Campylobacteriosis, Eastern Townships, Quebec.Independent risk factors for campylobacteriosis (eating raw, rare, or undercooked poultry; consuming raw milk or raw milk products; and eating chicken or turkey in a commercial establishment) account for <50% of cases in Quebec. Substantial regional and seasonal variations in campylobacteriosis were not correlated with Campylobacter Campylobacter Genus of gram-negative spiral-shaped bacteria infecting mammals. Many species, especially C. fetus, cause miscarriage in sheep and cattle. C. jejuni is a common cause of food poisoning. Sources include meats (particularly chicken) and unpasteurized milk. in chickens and suggested environmental sources of infection, such as drinking water drinking water supply of water available to animals for drinking supplied via nipples, in troughs, dams, ponds and larger natural water sources; an insufficient supply leads to dehydration; it can be the source of infection, e.g. leptospirosis, salmonellosis, or of poisoning, e.g. . ********** Published case-control studies provide conflicting results regarding the risk factors for sporadic campylobacteriosis. Poultry is commonly considered the principal source, and in some studies, was implicated im·pli·cate tr.v. im·pli·cat·ed, im·pli·cat·ing, im·pli·cates 1. To involve or connect intimately or incriminatingly: evidence that implicates others in the plot. 2. in 50% to 70% of endemic cases (1,2). Campylobacter have been frequently cultured from poultry during processing (47%-82%) and retail distribution (23%-62%) (3-6). However, some studies observed no significant risk associated with eating chicken (7,8); in other studies, this factor was actually protective (9,10). We describe a prospective case-control study of domestically acquired Campylobacter infections combined with a prevalence study of Campylobacter spp. in whole retail chickens purchased in the Eastern Townships The Eastern Townships (French: Les Cantons de l'Est) is a tourist region in south-central Quebec, lying between the former seigneuries south of the Saint Lawrence River and the United States border. , Quebec. The Study The Eastern Townships comprise seven counties and total [approximately equal to] 300,000 inhabitants
The game is based loosely on the concepts from SameGame. . Hospital microbiology laboratories routinely report all Campylobacter enteritis campylobacter enteritis Infectious disease A water-borne gastroenteritis caused by C jejuni, a cause of travelers' diarrhea Epidemiology Linked to ingestion of contaminated eggs, poultry, water; 2-4 day incubation period Clinical Abdominal pain, ± cases to the regional public health department. All the laboratories in the study region, except in Granit County, routinely evaluated stool specimens for Campylobacter by using comparable standard methods for isolation and identification (Karmali or Skirrow media incubated for 72 h at 42[degrees]C in a microaerobic atmosphere). Granit County's laboratory sent stool specimens for Campylobacter culture to our hospital microbiology laboratory on special medical request only. Incidence rates of campylobacteriosis in the Eastern Townships and Quebec Province were calculated with demographic and reportable diseases reportable diseases, n.pl contagious diseases that must be reported by the physician to public health authorities. They include but are not limited to malaria, influenza, poliomyelitis, relapsing fever, typhus, yellow fever, cholera, and bubonic plague. data from provincial registers. All cases reported from July 1, 2000, through September 30, 2001, were eligible. Case-patients were excluded if the infection was acquired outside Quebec (i.e., travel abroad during the 10-day period before the onset of symptoms) or if the interval between the onset of symptoms and reporting was >6 weeks. All investigations were conducted within 2 weeks of reporting. For participants with infections reported on multiple occasions during the study period, the first episode of infection was considered. The median interval from the onset of symptoms to the interview of the cases was 13 days (range 5-56 days; 90th percentile percentile, n the number in a frequency distribution below which a certain percentage of fees will fall. E.g., the ninetieth percentile is the number that divides the distribution of fees into the lower 90% and the upper 10%, or that fee level , 23 days). Each case was matched for sex and age group (<1, 1-4, 5-14, 15-34, 35-64, and [greater than or equal to] 65 years) to two controls living in the Eastern Townships, who were identified through random digit dialing Random digit dialing (RDD) is a method for selecting people for involvement in telephone statistical surveys by generating telephone numbers at random. Random digit dialing has the advantage that it includes unlisted numbers that would be missed if the numbers were selected from a . Patients and controls were interviewed by telephone with a structured questionnaire to capture demographic and clinical