Abstract
Background Streptococcus suis infection, an emerging zoonosis, is an increasing public health problem across South East Asia and the most common cause of acute bacterial meningitis in adults in Vietnam. Little is known of the risk factors underlying the disease.Methods and FindingsA case-control study with appropriate hospital and matched community controls for each patient was conducted between May 2006 and June 2009. Potential risk factors were assessed using a standardized questionnaire and investigation of throat and rectal S. suis carriage in cases, controls and their pigs, using real-time PCR and culture of swab samples. We recruited 101 cases of S. suis meningitis, 303 hospital controls and 300 community controls. By multivariate analysis, risk factors identified for S. suis infection as compared to either control group included eating “high risk” dishes, including such dishes as undercooked pig blood and pig intestine (OR1 = 2.22; 95%CI = [1.15–4.28] and OR2 = 4.44; 95%CI = [2.15–9.15]), occupations related to pigs (OR1 = 3.84; 95%CI = [1.32–11.11] and OR2 = 5.52; 95%CI = [1.49–20.39]), and exposures to pigs or pork in the presence of skin injuries (OR1 = 7.48; 95%CI = [1.97–28.44] and OR2 = 15.96; 95%CI = [2.97–85.72]). S. suis specific DNA was detected in rectal and throat swabs of 6 patients and was cultured from 2 rectal samples, but was not detected in such samples of 1522 healthy individuals or patients without S. suis infection.ConclusionsThis case control study, the largest prospective epidemiological assessment of this disease, has identified the most important risk factors associated with S. suis bacterial meningitis to be eating ‘high risk’ dishes popular in parts of Asia, occupational exposure to pigs and pig products, and preparation of pork in the presence of skin lesions. These risk factors can be addressed in public health campaigns aimed at preventing S. suis infection.
Highlights
The importance of zoonotic emerging infections is increasingly recognized, as illustrated by outbreaks of SARS coronavirus and the ongoing threat of human infections with avian influenza H5N1 virus
This case control study, the largest prospective epidemiological assessment of this disease, has identified the most important risk factors associated with S. suis bacterial meningitis to be eating ‘high risk’ dishes popular in parts of Asia, occupational exposure to pigs and pig products, and preparation of pork in the presence of skin lesions
These risk factors can be addressed in public health campaigns aimed at preventing S. suis infection
Summary
The importance of zoonotic emerging infections is increasingly recognized, as illustrated by outbreaks of SARS coronavirus and the ongoing threat of human infections with avian influenza H5N1 virus. Streptococcus suis infection is an emerging zoonotic infectious disease, which is increasingly reported in Asia It has become an important threat for human health, illustrated by the explosive outbreak in Sichuan Province China associated with at least 215 cases and 39 deaths in 2005 [2]. In Ho Chi Minh City and Hanoi, it causes approximately 40% of all adult acute bacterial meningitis cases. This is more than Streptococcus pneumoniae and Neisseria meningitidis combined [3,4,5]. Streptococcus suis infection, an emerging zoonosis, is an increasing public health problem across South East Asia and the most common cause of acute bacterial meningitis in adults in Vietnam.
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