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Dainon
07-26-2005, 08:49
A very long but interesting article in the Los Angles Times (July 26, 05) on water safety for hikers:

Bob DERLET drinks his water straight — without fancy filters or chemical treatments. He leans face down into Delaney Creek, which flows directly down into Tuolumne Meadows from the Sierra Crest, taking healthy gulps from the rushing stream, and then fills his water bottle. It's nearly noon on an early summer day, and temperatures are hovering in the mid-80s. After a rigorous two-mile ascent in altitudes around 9,500 feet, the pristine mountain water is indescribably refreshing: no chemical aftertaste of tap water and chilled to perfection by the Sierra's melting snowpack.

"No one camps above here. There's no livestock or park animals so there's little chance of contamination," says Derlet, gesturing toward Mt. Dana in the distance and the lush, grassy alpine meadow surrounding the creek.

Derlet should know. The emergency room physician and professor at UC Davis School of Medicine in Sacramento has spent part of the last five summers hiking about 2,000 miles throughout the Sierra and stopping at spots such as Bubbs Creek in Kings Canyon and Vogelsang Lake in Yosemite to test the water at 100 sites each year for the presence of microscopic miscreants.

It's a Herculean task, but he's driven by a desire to meld his lifelong passion for the outdoors with his expertise as a scientist. Because half of California's fresh water comes from the Sierra Nevada, Derlet is curious about pollution levels in the wilderness and what that would mean for the future of a state whose growth is dependent on clean water. Funded by grants from the Wilderness Medical Society, Derlet's field work is part of a projected 20-year water quality study.

But what he's uncovered already is surprising, both for the seasoned wilderness traveler as well as the day hiker who stares longingly at a gushing river and wonders whether it's safe to take a slug. At many trails and backcountry camps throughout California, signs warn visitors off casual sipping. But are the dangers of Giardia lamblia, E. coli, Cryptosporidium and other bugs that wreak intestinal havoc grossly exaggerated?

Derlet thinks so, and his research reveals that the water is much cleaner than most people believe. His findings thrust him into the middle of a long-simmering controversy that's blatantly at odds with what many state biologists preach and what wilderness classes teach: Purify water before drinking. But is that really necessary? Do those high-priced pumps, chemical disinfectants and elaborate filtration gadgets truly merit a place in the backpack?

"It's a huge debate," says Ryan Jordan, a biofilm engineer at Montana State University in Bozeman who has studied pollution in wilderness areas.

The available scientific evidence, which is admittedly limited because of the scarcity of funding for testing wilderness water quality, confirms Derlet's findings. The threat is comparable to the chances of beachgoers being attacked by a shark, according to University of Cincinnati researchers who studied the danger giardia poses to backpackers, namely "an extraordinarily rare event to which the public and the press have seemingly devoted inappropriate attention."

And yet, some doctors say that backcountry water is not safe to drink, even if it looks clear as glass. Defecating wildlife and encroaching hordes of campers who aren't environmentally savvy have spoiled the lakes, rivers and streams of the pristine wilderness. "Infectious agents don't change the water's appearance. You can't taste, smell or see them," says Dr. Paul Auerbach, an emergency room physician at Stanford University in Palo Alto and author of the standard text "Field Guide to Wilderness Medicine." "All it takes is a few beavers upstream, and you're in big trouble."

The National Park System and the U.S. Forest Service urge backpackers not to drink untreated water, and it has become an accepted article of faith among wilderness travelers that a water cleanser is as indispensable as a tent, compass and boots. Veteran backpackers like Jim Metropulos, who handles water quality issues for the Sierra Club in Sacramento, view water purification devices as an insurance policy that "provides a backup layer of security."

Little wonder people are convinced that drinking untreated water these days is inviting trouble. A bad case of the runs can ruin a backpacking trek, and you can end up chained to the bathroom for weeks if you contract giardiasis, the intestinal scourge that ignited the water purification debate more than two decades ago. "The issue was first widely publicized in the early 1980s," says Derlet. "Because it only takes a small dose, 10 to 25 giardia cysts [infectious particles of the parasite], to become sickened, people were alarmed."

Some point the finger at pump makers for inflating the risks and making backpackers ultra-vigilant about purifying water. "The advent of affordable water filters kick-started this whole debate," says Jordan, who is also editor of Backpacking Light magazine. "There's a lot of money in water filters: They cost anywhere from $40 to $100 a pop, and there are several million backpackers in the United States, so do the math. The water filter industry has instilled in people a mantra of 'you just never know,' rather than trying to educate them about the differences between good water sources and bad ones."

The results of a study conducted in 1993 by researchers at the University of Nevada in Reno and the U.S. Geological Survey in Sacramento were eye-opening. Of 41 backpackers who trekked to the Desolation Wilderness in Eldorado National Forest west of Lake Tahoe, six of them were stricken with cramping, diarrhea, nausea and bloating. Yet lab tests revealed that none of them was infected with giardiasis. Researchers didn't determine exactly which bugs were sickening the backpackers, but they think the culprits were the usual suspects — E. coli, salmonella or Campylobacter jejuni — which they might not have contracted from drinking water.

Taking this research one step further, the scientists analyzed the backcountry water for giardia. The bug was indeed present, but at such low levels of concentration — just a few cysts per 100 gallons — that backpackers, on average, would have to drink 250 gallons a day to become ill.

"People tell me they went on a five-day backpacking trip and when they got back they got diarrhea, so they assume they had giardia," says Derlet. "But when I ask them if they've been tested for it, they haven't. But they're still convinced that it has to be that. The fact is that if someone develops diarrhea after a wilderness trip, they most likely got the bug before they entered the wilderness or from someone while they were on the trip, not from the water."

The 1995 University of Cincinnati survey of 48 of the 50 state health departments in the United States came to similar conclusions. Only two of the agencies considered giardia a problem for backpackers, and even then, they had no data to support this concern. Although giardia sickens about 20,000 Americans each year — outbreaks have been linked to contaminated drinking water in small towns, food handlers and child-care workers who are infected when they change diapers — the researchers didn't find any evidence that wilderness water is a cause. "Neither health department surveillance nor the medical literature," they note, "support the widely held perception that [giardia] is a significant risk to backpackers."

The reality is that poor personal hygiene, not contaminated water, "is to blame for people getting sick in the backcountry," says Gregg Fauth, wilderness manager for Sequoia and Kings Canyon national parks. Diarrhea-causing bugs, such as giardia and its cousin, Cryptosporidium, two parasites that live in the intestines of animals and humans, are transmitted through fecal matter — primarily by people who don't practice good sanitary habits, such as washing their hands or properly disposing of their feces, which should be buried at least 10 feet away from the water.

The typical chain of events is that hikers or backpackers go to the bathroom, then don't wash their hands thoroughly, if at all. Afterward they make dinner or even share a snack and contaminate the food with fecal matter, along with any disease-causing germs that were hitching a ride in their intestines. Giardia can even be spread by touching surfaces — eating utensils, camping gear, water filtration pumps — that are contaminated with feces from an infected person.

"We are so dependent on convenient sanitation that when people go out in the wilderness," says Dr. Howard Backer, a water purification expert and a past president of the Wilderness Medical Society, "they fall apart, and their habits drop to Third World standards."

In light of this growing evidence, Derlet decided to do some testing of his own — not only to debunk some myths, but also to figure out ways to preserve wilderness water for future generations. Starting in early May until the first snowfall in October or November, Derlet shoehorns wilderness forays into his busy schedule of teaching, research and stints in the emergency room, racking up 24 miles on a day hike, during which he hits about 10 places, or taking three-day backpacking trips to visit more than 20 spots. In the process, he's become intimately acquainted with the terrain of nearly every lake, creek and tributary off the hiking trails in the Sierra.