data, travel history, food history, water consumption, recreational water activity, animal contacts, and other illness during the 10 days before the onset of symptoms. Controls had to be interviewed within 3 weeks of the patient and were excluded if they could not be reached after three telephone calls; had fever, abdominal pain Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem. , nausea, vomiting vomiting, ejection of food and other matter from the stomach through the mouth, often preceded by nausea. The process is initiated by stimulation of the vomiting center of the brain by nerve impulses from the gastrointestinal tract or other part of the body. , diarrhea, or bloody stools; traveled abroad during the 10-day period before the patient's onset of symptoms; or refused to participate. Controls did not have stool samples tested for Campylobacter. A surrogate parent was interviewed when the patient or control was a child <14 years of age. The interviewers were not blinded to the patient or control status of study participants. Risk factors for campylobacteriosis were evaluated by conditional logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. for matched data adjusted for the county of residency. All risk factors with p < 0.05 by univariate analysis were included in a multivariate, conditional, logistic regression, stepwise stepwise incremental; additional information is added at each step. stepwise multiple regression used when a large number of possible explanatory variables are available and there is difficulty interpreting the partial regression selection model for matched data. All statistical analyses were performed using SAS (1) (SAS Institute Inc., Cary, NC, www.sas.com) A software company that specializes in data warehousing and decision support software based on the SAS System. Founded in 1976, SAS is one of the world's largest privately held software companies. See SAS System. version 6.1 (SAS, Cary, NC). During the study, four fresh, eviscerated whole chickens were bought weekly in different counties (one chicken per store); for each county, the number of chickens sampled monthly was proportional to the population. Retail chickens sold in the Eastern Townships are produced by multiple companies based elsewhere in Quebec Province. The chickens were stored at 4[degrees]C overnight and washed vigorously with 250 mL of nutrient broth. The broth was filtered through cheesecloth cheese·cloth n. A coarse, loosely woven cotton gauze, originally used for wrapping cheese. cheesecloth Noun a light, loosely woven cotton cloth Noun 1. and centrifuged at 16,300 x g for 15 min. The sediment was suspended in 5 mL of brucella Brucella /Bru·cel·la/ (broo-sel´ah) a genus of schizomycetes (family Brucellaceae). B. abor´tus causes infectious abortion in cattle and is the most common cause of brucellosis in humans. B. broth; 100 mL of Park and Sanders' selective enrichment broth with 0.5 mL of Supplement A (0.2% vancomycin vancomycin (văn'kōmī`sĭn), antibiotic resembling penicillin in the way it acts. It is derived from the bacterium Streptomyces orientalis, which was isolated from soil of India and Indonesia. and 0.2% trimethoprim trimethoprim /tri·meth·o·prim/ (-meth´o-prim) an antibacterial closely related to pyrimethamine; almost always used in combination with a sulfonamide, primarily for the treatment of urinary tract infections. lactate Lactate A salt or ester of lactic acid (CH3CHOHCOOH). In lactates, the acidic hydrogen of the carboxyl group has been replaced by a metal or an organic radical. Lactates are optically active, with a chiral center at carbon 2. ) and 5 mL of Supplement B (0.064% sodium cefoperazone in brucella broth) (11) were added to the suspension, gently mixed, and incubated under microaerobic atmosphere at 37[degrees]C for 4 h, then at 42[degrees]C for 48 h. Three loopfuls (0.05 mL) of the suspension were plated on Karmali agar and incubated at 42[degrees]C for 48 h under microaerobic conditions. Isolates of Campylobacter were identified to the species level by routine phenotypic methods. From July 2000 through October 2001, a total of 201 cases of campylobacteriosis were reported, of which 43 were excluded: 18 patients acquired their infection outside Quebec, 18 resided outside the Eastern Townships, 6 could not be interviewed within 6 weeks after the onset of symptoms, and 1 patient declined to participate. All but two patients were matched to two controls each; consequently, the final dataset comprised 158 cases and 314 controls. Cases and controls were well-distributed across the seven counties, except in Val St-Francois, which represented 15% of cases and 7% of controls (data not shown). During the study period, the mean crude incidence of campylobacteriosis was 63.1/100,000 in the Eastern Townships, compared to 44.5/100,000 in the remainder of Quebec Province (p < 0.0001). Most cases occurred during July, August, and September (Figure 1). The median age of the case-patients was 31 years (range 11 days to 91 years). The