Abstract
Very few reports describe all hospitalized patients with campylobacteriosis in the setting of a single waterborne outbreak. This study describes the demographics, comorbidities, clinical features, microbiology, treatment and complications of 67 hospitalized children and adults during a large waterborne outbreak of Campylobacter jejuni in Askoy, Norway in 2019, where more than 2000 people in a community became ill. We investigated factors that contributed to hospitalization and treatment choices. Data were collected from electronic patient records during and after the outbreak. Fifty adults and seventeen children were included with a biphasic age distribution peaking in toddlers and middle-aged adults. Most children, 14 out of 17, were below 4 years of age. Diarrhea was the most commonly reported symptom (99%), whereas few patients (9%) reported bloody stools. Comorbidities were frequent in adults (63%) and included cardiovascular disease, pre-existing gastrointestinal disease or chronic renal failure. Comorbidities in children (47%) were dominated by pulmonary and gastrointestinal diseases. Adult patients appeared more severely ill than children with longer duration of stay, higher levels of serum creatinine and CRP and rehydration therapy. Ninety-two percent of adult patients were treated with intravenous fluid as compared with 12% of children. Almost half of the admitted children received antibiotics. Two patients died, including a toddler. Both had significant complicating factors. The demographic and clinical findings presented may be useful for health care planning and patient management in Campylobacter outbreaks both in primary health care and in hospitals.
Highlights
Campylobacter is the most frequent bacterial cause of gastroenteritis in both high- and lowincome countries [1], and outbreaks are often water-borne [2]
An outbreak of infectious gastroenteritis was suspected in the Askoøy municipality in the Western part of Norway on June 6th after a period of drought followed by heavy rainfall [7]
An unusually high number of contacts due to gastroenteritis was made to the local primary health care services
Summary
Campylobacter is the most frequent bacterial cause of gastroenteritis in both high- and lowincome countries [1], and outbreaks are often water-borne [2]. When public water supply systems are the source of infection, large parts of a population can potentially be affected in a short period. An outbreak of infectious gastroenteritis was suspected in the Askoøy municipality in the Western part of Norway on June 6th after a period of drought followed by heavy rainfall [7]. The following day an elevated water reservoir was shown to be the source. Investigations by the Norwegian Institute of Public Health, Norwegian Food Safety Authority and Askoy Municipality found the outbreak to be clonal as Campylobacter jejuni isolates from patients and water samples were identical by whole-genome sequencing. Judging by the number of people affected, this was the largest documented single pathogen outbreak of Campylobacter jejuni in the world since the Klarup (Denmark) outbreak in 1995–96 [8]
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