By collecting enough information so that pollution patterns become strikingly apparent, he hopes to identify the reasons why some areas become contaminated while others remain pristine. That way, effective steps can be taken to keep all the waters clean. "Initially, this was instigated by the backpacking water quality debate," he says. "But I also want to come up with some conclusions about which water is always pure, which water is subject to pollution and why that is and what we can do about it."

Lean and lanky, the 56-year-old physician, with his shock of thick, dark hair and long unlined face, is a poster boy for the benefits of clean living. He nimbly climbs up the steep 700-foot incline from the trailhead off of Tioga Road, the two-lane blacktop that traverses Yosemite, to his first stop of the day: Dog Lake in Tuolumne Meadows near Lembert Dome, at the eastern edge of Yosemite. He walks in long loping strides past the lodgepole pines, and the profusion of yellow and red wildflowers that burst into life in the early summer, and kneels at the edge of the water.

"Lake water is better," he says, glancing up. "Most people think the water is better from a nice, running stream because it's so fresh and churned up. But the top few inches of lake water are zapped with ultraviolet rays from the sun, which are a very powerful disinfectant."

Despite his lofty goals, Derlet's testing methods are decidedly low-tech. He carries his equipment in a fanny pack strapped around his waist that is about the size and heft of a tool belt. His routine is virtually the same at each of the sites where he takes samples: He snaps on a pair of blue latex gloves to avoid contamination and then skims a plastic test tube along the surface of the water, collecting just enough to fill the 2-inch rectangular container, which he stores neatly in an ice chest that he stows in his SUV. He dips a thermometer in the water, and then jots down the time, water temperature and altitude on a log to record each visit. The samples will be taken back to his laboratory at UC Davis and tested for such bugs as giardia.

After making the late morning ascent to Dog Lake, he drives along Tioga Road to do a series of hikes into other places in the park, ranging from the highlands of Tioga Pass, where he clambers through packed snow in altitudes that climb to 10,000 feet, to boulder-strewn trails in the lower elevations around Tenaya Lake closer to Yosemite Valley. He finishes up in the early evening after treks along Gaylor, Budd, Snow and Yosemite creeks to collect samples in designated wilderness areas that aren't heavily trafficked.

It's an arduous day, but what his research reveals so far is encouraging: High Sierra waters are not nearly as polluted as was thought 15 or 20 years ago and contain about 10,000 normal aquatic bacteria per quart, which is not harmful at all. Derlet has mostly found low levels of E. coli, primarily in regions below cattle grazing tracts and popular campgrounds, and Yersinia enterocolitica, a bacteria from the droppings of migrating flocks of birds, in high country alpine lakes. The most fecal matter he's unearthed has been in the runoff from the melting snow in the spring, when it washes the ground, and sweeps everything, including manure, into the streams. The only situation in which Derlet treats water is below sheep and cattle pastures, and in slow-flowing warm streams immediately below heavily used campsites. Otherwise, most of the water is clean enough to drink

"I've felt at home in the wilderness for the past 50 years," he reflects, perched on a log near the trailhead leading to Gaylor Lakes in between bites of a tuna salad, fruit and crackers. "I want to do whatever I can to ensure that 100 years from now, we have clean water and clean forests. That why I'm doing this — to contribute to the science to help preserve it and to distill the true science from rumor."

TIPS

Drink responsibly

There are many places in the Sierra where you can safely drink the water, but choose carefully. "If you have a question, then treat it," says Gregg Fauth, wilderness manager for Sequoia and Kings Canyon National Parks. But if you have a hankering for fresh water and don't want to lug a pump or disinfectants that make the water unappetizing, drinking smart can minimize risks of getting sick.

Don't drink untreated water in places downstream from livestock pastures and large backpacker camps. "Humans and cattle are the worst offenders," Fauth says.

Water at higher elevations is safer because there's less risk of pollution by humans or wildlife. As water travels to lower elevations, it can pick up contaminants along the way.

Lake water, especially the top few inches, has less bacteria than running streams because the rays of the sun act as a disinfectant. And big lakes are better than smaller, shallow lakes because there's more of a surface to sanitize.

Clean melted snow is less risky than ice from the surface of a lake or stream because hardy diarrhea-causing bacteria can survive for months on ice.

Deep well water is considered safe because the water is filtered when passing through the soil, which removes giardia cysts. Springs bubbling from the side of a mountain are generally safe too.

Avoid drinking untreated water from stagnant ponds or slow-moving streams.

Don't leave home without them: Alcohol hand gels, which are available in drug stores, are incredibly effective at inactivating bacteria on your hands. "Washing your hands," says Dr. Howard Backer, a water purification expert, "will prevent you from spreading bacteria to your fellow camper when you prepare the food."

SGT Rock
07-26-2005, 09:37
Great Article!

Lone Wolf
07-26-2005, 09:40
I'm with the doc. I drink water worry free.

SGT Rock
07-26-2005, 09:43
I'm with the doc. I drink water worry free.Yes, but do you remember to wash your nasty hands :cool:

Alligator
07-26-2005, 10:03
I think it was somewhere in the ATC's new mag about two guys doing some water sampling along the AT. Hopefully the data will be available soon.

Lanthar Mandragoran
07-26-2005, 10:38
I tend to lean to Derlet's side of the equation. Most disease is caused by improper sanitation rather than pollution.


And yet, some doctors say that backcountry water is not safe to drink, even if it looks clear as glass. Defecating wildlife and encroaching hordes of campers who aren't environmentally savvy have spoiled the lakes, rivers and streams of the pristine wilderness. "Infectious agents don't change the water's appearance. You can't taste, smell or see them," says Dr. Paul Auerbach, an emergency room physician at Stanford University in Palo Alto and author of the standard text "Field Guide to Wilderness Medicine." "All it takes is a few beavers upstream, and you're in big trouble."
My biggest gripe about this arguement is... then why haven't the beavers killed off all the deer?

As long as you're drinking responsibly, not much is likely to happen. Tap water in most large cities in america is far nastier than what you'll find in the backcountry. I'm pretty sure our bodies weren't designed to handle water laced with metal oxides...

SGT Rock
07-26-2005, 10:46
My biggest gripe about this arguement is... then why haven't the beavers killed off all the deer?
Come on, with logic like that we will never get a Federal Program to provide water filters for wildlife:datz

HikerHobo
07-26-2005, 11:00
Don't leave home without them: Alcohol hand gels!
Poor personal hygiene, not contaminated water, "is to blame
for people getting sick in the backcountry."

Lake water, especially the top few inches, has less bacteria.
The ultraviolet rays of the sun are a very powerful disinfectant.
Big lakes are better than smaller, shallow lakes; more of surface to sanitize.

Don't drink untreated water downstream from livestock pastures
and large backpacker camps. "Humans and cattle are the worst offenders."

Water at higher elevations is safer; less risk of pollution by humans
or wildlife. As water travels to lower elevations, it can pick up contaminants
along the way.

Clean melted snow is less risky; hardy diarrhea-causing bacteria
can survive for months on ice.

Deep well water is considered safe; water is filtered passing through
soil, which removes giardia cysts. Springs bubbling from the side of a
mountain are generally safe too.

Avoid drinking untreated water from stagnant ponds or slow-moving
streams.
"News" we can use.....
Good post!

Lanthar Mandragoran
07-26-2005, 11:01
Come on, with logic like that we will never get a Federal Program to provide water filters for wildlife:datz
:-?Wow, you know, an unscrupulous person could make some money on that idea, fit all the deer with muzzles with and integrated water filter. That's how to protect wildlife!

