Preventing campylobacteriosis depends on a thorough understanding of its epidemiology. We used casecase analysis to compare cases of Campylobacter coli infection with cases of C. jejuni infection, to generate hypotheses for infection from standardized, population-based sentinel surveillance information in England and Wales. Persons with C. coli infection were more likely to have drunk bottled water than were those with C. jejuni infection and, in general, were more likely to have eaten pâté. Important differences in exposures were identified for these two Campylobacter species. Exposures that are a risk for infection for both comparison groups might not be identified or might be underestimated by case-case analysis. Similarly, the magnitude or direction of population risk cannot be assessed accurately. Nevertheless, our findings suggest that case-control studies should be conducted at the species level.
The risk for diarrhea-associated HUS was higher for children infected with Escherichia coli O157 phage type (PT) 2 and PT21/28 than for those infected with other PTs.
Although mortality risk scores for chronic hemodialysis (HD) patients should have an important role in clinical decision-making, those currently available have limited applicability, robustness, and generalizability. Here we applied a modified Framingham Heart Study approach to derive 1- and 2-year all-cause mortality risk scores using a 11,508 European incident HD patient database (AROii) recruited between 2007 and 2009. This scoring model was validated externally using similar-sized Dialysis Outcomes and Practice Patterns Survey (DOPPS) data. For AROii, the observed 1- and 2-year mortality rates were 13.0 (95% confidence interval (CI; 12.3–13.8)) and 11.2 (10.4–12.1)/100 patient years, respectively. Increasing age, low body mass index, history of cardiovascular disease or cancer, and use of a vascular access catheter during baseline were consistent predictors of mortality. Among baseline laboratory markers, hemoglobin, ferritin, C-reactive protein, serum albumin, and creatinine predicted death within 1 and 2 years. When applied to the DOPPS population, the predictive risk score models were highly discriminatory, and generalizability remained high when restricted by incidence/prevalence and geographic location (C-statistics 0.68–0.79). This new model offers improved predictive power over age/comorbidity-based models and also predicted early mortality (C-statistic 0.71). Our new model delivers a robust and reproducible mortality risk score, based on readily available clinical and laboratory data.
Campylobacter incidence in England and Wales between 1990 and 1999 was examined in conjunction with weather conditions. Over the 10-year interval, the average annual rate was determined to be 78.4 ؎ 15.0 cases per 100,000, with an upward trend. Rates were higher in males than in females, regardless of age, and highest in children less than 5 years old. Major regional differences were detected, with the highest rates in Wales and the southwest and the lowest in the southeast. The disease displayed a seasonal pattern, and increased campylobacter rates were found to be correlated with temperature. The most marked seasonal effect was observed for children under the age of 5. The seasonal pattern of campylobacter infections indicated a linkage with environmental factors rather than food sources. Therefore, public health interventions should not be restricted to food-borne approaches, and the epidemiology of the seasonal peak in human campylobacter infections may best be understood through studies in young children.Nearly 30 years ago, campylobacter infection emerged as a leading bacterial cause of gastroenteritis in developed countries (47). Two species, Campylobacter jejuni and Campylobacter coli, are responsible for over 99% of human campylobacter infections (6, 23). Major infection sources include undercooked poultry, contaminated milk, untreated water, and animal contact (24). The public health consequences of human campylobacter infection are large, in part because of its high incidence (61). In developed countries, campylobacter causes more illnesses than Shigella spp. and Salmonella spp. combined (55). Only a fraction of cases are reported (25), and some estimates suggest as much as 1% of the population in the United States and Europe is affected by campylobacter each year (57). The annual cost in the United States in 1996 alone was estimated at US$4.3 billion (5), and £69.6 million was the estimated cost in the United Kingdom in 1994 (43). In addition to acute gastroenteritis, campylobacter infections may be complicated by neurological (35, 53), rheumatological (26, 34), and renal (10) problems. Effective prevention and control strategies to reduce the population burden of campylobacter infections require a robust understanding of the epidemiology of this disease. Case-control studies to investigate the origins of human infection showed that the majority of cases of campylobacter infection were not explained by the commonly recognized risk factors (1,13,14,30,37,44). For example, despite public health interventions focused on reducing food-borne transmission (16, 17), campylobacter incidence remains high (15). A striking phenomenon is the remarkably pronounced and consistent seasonal pattern, for which the explanation is unclear (29,38,41). This study investigated the relationship between seasonal variation in human campylobacter infection in England and Wales and environmental conditions to obtain new insights with respect to disease transmission. MATERIALS AND METHODSEpidemiological data. Campylobacter data...
The effects of temperature on reported cases of a number of foodborne illnesses in England and Wales were investigated. We also explored whether the impact of temperature had changed over time. Food poisoning, campylobacteriosis, salmonellosis, Salmonella Typhimurium infections and Salmonella Enteritidis infections were positively associated (P<0.01) with temperature in the current and previous week. Only food poisoning, salmonellosis and S. Typhimurium infections were associated with temperature 2-5 weeks previously (P<0.01). There were significant reductions also in the impact of temperature on foodborne illnesses over time. This applies to temperature in the current and previous week for all illness types (P<0.01) except S. Enteritidis infection (P=0.079). Temperature 2-5 weeks previously diminished in importance for food poisoning and S. Typhimurium infection (P<0.001). The results are consistent with reduced pathogen concentrations in food and improved food hygiene over time. These adaptations to temperature imply that current estimates of how climate change may alter foodborne illness burden are overly pessimistic.
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