**7. Treatments decrease giardiasis risk**

#### **7.1. Water**

It has been proven that the use of effective removal treatments for *Giardia* in water decreases the risk of acquiring the disease considerably. According to Surface Water Treatment Rule (SWTR), a series of requirements for superficial and underwater treatments were developed, which specify a removal or minimum inactivation of 3 log for *Giardia* [61].

The stabilization ponds are biological treatment systems that consist of excavated deposits with the sufficient surface and volume to provide the treatment periods; depending on oxygen requirements, the artificial lagoons can be aerobic, facultative, and anaerobic; it has been reported that these lagoons eliminate up to 2 logarithmic units of *Giardia* cysts. Stabilization ponds are the most conventional and it does not reach the minimum requirements for cyst removal according to the EPA; only does aerobic digestion reach 1.3 log of *Giardia* removal [11]; as to the water treatment with coagulation-flocculation only two logarithmic units of removal were achieved [78].

Currently, the best *Giardia* cyst removal treatments consist of using activated mud together with UV disinfection, with which 3.6 logarithmic units of cyst removal are reached [79]. The future bets on removing water contaminants by nanotechnological compounds, for example, nanocompounds of clay polymers and nanoadsorbents based on carbon and polymerics. Besides being effective, these compounds are economic [80].

#### **7.2. Food**

After water, the most important infection route with *Giardia* cysts is by food. The infections caused by these parasites are greatly the result of bad hygiene of the person responsible for food preparation. *Giardia* is always found coinfecting with other microorganisms, such as *Cryptosporidium*, *Vibrio cholerae*, and *Rotavirus* [81].

The consumption of raw food increases the risk of infection, which is why international recommendations exist to provide innocuousness in food preparation. It is especially important to (1) practice adequate hand hygiene for protection against this parasite; (2) buy food from reliable providers; (3) maintain food packed or closed; (4) perform pest control frequently; (5) make sure refrigerator temperature is below 5°C; (6) avoid cross-contamination by surfaces and recipients; (7) separate cooked from raw food; (8) use purified or boiled water especially if food is consumed raw; and (9) make sure food is cooked at high temperatures (≥70°C).

One of the main regulators of food innocuousness is the system ISO 22000, which is a combination of preliminary programs, such as the hazard analysis and critical control point (HACCP) principles, the implementation steps defined by the *Codex Alimentarius* Commission (CAC) and the regulated components of the norm ISO 9001:2000 [82].