:DGawd, the image of that is insanely funny for some reason...

Mags
07-26-2005, 11:07
Great article! I forwarded it to my friends in Boulder who think I am nuts for drinking from the streams. Of course, I think they are nuts for using $100 filters! :)

SGT Rock
07-26-2005, 11:09
Here is a questions for the knowledgeable. Can I add this to our article database without violating any laws? I would think as long as there is proper link and citation we would be safe. Any thoughts?

tlbj6142
07-26-2005, 11:29
I'm more concerned about chemical run-off than bugs in the water. Quite a few places I hike are former coal mining areas. What about that stuff? AM handles that quite well.

MOWGLI
07-26-2005, 11:36
Diarrhea-causing bugs, such as giardia and its cousin, Cryptosporidium, two parasites that live in the intestines of animals and humans, are transmitted through fecal matter — primarily by people who don't practice good sanitary habits, such as washing their hands or properly disposing of their feces, which should be buried at least 10 feet away from the water.

Geez, I hope people are crapping more than 10' away from water sources!

Alligator
07-26-2005, 11:51
The only study mentioned in the article that is pertinent to the AT is possibly the University of Cincinnati article, which lacks a complete citation. Much of the article concerns the Sierras, with the tips section apparently provided by Gregg Fauth[for the Sierras]. While the tips section of the article might be reasonable the first half of the article presents data for the Sierras, making it a terrible lead-in for folks consider water treatment on the AT. I'm not saying I disagree with the findings about water quality, just that they don't necessarily transfer to the AT.

kncats
07-26-2005, 12:05
Here is a questions for the knowledgeable. Can I add this to our article database without violating any laws? I would think as long as there is proper link and citation we would be safe. Any thoughts?
While I personally think that much of the danger is probably overblown, I would question the direct applicability of this study/testing to the areas along the AT. It's two entirely different environments. The AT is much more accessible to many more people and I would suspect that there is more wildlife on the right coast that is capable of passing on giardia and crypto. I would love to see the results of similar testing done along the Appalachian Trail.

SGT Rock
07-26-2005, 12:36
It does say where the data was collected. Readers can still draw their own conclusions.

And, I think in the sense it shows that the main causes of gastrointestinal diseases appears to be from poor hygiene more than anything, and that Guardia is a lot more rare than people think, it is a good idea to maintain this as a good article on the subject. I've heard people say they had Guardia, but when asked about symptoms and where they think they got it, it doesn't seem to be Guardia, it seems to be standard food contamination. If this is true even in the east, then the warning about cleanliness is VERY applicable.

But personally I agree with the part:


Some point the finger at pump makers for inflating the risks and making backpackers ultra-vigilant about purifying water. "The advent of affordable water filters kick-started this whole debate," says Jordan, who is also editor of Backpacking Light magazine. "There's a lot of money in water filters: They cost anywhere from $40 to $100 a pop, and there are several million backpackers in the United States, so do the math. The water filter industry has instilled in people a mantra of 'you just never know,' rather than trying to educate them about the differences between good water sources and bad ones."
I backpacked for years and remember the first time someone hipped me to even using Iodine. Then filters came along and now many people feel they have to have them to be safe, yada yada yada. As soon as the data comes out from somewhere saying water on the AT is 90% safe, then someone will have a reason that we should still buy $100 filters because of the 10%.

soulrebel
07-26-2005, 14:10
Great article!!!

Anybody watch Outdoor Investigations? A recent episode covered the growing problem of meth labs being run in our forests. Before I even saw the show, I was aware that ICE (methamphetamines) is becoming rampant through the country. And as seen on the show, 3 or 4 illegal immigrants generally run a lab for a week, then dump the chemicals and residues into a stream or runoff ditch...

Anybody else concerned about this growing problem?

And how do you think the hiker community can help free up or provide resources so that rangers can remove illegal drug production from public lands?

Alligator
07-26-2005, 15:30
It does say where the data was collected. Readers can still draw their own conclusions. Yes it does, and if this was a general hiking site, I might not object. It is, however an AT site.


And, I think in the sense it shows that the main causes of gastrointestinal diseases appears to be from poor hygiene more than anything, and that Guardia is a lot more rare than people think, it is a good idea to maintain this as a good article on the subject. I've heard people say they had Guardia, but when asked about symptoms and where they think they got it, it doesn't seem to be Guardia, it seems to be standard food contamination. If this is true even in the east, then the warning about cleanliness is VERY applicable. This article does not present any evidence that the gastrointestinal distress incurred by the hikers resulted from poor hygiene. From the article

Yet lab tests revealed that none of them was infected with giardiasis. Researchers didn't determine exactly which bugs were sickening the backpackers, but they think the culprits were the usual suspects — E. coli, salmonella or Campylobacter jejuni — which they might not have contracted from drinking water.
An underlying premise of the article is that given the low levels of giardiasis in the Sierra Nevadas, some other culprit is the cause of illnesses there. However, the scientists did not demonstrate what caused the illness, they only speculate. At most their conclusions are, "In the Sierras, where giardiasis is rare, sick hikers were found not to suffer from giardia." This cannot be translated to the AT as the water quality has not been sufficiently tested. (As far as I'm aware, is there water data out there?)

I agree mostly with what you are saying Rock: that giardia is rare, sanitation is important, and that poor hygiene may cause the majority of gastrointestinal disorders. But this article does not have tight enough standards to be placed in the Articles section. It's not good enough IMO.

SGT Rock
07-26-2005, 18:51
OK, so too much Sierras. But I think a lot of the information, even if you took the information about the Serras as simple evidence about what was assumed and wat was reality, and then looked at the rest of the article with the findings as to which water sources were likely to be most safe and which were least safe, it still stands as good info for the AT.

Here is an article that talks specifically about Giardia, with special attention on the Sierras. Personally I think it is a better article about what Giardia really is and how much it really affects people, and other good to know info - except that it lacks some of the backpacker directed reccomendations of the first Article:

Retreived 26 July 2005 from http://www.californiamountaineer.com/giardia.html



January 21, 2002


Giardia Lamblia and Giardiasis





With Particular Attention to the Sierra Nevada








By Robert L. Rockwell



(View original Microsoft Word document (http://www.californiamountaineer.com/giardia2002.doc))












Figure 1. Giardia lamblia trophozoites as they appear with the scanning electron microscope.
(http://www.californiamountaineer.com/giardia.html#_ftn1)




Ask the average outdoors person about Giardia lamblia or giardiasis, and they have certainly heard about it. Almost always, however, they are considerably misinformed about both the organism’s prevalence in wilder­ness water, and the seriousness of the disease if contracted.

With the advent of the Internet, the amount of information one can easily find on the subject is voluminous. Unfortunately, most of it is flawed in important aspects, being unsubstantiated, anecdotal, or merely quoting other unsubstantiated and anecdotal articles. Official sources, such as many informational publications put out by the US government, are not immune to this criticism.

This paper is the result of a critical distillation of relevant articles, retaining only those from scholarly, peer-reviewed, or otherwise professional and trustworthy sources.

One conclusion of this paper is that you can indeed contract giardiasis on visits to the Sierra Nevada, but it won’t be from the water. So drink freely and confidently: Proper personal hygiene is far more important in avoiding giardiasis than treating the water.

