95% CI: 0.137-2.05) per 10⁵ persons per year for those consuming water treated with advanced technology. These values were lower than the acceptable risk (1.97 × 10^-5 DALYs per year). This study revealed the risk of Giardia infection to the people in river networks of Zhejiang Province for the first time, and provides a method to evaluate the risk of Giardia infection. The results are useful for the modification of drinking water quality standards based on cost-benefit analysis.