incidence of campylobacteriosis varied considerably by age (Figure 2), with the highest rates among children 0-4 years of age (169.2/100,000) and young adults 15-34 years of age (mean = 79.4/100,000). Overall, 64 (40.5%) participants were female. [FIGURES 1-2 OMITTED] The rates varied from 38.3/100,000 in Memphremagog to 113.5/100,000 in Asbestos (excluding Granit, where case ascertainment was different); these interregional in·ter·re·gion·al adj. Of, involving, or connecting two or more regions: interregional migration; interregional banking. differences persisted after stratification for age (Table 1). The risk of campylobacteriosis was 2.4-fold higher in Asbestos (p = 0.0001) and 1.3-fold higher in Val St-Francois (p = 0.04) than elsewhere in the Eastern Townships. Among 41 exposure factors evaluated by univariate conditional logistic regression, four achieved p values < 0.01 (Table 2). Two were associated with poultry: eating raw, rare, or undercooked poultry (p = 0.003) and eating turkey or chicken in a restaurant, a fast food establishment, or a buffet (p = 0.004). Two were associated with other exposures: consuming raw milk or raw milk products (p = 0.0001) and professional exposure to animals or a contact with farm or zoo animals (p = 0.0003). No other activity related to consuming or handling poultry appeared related to infection (Table 2). Conditional multivariate analysis multivariate analysis, n a statistical approach used to evaluate multiple variables. multivariate analysis, n a set of techniques used when variation in several variables has to be studied simultaneously. adjusted for the county of residency resolved only three independent risk factors: raw, rare, or undercooked poultry (odds ratio [OR] 5.00, 95% confidence interval confidence interval, n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%. [CI] 1.79-13.98, p = 0.002), raw milk or raw milk products (OR 3.67, 95% CI 1.95-6.90, p = 0.0001), and turkey or chicken eaten in a restaurant, a fast food or a buffet (OR 1.96, 95% CI 1.24 3.11, p = 0.004). These factors accounted for 8%, 18%, and 20% of cases, respectively. A total of 177 chickens from 58 different food stores were cultured (median per month, 16; range 8-20). Campylobacter spp. were cultured from 41 (23%) (37 C. jejuni; 4 C. coli). The prevalence of Campylobacter was low from November 2000 to July 2001 inclusively, with 0-2 positive chickens (0%-25%) per month (Figure 1) but increased sharply in August, September, and October 2001, with rates reaching 69%, 55%, and 56%, respectively. The number of locally acquired Campylobacter enteritis in humans peaked at 16 cases in July 2001 (i.e., 1 month before the peak of chicken contamination) and then decreased to 11, 3, and 3 cases in August, September, and October 2001, respectively. Further, we analyzed data for each county separately and found no geographic correlation between campylobacteriosis in humans and Campylobacter in chickens (p = 0.42). Thus, although chicken consumption is an important risk factor for Campylobacter enteritis, it does not explain either the seasonal or regional variations in the incidence of sporadic cases of campylobacteriosis in humans. Conclusions Exposures to poultry account for fewer than half the episodes of sporadic Campylobacter infection. Substantial seasonal and interregional variations suggest environmental sources of infection. In the univariate analysis, drinking tap water at home or at work tended to be associated with an increased risk for infection (OR 1.90, p = 0.03), and in a subanalysis of cases in Asbestos County, which had the highest incidence, drinking tap water from a deep well at home was the only risk factor identified (53% of cases compared to 23% of controls; OR 3.83, p = 0.06 by univariate analysis and OR 3.96, p = 0.06 after adjusting for age group and sex). A recent case-control study (12) identified drinking water that was not disinfected Disinfected Decreased the number of microorganisms on or in an object. Mentioned in: Isolation as an independent risk factor for campylobacteriosis, with an etiologic fraction of 26%. These results are consistent with the hypothesis that the waterborne route of infection may be the common underlying pathway linking infection in humans, poultry, other domestic animals, and wild birds. In waterborne outbreaks associated with Campylobacter, fecal fecal /fe·cal/ (fe´k'l) pertaining to or of the nature of feces. fe·cal adj. Relating to or composed of feces. fecal pertaining to or of the nature of feces. contamination of the drinking water source has been traced to runoff of surface water after rain or to leakage from a sewage line into an adjacent drinking water pipe (13-15). Since a few hundred viable organisms represent an infectious dose, even apparently low levels of contamination could result in infection. The true importance of drinking water as a source of sporadic infection in humans may have been underestimated in the past and should be investigated in future studies.