First, an excerpt written by a highly regarded wilderness physician:



“In recent years, frantic alarms about the perils of giardiasis have aroused exaggerated concern about this infestation. Government agencies, particularly the United States Park Service and the National Forest Service, have filtered hundreds of gallons of water from wilderness streams, found one or two organisms (far less than enough to be infective), and erected garish signs proclaiming the water ‘hazardous.’”[1] (http://www.californiamountaineer.com/giardia.html#_edn1)



And another, by researchers who surveyed the health departments in all 50 states and scanned the medical literature looking for evidence that giardiasis is a significant threat to outdoor folk:



“Neither health department surveillance nor the medical literature supports the widely held perception that giardiasis is a significant risk to backpackers in the United States. In some respects, this situation resembles (the threat to beachgoers of a) shark attack: an extraordinarily rare event to which the public and press have seemingly devoted inappropriate attention.”[2] (http://www.californiamountaineer.com/giardia.html#_edn2)



I explored this subject in 1987[3] (http://www.californiamountaineer.com/giardia.html#_edn3) and again in 1996[4] (http://www.californiamountaineer.com/giardia.html#_edn4) with an update in 1997.[5] (http://www.californiamountaineer.com/giardia.html#_edn5) The conclusions have always been that the “Giardia problem” in Sierra Nevada water is grossly exaggerated, and that the cases of giardiasis subsequent to wilderness visits are wrongly blamed on the water. After incorporating the recent information for this paper, those prior conclusions are not only still valid but also considerably reinforced.



Just who is this little guy, anyway? [6] (http://www.californiamountaineer.com/giardia.html#_edn6), [7] (http://www.californiamountaineer.com/giardia.html#_edn7), [8] (http://www.californiamountaineer.com/giardia.html#_edn8), [9] (http://www.californiamountaineer.com/giardia.html#_edn9), [10] (http://www.californiamountaineer.com/giardia.html#_edn10)

Giardia lamblia, now also known as G. intestinalis or G. duodenalis, was first observed in 1681 by Anton van Leeuwenhoek, inventor of the microscope. The parasite was named in 1915 for two scientists who studied it: Prof. A. Giard in Paris and Dr. F. Lambl in Prague.

Giardia is a flagellated (having whip-like appendages for locomotion) protozoan that, in the trophozoite (active) form, attaches itself with an adhesive disk to the lining of the upper intestinal tract of the host animal. There, it feeds and reproduces. Trophozoites divide by binary fission about every 12 hours. Thus, a single parasite can theoretically result in more than a million in 10 days and a billion in 15 days.

At some time in its active life, the trophozoite releases its hold on the bowel wall and floats in the fecal stream. As it makes its journey, it transforms into an egg-like structure called a cyst, which is eventually passed in the stool. Duration of cyst excretion, called shedding, may persist for months. Once outside the body, the cysts can be ingested by another animal. Then, they “hatch” into trophozoites due to stomach acid action and digestive enzymes, and the cycle repeats.

The trophozoite is 9 - 15 mm long, 5 - 15 mm wide, and 2 - 4 mm thick. Unlike the cyst, it cannot live for long outside a host. Cysts are 8 - 12 mm long by 6 - 9 mm in diameter; so a million could fit under a fingernail. Cysts can survive for as long as 2 to 3 months in cold water,10, [11] (http://www.californiamountaineer.com/giardia.html#_edn11) but they cannot tolerate freezing.9, [12] (http://www.californiamountaineer.com/giardia.html#_edn12)

A significant infestation can leave millions of trophozoites stuck tight to the intestinal lining. There, they cripple the gut’s ability to secrete enzymes and absorb food, especially fats, thereby producing the disease’s symptoms. The symptoms typically appear one to two weeks after ingestion, with an average of nine days, but four weeks is not uncommon. Symptoms can vanish suddenly and then reappear. They may hide for months. They may not appear at all.10, [13] (http://www.californiamountaineer.com/giardia.html#_edn13)

There are three ways that giardiasis, the disease caused by ingesting Giardia cysts, can be contracted: contaminated water, contaminated food, and direct fecal-oral. A person who has just come down with the disease and who wishes to identify the source needs to reflect on not only the possibility of each of these, but in a suspect period ranging from typically one week to four weeks earlier.



The bad news: Giardia lamblia is almost everywhere 1, 6, 7, 8, 9, 10, [14] (http://www.californiamountaineer.com/giardia.html#_edn14), [15] (http://www.californiamountaineer.com/giardia.html#_edn15), [16] (http://www.californiamountaineer.com/giardia.html#_edn16), [17] (http://www.californiamountaineer.com/giardia.html#_edn17), [18] (http://www.californiamountaineer.com/giardia.html#_edn18), [19] (http://www.californiamountaineer.com/giardia.html#_edn19)

Giardiasis has been most often associated with travel to such places as Latin America, Africa, Asia, and the former Soviet Union. However, Giardia has always been present in wilderness streams, in the water supplies of most cities around the world, and even in the municipal water of large US cities. In fact, in the 1930s and 1940s, before regulated municipal water treatment plants, everyone was drinking Giardia all the time.[20] (http://www.californiamountaineer.com/giardia.html#_edn20)

Currently, Giardia lamblia is the most commonly diagnosed intestinal parasite in North America.22 It is the most frequently identified cause of diarrheal outbreaks associated with drinking water in this country. Fully 20 percent of the world’s population is infected, and up to 7 percent of Americans, most without any symptoms at all.10, [21] (http://www.californiamountaineer.com/giardia.html#_edn21) The Centers for Disease Control and Prevention (CDC) estimates that as many as 2,500,000 cases occur annually in the US or almost one for every 100 persons.[22] (http://www.californiamountaineer.com/giardia.html#_edn22)

Infestation rates of 60 percent of the children in day care centers across the country have been noted. Institutions for mentally retarded persons can have high rates. Other high-rate populations include promiscuous male homosexuals, international travelers, and patients with cystic fibrosis. And family members of these individuals.

In an incident in New Jersey a child had a “fecal accident” in a 700,000-liter swimming pool, and nine swimmers came down with the disease.[23] (http://www.californiamountaineer.com/giardia.html#_edn23) How many Giardia cysts might have been involved? The number of cysts shed in feces is highly variable but has been estimated as high as 900 million per day for humans.

Municipal water utilities must use filters to remove the organism. San Francisco water, coming primarily from the Hetch Hetchy watershed in Yosemite National Park, has repeatedly tested positive for Giardia, although at very low levels: typically 0.12 cysts per liter[†] (http://www.californiamountaineer.com/giardia.html#_ftn2). Water collected in Hetch Hetchy already meets govern­mental standards for drinking water and is not required to be filtered before distribution because of its high quality.[24] (http://www.californiamountaineer.com/giardia.html#_edn24) The Los Angeles Aqueduct, which transports water to that city from the eastern slopes of the Sierra Nevada, averages 0.03 cysts per liter.[25] (http://www.californiamountaineer.com/giardia.html#_edn25)

Drinking highly contaminated water is one way to get the disease. Less common in developed countries is direct passage from stool to the hands of a food preparer and then to the food itself. When 16 people got sick from the salad at a Connecticut picnic, the CDC tracked the source to a woman who had mixed the salad with her hands. She didn’t have giardiasis, but one of her children did—without any symptoms.13 A similar situation occurred in New Jersey, with the salad preparer testing positive for Giardia along with her child and pet rabbit.[26] (http://www.californiamountaineer.com/giardia.html#_edn26)

Contaminated food may be a less-common source for the general population, but for wilderness visitors, it may be the most important one. Put another way: If the water is clean, food-borne and direct fecal-oral routes are the only pathways.

On a recent climbing expedition to Tibet, members of our party came down again and again with what was undoubtedly giardiasis. Our water came from glacial melt, but all our food in advanced base camp and below was prepared by Sherpa cooks. Much of the food they prepared—potatoes, rice, cauliflower, cabbage, onions—came from Nepal. We were continually assured that the cooks were practicing good hygiene, yet we had major intestinal problems that prevented many of the participants from getting high on the mountain.

