Abstract
Campylobacter infection is a leading cause of bacterial gastroenteritis worldwide, and most clinical cases appear as isolated, sporadic infections for which the source is rarely apparent. From July 2005 to December 2007 we conducted a prospective case-case study of sporadic, domestically-acquired Campylobacter enteritis in rural versus urban areas and a prevalence study of Campylobacter in animal and environmental sources in the Eastern Townships, Quebec. Isolates were typed using Multilocus Sequence Typing (MLST) to reinforce the case-case findings and to assign a source probability estimate for each human isolate. The risk of human campylobacteriosis was 1.89-fold higher in rural than urban areas. Unconditional multivariate logistic regression analysis identified two independent risk factors associated with human Campylobacter infections acquired in rural area: occupational exposure to animals (OR = 10.6, 95% CI: 1.2–91, p = 0.032), and household water coming from a private well (OR = 8.3, 95% CI: 3.4–20.4, p<0.0001). A total of 851 C. jejuni isolates (178 human, 257 chicken, 87 bovine, 266 water, 63 wild bird) were typed using MLST. Among human isolates, the incidence rates of clonal complexes (CC) CC-21, CC-45, and CC-61 were higher in rural than urban areas. MLST-based source attribution analysis indicated that 64.5% of human C. jejuni isolates were attributable to chicken, followed by cattle (25.8%), water (7.4%), and wild birds (2.3%). Chicken was the attributable source for the majority of cases, independent of residential area, sex and age. The increased incidence in rural compared to urban areas was associated with occupational exposure to animals, particularly cattle among those aged 15–34 years, and with consumption of private well water. Both bovine and water exposure appeared to contribute to the seasonal variation in campylobacteriosis. These results provide a basis for developing public education and preventive programs targeting the risk factors identified.
Highlights
Campylobacter infection is a leading cause of bacterial gastroenteritis worldwide
111 were excluded: 41 cases acquired their infection outside Quebec, 19 resided outside the Eastern Townships, 49 could not be interviewed or declined to participate, and two were cases with reinfections
We identified rurality of residence location, age, season, and exposures such as occupation with animals and household water coming from a private well as important risk factors for human campylobacteriosis
Summary
Campylobacter infection is a leading cause of bacterial gastroenteritis worldwide. Canada has reported an average of 39 cases per 100,000 inhabitants annually in the last decade [1] and United States reports 13,000 hospitalizations and over 100 deaths each year [2]. Campylobacter colonizes the digestive tract of a wide range of warm-blooded animal hosts, including all major domestic animals and wildlife, and the feces of infected animals are responsible for the greatest environmental burden of campylobacters [3]. Raw milk and untreated water are welldocumented sources of human campylobacteriosis outbreaks [4]. Most cases appear as isolated, sporadic infections for which the source is rarely apparent. Identifying the sources and routes of transmission of campylobacteriosis is essential for developing effective, targeted preventive measures
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