Table 1. Incidence rates of campylobacteriosis in each county in the
Eastern Townships with crude and age-stratified relative risk compared
with incidence rates in the other counties in the region
Incidence
No. of Total rate per
County cases population 100,000
Asbestos 17 14,975 113.5
Val St-Francois 23 28,809 79.8
Sherbrooke 85 143,792 59.1
Coaticook 9 16,444 54.7
Memphremagog 16 41,785 38.3
Haut St-Francois 10 22,358 44.7
Granit 4 21,905 ND (c)
RR stratified
County Crude RR for age (a) p value (b)
Asbestos 2.23 2.37 0.0001
Val St-Francois 1.48 1.33 0.04
Sherbrooke 1.09 1.14 NS
Coaticook 0.97 0.85 NS
Memphremagog 0.64 0.79 NS
Haut St-Francois 0.78 0.74 NS
Granit ND (c) ND (c) ND (c)
(a) The relative risk (RR) represents the incidence rate of
campylobacteriosis in one county compared to the incidence rate in
the other counties taken as a whole, before (crude RR) and after
stratification for age (stratified RR).
(b) The p values apply to the stratified relative risks.
(c) Rates not calculated for county of Granit because of different
case ascertainment process used there; see text for details
Table 2. Exposure factors significantly associated with
campylobacteriosis (a) and other factors relating to consuming
and handling poultry (b,c)
Factor Case-patients Controls
Eating raw, rare or undercooked poultry 13/154 7/310
Consuming raw milk or raw milk products 33/153 25/310
Professional exposure to animals or contact 39/158 36/312
with farm or zoo animals
Eating turkey or chicken in a restaurant, 57/140 77/289
a fast food restaurant, or a buffet
Eating smoked turkey or chicken
In a restaurant, a fast food restaurant, 5/156 6/309
or a buffet
At home 42/153 93/310
Eating poultry cooked in fondue 5/156 7/312
Eating microwaved poultry 2/158 3/309
Eating barbecued poultry 34/157 66/310
Handling raw poultry 78/153 160/314
Eating microwaved chicken croquettes 5/157 11/308
Using the same plate to carry raw meat or 38/156 66/302
poultry and to take it back once cooked
Eating turkey or chicken at home 128/140 274/289
Eating ground turkey or chicken 3/158 12/314
Factor OR 95% CI
Eating raw, rare or undercooked poultry 4.51 1.67-12.14
Consuming raw milk or raw milk products 3.12 1.78-5.48
Professional exposure to animals or contact 2.53 1.44-4.13
with farm or zoo animals
Eating turkey or chicken in a restaurant, 1.89 1.23-2.90
a fast food restaurant, or a buffet
Eating smoked turkey or chicken
In a restaurant, a fast food restaurant, 1.67 0.50-5.57
or a buffet
At home 0.90 0.58-1.38
Eating poultry cooked in fondue 1.49 0.46-4.79
Eating microwaved poultry 1.36 0.22-8.26
Eating barbecued poultry 1.02 0.64-1.64
Handling raw poultry 0.97 0.66-1.44
Eating microwaved chicken croquettes 0.92 0.31-2.72
Using the same plate to carry raw meat or 0.78 0.48-1.29
poultry and to take it back once cooked
Eating turkey or chicken at home 0.58 0.26-1.27
Eating ground turkey or chicken 0.50 0.14-1.79
(a) By univariate conditional logistic regression for matched data
adjusted for the county of residency.