The disease has been referred to as “beaver fever” because of a presumed link to those water-dwelling animals known to be carriers. However, it has been suggested that it is more likely that humans have carried the parasite into the wilderness and that beavers may actually be the victims. In particular, there is a growing amount of data showing that beavers living downstream from campgrounds have a high Giardia infection rate compared with a near-zero rate for beavers living in more remote areas.

In any case, beavers can and do contract giardiasis. Being water-dwellers, they are thus able to contaminate water more directly than an animal that defecates on the ground.

Other animals that can harbor Giardia are bighorn sheep, cats, cattle, coyotes, deer, dogs, elk, muskrats, pet rabbits, raccoons, and squirrels. But not horses and domestic sheep. And naturally occurring infections have not been found in most wild animals including badgers, bears, bobcats, ferrets, lynxes, marmots, moose, porcupines, rabbits, and skunks.

If “It’s everywhere!” why is it not more of a problem?



The good news: Most of the time, the concentration of Giardia cysts is very low 1, 6, 8

Outside of places where dirty diapers congregate and cities where water treatment plants break down or are ineffective, there is little room to worry. A few Giardia cysts now and then will cause no harm and in fact may be useful in developing an immunity as will be mentioned later.

How many cysts does it take to get the disease? Theoretically only one, but volunteer studies have shown that 10 or so are required to have a reasonable probability of contracting giardiasis: About one-third of persons ingesting 10 – 25 cysts get detectable cysts in their stools. 6, 7, 8, 10, [27] (http://www.californiamountaineer.com/giardia.html#_edn27), [28] (http://www.californiamountaineer.com/giardia.html#_edn28)

But be careful with statistics: Animal droppings containing 100,000 Giardia cysts deposited at the edge of a 10 million liter lake may be an average of only 0.01 per liter for the lake as a whole, but in the immediate vicinity of the deposit, the concentration can be much higher.

A comforting observation is that significant cyst inactivation, as high as 99.9 percent, can occur as a result of anaerobic digestion in sewage sludge.[29] (http://www.californiamountaineer.com/giardia.html#_edn29) Of course, using a simple cat hole is not exactly a good approxima­tion to the sewage plant process, but this points out the wisdom of doing something better than just leaving it on the ground or under a rock.

Since cysts that “winter over” in the Sierra Nevada are either in liquid water for considerably more than 2 to 3 months or exposed to freezing temperatures, it would appear that few will survive the harsh Sierra winters. So, except for pollution by winter mountaineers and non-hibernating animals, Giardia contamination in the high country must begin essentially anew each spring.



More good news: If you have a Giardia infestation, you will likely have no symptoms 1, 6, 7, 15, 16, [30] (http://www.californiamountaineer.com/giardia.html#_edn30), [31] (http://www.californiamountaineer.com/giardia.html#_edn31)

The symptoms of giardiasis vary widely. Characteristic symptoms, when they occur, are mild to moderate abdominal discomfort, abdominal distention due to increased intestinal gas, sulfurous or “rotten egg” burps, highly offensive flatulence, and mild to moderate diarrhea. Stools are soft (but not liquid), bulky, and foul smelling. They have been described as greasy and frothy, and they float on the surface of water. Nausea, weakness, and loss of appetite may occur. Studies have shown that giardiasis can be suspected when the illness lasts seven or more days with at least two of the above symptoms.7

However, most infected individuals have no symptoms at all! In one incident1 studied by the CDC, disruption in a major city’s water disinfection system allowed the entire population to consume water heavily contaminated with Giardia. Yet only 11 percent of the exposed population developed symptoms even though 46 percent had organisms in their stools. These figures suggest that (a) even when ingesting large amounts of the parasite, the chance of contracting giardiasis is less than 1 in 2, and (b) if you are one of the unlucky ones to contract it, the chance of having symptoms is less than 1 in 4. But perhaps the most telling statistic is that drinking heavily contaminated water resulted in symptoms of giardiasis in only 1 case in 9.



If you have symptoms it may not be giardiasis 1, 7, 13, 16, [32] (http://www.californiamountaineer.com/giardia.html#_edn32)

Many people claim that they “got it” on a particular trip into the wilderness. Yet upon questioning, they usually report that the presence of Giardia was not confirmed in the laboratory. (Only 8 percent of persons with a diarrheal illness in this country seek medical care.22) Depending on the situation, other possible offenders are Campylobacter, Cryptosporidium, Salmonella, Shigella, Yersinia, Aeromonas, Clostridium, and Escherichia coli, with the last being the most common cause of traveler’s diarrhea worldwide. Food poisoning is also a possibility.

Cryptosporidiosis, in particular, is a growing problem in this country, and currently, there is no effective treatment for it. An outbreak in Milwaukee in 1993 caused 403,000 people to become ill and 100 to die. A year later, 43 people in Las Vegas died from the same disease.[33] (http://www.californiamountaineer.com/giardia.html#_edn33) The severity of cryptosporidiosis depends on the condition of the host’s immune system. In immu­nologically normal people, symptoms and duration are similar to those of giardiasis. But in persons whose immune systems have been compromised (e.g., AIDS victims), symptoms can be profound: Frequent (6 to 25), voluminous (1 to 25 liters) daily bowel movements, serious weight loss, and cyst shedding often persist for months.

The diarrhea being blamed on Giardia from that climbing trip a week ago may instead be due to some spoiled food eaten last night or Campylobacter in undercooked chicken four days ago. Or because the incubation period is usually from one to four weeks, even if it is giardiasis the uncertainty range indicates that the culprits could have been ingested anytime during a full three weeks worth of meals and beverages. People in high-risk groups for Giardia, such as family members of children in day care centers or promiscuous male homosexuals, have even more possible sources to consider. To indict a particular stream or lake under such circumstances, without being able to at least verify that cysts are indeed there at all, is illogical at best.

The type of diarrhea can help in the diagnosis: If it is liquid and mixes readily with water rather than floating on top and is not particularly foul smelling, the problem is likely something other than giardiasis. Diarrhea which lasts less than a week, untreated, is probably not from giardiasis.



Almost always, giardiasis goes away without treatment 1, 6, 7, 13, 14, 15, 30, [34] (http://www.californiamountaineer.com/giardia.html#_edn34)

If you are unlucky enough to get giardiasis with symptoms, the symptoms will probably go away in a week or so without treatment. You may still be harboring the cysts, however, and can unknowingly spread the disease. Thus, practicing commonly recommended wilderness sanitary habits—defecating 100 feet from water, burying or packing out feces and toilet paper, washing before handling food, etc.—is an excellent idea.

The Food and Drug Administration, observing that giardiasis is more prevalent in children than adults, suggests that many individuals seem to have a lasting immunity after infection.[35] (http://www.californiamountaineer.com/giardia.html#_edn35) Furthermore, citizens of cities and countries where the parasite is numerous clearly seem to have few if any problems with their own water, which also points to an acquired immunity. So there is a possible bright side to contracting the disease.

Looking for cysts and trophozoites in stool specimens under the microscopic has been the traditional method for diagnosing giardiasis, but it is notoriously unreliable. Now, however, an immunologic test (enzyme-linked immunosorbent assay, or ELISA) for the detection of Giardia antigens in stool samples is available. The antigens are present only if there is a Giardia infection. ELISA is a big improvement over the microscopic search, with detection sensitivities of 90 percent or more.

Rare individuals not only do not spontaneously rid themselves of the organisms but instead develop serious symptoms of malabsorption, weight loss, ulcer-like stomach pain, and other chronic disturbances. Fortunately, this occurs in fewer than 1 percent of those with infestations. These unlucky people need medical treatment.

Metronidazole (Flagyl) has been the standard medication, with about a 92 percent cure rate. Recommended by the CDC, it is not approved by the FDA for giardiasis because it can have some serious side effects and is potentially carcinogenic. Quinacrine (Atabrine) and furazolidone (Furoxone) are also prescribed. Tinidazole (Tinebah) is highly effective in single doses and is widely used throughout the world, but it is not available in the US; it can be purchased over-the-counter in many developing countries.7, 22

Giardiasis has been called a disease of “somes.” Some people do not contract it even from heavily contaminated sources. Some infestations vanish with no treatment at all. Some people become asymp­tomatic carriers. Some evidence suggests that some people acquire a natural immunity to some strains. And some strains seem more virulent than others.13

The problem may not be whether you are infected with the parasite but how harmoniously you both can live together. And how to get rid of the parasite when the harmony does not exist or is lost.6



So, what about the Sierra Nevada? 1, 6, 7, 8, 14, 16

In 1984, the US Geological Survey in cooperation with the California Department of Public Health examined water at 69 Sierra Nevada stream sites that were selected in consultation with Park Service and National Forest managers.[36] (http://www.californiamountaineer.com/giardia.html#_edn36) Forty-two of the stream sites were considered “high-use” (high probabil­ity of human fecal contamination), and 27 were “low-use.” Cysts were found at only 18 (43 percent) of the high-use sites and at 5 (19 percent) of the low-use sites. The highest concentration of Giardia cysts was 0.108 per liter of water in Susie Lake, south of Lake Tahoe. The next highest was 0.037 per liter near Long Lake, south­west of Bishop. Samples taken in the Mt. Whitney area varied from 0 (most sites) to 0.013 (Lone Pine Creek at Trail Camp) per liter. The concentration was 0.003 per liter in Lone Pine Creek at Whitney Portal.

Recall that San Francisco water can contain a concentration of 0.12 cysts per liter,24 a figure now seen to be higher than that measured anywhere in the Sierra. San Francisco city officials go to great lengths to assure their citizens that the water is safe to drink, and if true—as it most assuredly must be—this comparison alone is quite revealing.

Even Los Angeles Aqueduct water, with only 0.03 cysts per liter,25 has a higher concentration of Giardia than all but two of the 69 Sierra sites examined.

Taking the highest concentration measured in the Sierra (0.108), we can make some calculations. The probability[‡] (http://www.californiamountaineer.com/giardia.html#_ftn3) of finding 10 or more cysts in a liter of water—to have at least a one-third chance of contracting giardiasis—is about 10-17. Ten cysts in 10 liters of water, about 10-7. In fact, one would have to drink over 89 liters to have a 50 percent probability of ingesting 10 or more cysts.

A word of caution: The concentration is never uniform, as suggested by the “lake incident” above.

Another reason for caution: 1984 was some time ago, and areas of the Sierra may be differ­ently contaminated now: perhaps more, perhaps less. Also, while so much attention is being given to Giardia, there are worse organisms to worry about such as Campylobacter, Cryptosporidium, E. coli, and the other organisms mentioned earlier.

In an informative study,[37] (http://www.californiamountaineer.com/giardia.html#_edn37) investigators contacted thousands of visitors to one of the high-use sites during the summers of 1988 through 1990. Water samples taken on 10 different dates at each of three locations exhibited Giardia cyst concentrations between 0 and 0.062 (average 0.009) per liter. A goal was to enlist volunteers who were cyst-negative before their trip, verified by stool analysis, and then determine what fraction were cyst carriers after the trip. Unfortunately, stool collection is not a particularly enjoyable task, and only 41 people agreed to participate. Of these, two acquired Giardia cysts during their trip, but neither came down with symptoms. Six of the others exhibited post-visit intestinal symptoms, but none tested positive for Giardia (interestingly, all six had filtered their water). In sum, no cases of laboratory-confirmed symptomatic giardiasis were found.

The water that wilderness travelers are apt to drink, assuming that they use a little care, seems almost universally safe as far as Giardia is concerned. The study referred to earlier,2 in which the researchers concluded that the risk of contracting giardiasis in the wilderness is similar to that of a shark attack, is telling. What they did find is that Giardia and other intestinal bugs are for the most part spread by direct fecal-oral or food-borne transmission, not by contaminated drinking water. Since personal hygiene often takes a backseat when camping, the possibility of contracting giardiasis from someone in your own party—someone who is asymptomatic, probably—is real. Recalling that up to 7 percent of Americans, or 1 in 14, are infected, it is not surprising that wilderness visitors can indeed come home with a case of giardiasis contracted not from the water…but from one of their friends.

This theme, that reduced attention to personal hygiene is an important factor for contracting giardiasis in the wilderness, is becoming more frequent in the literature.2, 10, 14, 37, [38] (http://www.californiamountaineer.com/giardia.html#_edn38)

Outside of the Sierra, Giardia cysts in concentrations “as high as four per gallon[§] (http://www.californiamountaineer.com/giardia.html#_ftn4)” have been detected in untreated water in northeastern and western states.[39] (http://www.californiamountaineer.com/giardia.html#_edn39) But even with this concentration, one would have to consume over nine liters of water to have a 50 percent chance of ingesting 10 or more cysts.

Indeed, there may be as much unwarranted hysteria surrounding Giardia in wilderness water in these other areas as there is for the Sierra. For example, an oft-cited report describing acquisition of the disease by 65 percent of a group of students hiking in the Uinta Mountains of Utah[40] (http://www.californiamountaineer.com/giardia.html#_edn40) is now viewed with considerable skepticism. Specifically, the attack rate was far beyond that usually seen with water-contracted giardiasis, no cysts were identified in the suspect water, there was no association between water consumption rates and the likelihood of the disease, and the authors categorically discounted food-borne or fecal-oral spread, stating that it had never been reported (correct at the time).2



Personal observations

I started visiting the Sierra Nevada in the early 1950s and have spent much of my free time there. I have never treated the water, and I have never had symptoms of giardiasis as a consequence of my visits. My many similarly active friends and acquaintances also drink the water with no ill effects. But because of other organisms possibly present, we are always careful to “drink smart”:



· Drink from large fast-flowing streams whenever possible, preferably those entering from the side rather than those paralleling the trail.

· Drinking water from a lake is best advised at the inlet, with the next best place at the hopefully fast-flowing outlet.

· Few Giardia cysts survive harsh Sierra winters. Contamination begins essentially anew each year, so springtime water is safer than summer or fall.

· Water at higher elevations is safer than lower, partly because of reduced human and animal presence up high, and partly because water flowing to lower elevations picks up more contaminants the more distance it travels.

· The colder the water is, the more likely it is freshly melted, meaning less opportunity for contamina­tion.

· Because filtration of water through soil removes Giardia cysts, deep well water is considered safe.7 By implication, springs in the wilderness should be, too.

· One would think that after a heavy snow year, when streams run full and long, some kind of “flushing out” effect of lakes and streams must be occurring. Conversely, it makes sense to be more cautious in dry years.

· Avoid water that likely could have passed through an area subject to heavy human or animal use.

· If it doesn’t look good—it’s cloudy or has surface foam—treat it or don’t drink it.