(b) Not associated with campylobacteriosis.
(c) OR, odds ratio; CI, confidence interval.
Acknowledgments We thank Diane Dion, Danielle Proulx Danielle Proulx (born October 12 1952) is a French Canadian actress. She is multi-award winning actress and she was married to Raymond Cloutier. Her son, Émile Proulx-Cloutier, is also an actor. She also has a niece, Catherine Proulx-Lemay, who is an actress. , Linda Billard, and Melanie Proulx for data collection; Reno Proulx for designing the random digit dial system; and Bruno Maynard for his appreciable help in purchasing chickens. Financial support was provided by Ministere de la Sante et des Services Sociaux du Quebec, the Regie Regionale de la Sante et des Services Sociaux de l'Estrie, and the Centre de Recherche re·cher·ché adj. 1. Uncommon; rare. 2. Exquisite; choice. 3. Overrefined; forced. 4. Pretentious; overblown. Clinique du Centre Hospitalier Universitaire de Sherbrooke. Dr. Michaud is a medical microbiologist and an infectious diseases infectious diseases: see communicable diseases. specialist at the Centre Hospitalier Universitaire de Sherbrooke and an adjunct professor at the Faculte de Medecine de l'Universite de Sherbrooke, Quebec “Sherbrooke” redirects here. For other uses, see Sherbrooke (disambiguation). Sherbrooke (2006 population: 147,427) is a city in south-eastern Quebec, Canada, the only major city in the Eastern Townships. , Canada. Her primary research interests are the clinical and molecular epidemiology molecular epidemiology Molecular medicine An evolving field that combines the tools of standard epidemiology–case studies, questionnaires and monitoring of exposure to external factors with the tools of molecular biology–eg, restriction endonucleases, of C. jejuni enteritis enteritis (ĕn'tərī`tĭs), inflammation of the gastrointestinal tract. Acute enteritis is not usually serious except in infants and older people, in whom the accompanying diarrhea can cause dehydration through the loss of fluids. . References (1.) Neal KR, Slack RC. The autumn peak in Campylobacter gastroenteritis Campylobacter gastroenteritis, n a gastrointestinal tract infection with typical symptoms, caused by C. jejuni bacteria, the microaerophilic bacteria naturally occurring in humans. . Are the risk factors the same for travel- and UK-acquired Campylobacter infections? J Public Health Med. 1995;17:98-102. (2.) Harris NV, Weiss NS, Nolan CM. The role of poultry and meats in the etiology of Campylobacter jejuni/coli enteritis. Am J Public Health. 1986;76:407-11. (3.) Park CE, Stankiewicz ZK, Lovett J, Hunt J. Incidence of Campylobacter jejuni Campylobacter jejuni Vibrio jejuni, Campylobacter fetus ssp jejuni A curved or spiral gram-negative bacillus with a single polar flagellum Epidemiology Linked to contact with domestic and farm animals, unpasteurized milk, primates, day care in fresh eviscerated whole market chickens. Can J Microbiol. 1981;27:841-2. (4.) Harris NV, Thompson D, Martin DC, Nolan CM. A survey of Campylobacter and other bacterial contaminants of pre- market chicken and retail poultry and meats, King County, Washington “King County” redirects here. For other uses, see King County (disambiguation). King County is located in the U.S. state of Washington. The population in the 2000 census was 1,737,034 and in 2006 was an estimated 1,835,300. . Am J Public Health. 1986;76:401-6. (5.) Bryan FL, Doyle MR Health risks and consequences of Salmonella and Campylobacter jejuni in raw poultry. J Food Prot. 1995;58:326-44. (6.) Prescott JF, Gellner OS. Intestinal carriage of Campylobacter jejuni and Salmonella by chicken flocks at slaughter. Can J Comp Med. 1984;48:329-31. (7.) Rodrigues LC, Cowden JM, Wheeler JG, Sethi D, Wall PG, Cumberland P, et al. The study of infectious intestinal disease in England: risk factors for cases of infectious intestinal disease with Campylobacter jejuni infection. Epidemiol Infect. 