If in doubt, treat it—but how? While useful in many instances, chlorine is not in general effective for Giardia disinfection, which is why swimming pools are primary sources for the disease. The best filters work, although they are costly, heavy, and bulky, and many are somewhat awkward to use.8, [41] (http://www.californiamountaineer.com/giardia.html#_edn41)

Boiling is usually inconvenient, but if you are preparing hot water for meals anyway, you may as well take advantage. Giardia cysts are highly susceptible to heat, and simply bringing water to 150° F. for five minutes,10 to 176° for a minute,8 or 190° momentarily, will kill them. But boiling for a few minutes at altitude is usually recommended because of the other organisms that may be present. At 10,000 feet elevation, water boils at 194°; at 14,000 feet, 187°.

Iodine is probably the best treatment choice, being inexpensive, convenient, and safe. Iodine is effective against most bacteria and viruses, too—and over a wide range of temperatures. (But Cryptosporidium may be resistant to iodine.) A popular system uses iodine crystals in a saturated water solution. Methods exist to mask or remove the iodine taste.



Summary figures

Here are some of the Giardia cyst concentrations discussed in various places above. Units are cysts per liter.



Concentration Comment

~1000 Typical swimming pool contamination

~100 Giardiasis is plausible[**] (http://www.californiamountaineer.com/giardia.html#_ftn5)

~10 Minimum needed to contract giardiasis**

~1 Some wilderness water outside California

0.12 San Francisco water

0.108 Worst Sierra Nevada water

0.030 Los Angeles water

0.013 Mt. Whitney at Trail Camp

0.003 Mt. Whitney at Whitney Portal




Conclusions

In a recent letter[42] (http://www.californiamountaineer.com/giardia.html#_edn42) the Supervisor of the Inyo National Forest admitted: “As to whether or not Giardia exists in the Sierra, we are not in a position to state a fact one way or the other.” This is a significant admission. So why do they persist in informing everyone that giardiasis is a potential hazard when visiting the Sierra Nevada?

First: They know that some waters might be contaminated by something, and Giardia is the organism on people’s minds so needs no elaboration. Contaminated water is certainly possible at lower elevations and in some locales. Noting in particular that novice hikers cannot be expected to make correct choices of which sources may be safe to drink, they point out that a conservative approach is to treat all water.

Second: If a person believes, albeit incorrectly, that they contracted giardiasis from Sierra Nevada water, they cannot accuse the Forest Service of not warning them. Potential lawsuits, for example to recoup medical expenses, are therefore avoided.

Unfortunately, this approach results in an incorrect perception of overall water quality in the Sierra by the general public. It also means that if someone contracts a gastrointestinal illness after a visit, they will be more apt to blame the water, having been “forewarned” that all water is suspect. And so the myth is perpetuated.

Untreated Sierra Nevada water should be, almost everywhere, safe to drink—if you “drink smart.” If you don’t “drink smart” you may ingest diarrhea-causing organisms. But it won’t be Giardia.

Because up to 1 in 14 of us carries the Giardia parasite, we all need to do what we can to keep the water pure. Defecate away from water, and bury it or carry it out.

Camp cooks in particular need to pay special attention to cleanliness. Wash hands thoroughly, especially before handling utensils and preparing meals. If you contract giardiasis in the back­country, blame your friends…not the water.

Sierra Nevada water has far too few Giardia cysts for you to contract an infestation from it. Even if you go somewhere where the concentration is high, you probably won’t get giardiasis. If you do get giardiasis, you probably won’t have any symptoms. If you have symptoms, they will probably go away by them­selves in a week or so. If they don’t or you develop serious persistent symptoms, you should seek medical treatment. Finally, those contracting giardiasis may develop immunity to it, thus lowering the likelihood that they will get it again.

There is certainly no reason for anxiety about giardiasis. Fewer than 1 percent of those who have an infestation, or about 5 percent of those with symptoms, need medical help.



Recommendation

Our wilderness managers are in a position to educate the outdoor public about the real culprit in the Giardia lamblia story: inadequate human hygiene. When they acknowledge that Sierra Nevada water has fewer Giardia cysts than, for example, the municipal water supply of the city of San Francisco, maybe they will turn their attention to it.

The thrust of the following observation is long overdue:



“Given the casual approach to personal hygiene that characterizes most backpacking treks, hand washing is likely to be a much more useful preventative strategy than water disinfection! [††] (http://www.californiamountaineer.com/giardia.html#_ftn6) This simple expedient, strictly enforced in health care, child care, and food service settings, is rarely mentioned in wilderness education materials.”2



About the author

Bob Rockwell has a BS in physics from the University of California, Berkeley, and PhD in biomedical engineering from Stanford University. He made his first trip into the Sierra Nevada in 1952 to climb Mt. Whitney, and he repeats this climb several times annually. In the course of making over a thousand Sierra Nevada ascents of hundreds of individual mountains, he has never filtered or otherwise treated the water and has never contracted symptoms of giardiasis. Retired since 1990, he is now able to fully indulge in his favorite pastime and spends more time there, enjoying the water, than ever before.



References



(http://www.californiamountaineer.com/giardia.html#_ftnref1) Original image by Arturo Gonzalez, CINVESTAV, Mexico. From http://www.biosci.ohio-state.edu/~parasite/giardia_sem.html


[†] (http://www.californiamountaineer.com/giardia.html#_ftnref2) The referenced sources use a variety of units for portraying cyst concentration: cysts per 100 liters, per 100 gallons, etc. For uniformity, all have been converted to cysts per liter since that is the size of the typical backpacker’s canteen.


[‡] (http://www.californiamountaineer.com/giardia.html#_ftnref3) These calculations involve use of a tool called the Poisson distribution.


[§] (http://www.californiamountaineer.com/giardia.html#_ftnref4) Author’s words.


[**] (http://www.californiamountaineer.com/giardia.html#_ftnref5) If one liter is consumed.


[††] (http://www.californiamountaineer.com/giardia.html#_ftnref6) Emphasis is in the original.




[1] (http://www.californiamountaineer.com/giardia.html#_ednref1) Wilkerson, James A., MD: Medicine for Mountaineering and Other Wilderness Activities. The Mountaineers, 4th edition, 1992


[2] (http://www.californiamountaineer.com/giardia.html#_ednref2) Welch, Thomas R. and Welch, Timothy P.: Giardiasis as a Threat to Backpackers in the United States: A Survey of State Health Departments. Wilderness and Environmental Medicine, Vol. 6, 1995


[3] (http://www.californiamountaineer.com/giardia.html#_ednref3) Rockwell, Bob: Giardiasis: Let’s Be Rational About It. Summit Magazine, Nov.-Dec. 1987


[4] (http://www.californiamountaineer.com/giardia.html#_ednref4) Rockwell, Bob: Giardia Lamblia and Giardiasis, with Implications for Sierra Nevada Visitors. California Mountaineering Club Newsletter, Vol. 7 no. 2, April 1996


[5] (http://www.californiamountaineer.com/giardia.html#_ednref5) Rockwell, Bob: Giardia Update. California Mountaineering Club Newsletter, Vol. 8 no. 2, April 1997


[6] (http://www.californiamountaineer.com/giardia.html#_ednref6) Juranek, Dennis D.: Giardiasis. Centers for Disease Control and Prevention, 1990


[7] (http://www.californiamountaineer.com/giardia.html#_ednref7) Swartz, Morton N., MD: Intestinal Protozoan Infections. Scientific American Medicine, 1994


[8] (http://www.californiamountaineer.com/giardia.html#_ednref8) Kerasote, Ted: Great Outdoors; Drops to Drink. Audubon, July 1986


[9] (http://www.californiamountaineer.com/giardia.html#_ednref9) Microbial Risk Assessment for Reclaimed Water. EOA, Inc., Final Report. Oakland, CA, 1995


[10] (http://www.californiamountaineer.com/giardia.html#_ednref10) Backer, Howard D.: Giardiasis: An Elusive Cause of Gastrointestinal Distress. The Physician and Sportsmedicine, Vol. 28 no. 7, July 2000


[11] (http://www.californiamountaineer.com/giardia.html#_ednref11) DeReigner D. P., et al: Viability of Giardia Cysts Suspended in Lake, River, and Tap Water. Applied Environmental Microbiology, Vol. 55 no. 5, 1989


[12] (http://www.californiamountaineer.com/giardia.html#_ednref12) Olsen, M. E., et al: Survival of Giardia Cysts and Cryptosporidium Oocysts in Water, Soil and Cattle Feces. American Association of Veterinary Parasitologists, 43rd Annual Meeting, 1998


[13] (http://www.californiamountaineer.com/giardia.html#_ednref13) Moser, Penny Ward: Danger in Diaperland. Health, September/October 1991


[14] (http://www.californiamountaineer.com/giardia.html#_ednref14) Suk, Thomas: Eat, Drink and Be Wary. California Wilderness Coalition


[15] (http://www.californiamountaineer.com/giardia.html#_ednref15) Berkow, Robert, MD, Editor: Parasitic Infections—Giardiasis. The Merck Manual, 14th edition, 1997


[16] (http://www.californiamountaineer.com/giardia.html#_ednref16) Wilkerson, James and Caulfield, Page: Wilderness Water Disinfection. Appalachia, No. 4, Winter 1985-86


[17] (http://www.californiamountaineer.com/giardia.html#_ednref17) Bemrick, W. J.: Some Perspectives on the Transmission of Giardiasis. Giardia and Giardiasis: Biology, Pathogenesis and Epidemiology, Erlandsen and Meyer, Editors, Plenum Press, 1984


[18] (http://www.californiamountaineer.com/giardia.html#_ednref18) Feachem, R. G., et al: Sanitation and Disease: Health Aspects of Excreta and Wastewater Management. John Wiley and Sons, 1983
[19] (http://www.californiamountaineer.com/giardia.html#_ednref19)Communicable Diseases in California, 1994, 1995. State of California Department of Public Health.


[20] (http://www.californiamountaineer.com/giardia.html#_ednref20) Vitusis, Ziegfried, chief microbiologist at the EPA. Quoted in Backpacker, Dec. 1996


[21] (http://www.californiamountaineer.com/giardia.html#_ednref21) Kappus KD, Lundgren RG and Juranek DD: Intestinal Parasitism in the United States: Update on a Continuing Problem. American Journal of Tropical Medicine and Hygiene. Vol. 60 no. 6, 1994


[22] (http://www.californiamountaineer.com/giardia.html#_ednref22) Giardiasis Surveillance—United States, 1992—1997. Centers for Disease Control and Prevention, August 2000.


[23] (http://www.californiamountaineer.com/giardia.html#_ednref23) Porter, J. D., et al: Giardia Transmission in a Swimming Pool. American Journal of Public Health, Vol. 78 no. 6, 1988


[24] (http://www.californiamountaineer.com/giardia.html#_ednref24)2000 Annual Water Quality Report. Stanford Utilities Division and San Francisco Public Utilities Commission.


[25] (http://www.californiamountaineer.com/giardia.html#_ednref25) Annual Water Quality Report for 2000. Los Angeles Department of Water and Power


[26] (http://www.californiamountaineer.com/giardia.html#_ednref26) Bean, Nancy H., PhD, et al: Foodborne Disease Outbreaks, 5-year Summary, 1983 – 1987. Centers for Disease Control and Prevention, March 1990


[27] (http://www.californiamountaineer.com/giardia.html#_ednref27) Ortega, Y.R. et al: Giardia: Overview and update. Clinical Infectious Diseases, Vol. 25, 1997


[28] (http://www.californiamountaineer.com/giardia.html#_ednref28) Rendtorff, R: The Experimental Transmission of Human Intestinal Protozoan Parasites. American Journal of Hygiene, Vol. 59, 1954


[29] (http://www.californiamountaineer.com/giardia.html#_ednref29) Cravaghan, P. D., et al: Inactivation of Giardia by Anaerobic Digestion of Sludge. Water Science Technology, Vol. 27, 1993
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SGT Rock
07-26-2005, 19:16
Also, I found a copy of the Ohio report that is cited:

"Forty-eight of the 50 state health departments in the United States responded to a questionnaire about giardiasis in their jurisdictions. The agencies had reports of 34348 cases during 1991 and studied 80 outbreaks in the same period. Nineteen of these outbreaks were attributed to consumption of contaminated drinking water; only two outbreaks were reported among identified as campers or backpackers. Only two departments considered water-associated giardiasis to be a problem for backpackers in their jurisdictions, and neither had any data to support this concern. The surveillance data of health departments indicated that giardiasis is a common communicable disease in the Unite States. They do not, however, provide any evidence that wilderness water is an important cause of the disease in this country."

Giardiasis as a Threat to Backpackers in the United States: A Survey of State Health Departments. Retrieved 26 July 2005 from http://www.wemjournal.org/pdfserv/i1080-6032-006-02-0162.pdf

Alligator
07-26-2005, 20:53
The Rockwell article is much better in explaining what giardiasis is. It also makes a very good case for not filtering in the Sierras. And they should never have dammed the Hetch Hetchy valley anyway! That article also makes a great case for personal hygiene, given the high prevalence in Americans, about 1 in 14. It's a great personal hygiene article.

The first article in this thread says that ponds are better than streams, but the second says the reverse. That's about the only major discrepancy I would note.

I didn't really like the Ohio report, the authors discuss cases and investigating "outbreaks". I get the feeling that the state agencies only looked seriously at outbreaks, and may not have the information necessary for wilderness cases. They should define outbreak. Given what was said in the Rockwell article, I don't suspect that there would be an "outbreak" among backpackers, just a few cases now and then.

Some baseline data would be helpful for the AT. Maybe this will be provided soon. Given the nature of the AT, with the concentration of people, the linearity of the trail, and high shelter usage, I am not as sure the situation will be the same. Probably still a very low risk. Maybe around shelters, I suspect treating is a good thing, especially those without privies. I think it's a crapshoot:) . Personally I use both hand sanitizer and iodine.

I'll bet LW is a carrier, can anybody report an instance of Wolf having highly offensive flatulence? Actually, come to think of it maybe I'm a carrier :eek: . I always seem to have this problem while hiking, I assumed it was the dehydrated beans...

SGT Rock
07-26-2005, 21:06
I'll bet LW is a carrier, can anybody report an instance of Wolf having highly offensive flatulence? Actually, come to think of it maybe I'm a carrier :eek: . I always seem to have this problem while hiking, I assumed it was the dehydrated beans...
Funny that you mention that. I think I must be a carrier - at least my wife would probable say that :eek:

And being a resistant carrier would explain a lot of our personal experiences with back country water. I think I said this to Lone Wolf at least once on this board somewhere :D

As fore me, I use hand sanitizer and some Iodine too - but I don't always use the iodine - only when water is suspect. Water coming directly from earth at high elevation (above where humans normally frequent) has been my most trusted source. Large streams have always been my least. I've avoided ponds and lakes, but it looks like maybe this isn't needed.

Notice in the articles that some places of high human travel do have higher rates of giardiasis, but well below that needed to cause illness.

And add to that Roland Musser's book that showed there was a higher incidence of illness (he didn't try to just peg it to giardiasis as some do) among hikers using filters than hikers using iodine or not treating at all.

dixicritter
07-26-2005, 23:17
Funny that you mention that. I think I must be a carrier - at least my wife would probable say that :eek:



Yes I think Rock and His sons are all carriers... :bse