2001 ; 127:185-93. (8.) Effler P, leong MC, Kimura A, Nakata M, Burr R, Cremer E, et al. Sporadic Campylobacter jejuni infections in Hawaii: associations with prior antibiotic use and commercially prepared chicken. J Infect Dis. 2001;183:1152-5. (9.) Adak GK, Cowden JM, Nicholas S, Evans HS. The Public Health Laboratory Service national case-control study of primary indigenous sporadic cases of campylobacter infection. Epidemiol Infect. 1995;115:15-22. (10.) Eberhart-Phillips J, Walker N, Garrett N, Bell D, Sinclair D, Rainger W, et al. Campylobacteriosis in New Zealand New Zealand (zē`lənd), island country (2005 est. pop. 4,035,000), 104,454 sq mi (270,534 sq km), in the S Pacific Ocean, over 1,000 mi (1,600 km) SE of Australia. The capital is Wellington; the largest city and leading port is Auckland. : results of a case-control study. J Epidemiol Community Health. 1997;51:686-91. (11.) Sanders G. Isolation of Campylobacter from food. Laboratory Procedure MFLP-46. Ottawa, Canada: Health Protection Branch; 1998. (12.) Kapperud G, Espeland G, Wahl E, Walde A, Herikstad H, Gustavsen S, et al. Factors associated with increased and decreased risk of Campylobacter infection: a prospective case-control study in Norway. Am J Epidemiol. 2003; 158:234-42. (13.) Waterborne outbreak of gastroenteritis gastroenteritis: see enteritis. gastroenteritis Acute infectious syndrome of the stomach lining and intestines. Symptoms include diarrhea, vomiting, and abdominal cramps. associated with a contaminated contaminated, v 1. made radioactive by the addition of small quantities of radioactive material. 2. made contaminated by adding infective or radiographic materials. 3. an infective surface or object. municipal water supply, Walkerton, Ontario Walkerton is a town and is the county seat of Bruce County, Ontario. It is located on the Saugeen River and is 75 km southwest of Owen Sound. The town was incorporated in 1871 and was named after Joseph Walker, who settled in this area in 1850. , May-June 2000. Can Commun Dis Rep. 2000;26:170-3. (14.) Hanninen ML, Haajanen H, Pummi T, Wermundsen K, Katila ML, Sarkkinen H, et al. Detection and typing of Campylobacter jejuni and Campylobacter coli and analysis of indicator organisms in three waterborne outbreaks in Finland. Appl Environ Microbiol. 2003;69:1391-6. (15.) Koenraad PMFJ PMFJ Pardon Me for Jumping In , Rombouts FM, Notermans SHW SHW Sherwin-Williams Company (stock symbol) SHW Slide Show (file extension) SHW Super Heavy Weight SHW System High Workstation SHW Shortest Hop Win (throughput scheme) . Epidemiological aspects of thermophilic ther·mo·phil·ic adj. Requiring high temperatures for normal development, as certain bacteria. Campylobacter in water-related environments: a review. Water Environ Res. 1997;69:52-63. Address for correspondence: Sophie Michaud, Department of Microbiology and Infectious Diseases, Faculte de Medecine de l'Universite de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4 Canada; fax: 819-564-5392; email: Sophie.Michaud@ USherbrooke.ca Sophie Michaud, * Suzanne Menard, ([dagger]) and Robert D. Arbeit ([double dagger double dagger n. A reference mark (  ) used in printing and writing. Also called diesis.Noun 1. ]) * Faculte de Medecine de l'Universite de Sherbrooke, Quebec, Canada; ([dagger]) Regie Regionale de la Sante et des Services Sociaux de I'Estrie, Quebec, Canada; and ([double dagger]) Boston University School of Medicine Boston University School of Medicine (BUSM) is one of the graduate schools of Boston University. It is an American medical school located in the South End neighborhood of Boston, Massachusetts. , Boston, Massachusetts “Boston” redirects here. For other uses, see Boston (disambiguation). Boston is the capital and most populous city of Massachusetts.[3] The largest city in New England, Boston is considered the unofficial economic and cultural center of the entire New , USA |
|
||||||||||||||||||||
Printer friendly
Cite/link
Email
Feedback
Reader Opinion