SUMMARYA case-control study comprising 1315 Campylobacter jejuni cases, 121 Campylobacter coli cases and 3409 frequency-matched controls was conducted in The Netherlands in [2002][2003]. Risk factors for both C. jejuni and C. coli enteritis were consumption of undercooked meat and barbecued meat, ownership of cats and use of proton pump inhibitors. Consumption of chicken was a predominant risk factor for C. jejuni enteritis, but many additional risk factors were identified. Unique risk factors for C. coli infections were consumption of game and tripe, and swimming. Contact with farm animals and persons with gastroenteritis were predominant risk factors for C. jejuni enteritis in young children (0-4 years). Important risk factors for the elderly (o60 years) were eating in a restaurant, use of proton pump inhibitors and having a chronic intestinal illness. Consumption of chicken in spring, steak tartare in autumn and winter and barbecued meat in rural areas showed strong associations with C. jejuni infections. This study illustrates that important differences in risk factors exist for different Campylobacter spp. and these may differ dependent on age, season or degree of urbanization.

Since 1996 Salmonella Typhimurium DT104 salmonellosis has increased in The Netherlands. This prompted a case-control study of risk factors for salmonellosis to inform transmission routes for this phage type. Cases were laboratory-confirmed patients with a Salmonella infection and controls were selected from population registries by frequency matching for age, sex, degree of urbanization and season. Cases and controls received a questionnaire on risk factors. Of the 1171 cases, 573 (49%) responded: 245 S. Enteritidis and 232 S. Typhimurium cases (both DT104 and non-DT104), of which 58 were DT104. Of the 10250 controls, 3409 (33%) responded. Use of H2 antagonists [odds ratio (OR) 4.4, 95% CI 1.6-12.2] and proton pump inhibitors (OR 4.2, 95% CI 2.2-7.9), consumption of raw eggs (OR 3.1, 95% CI 1.3-7.4) and products containing raw eggs (OR 1.8, 95% CI 1.1-3.0) were associated with endemic S. Enteritidis infection. Risk factors for endemic S. Typhimurium infection were use of proton pump inhibitors (OR 8.3, 95% CI 4.3-15.9), occupational exposure to raw meat (OR 3.0, 95% CI 1.1-7.9), playing in a sandbox (for children aged 4-12 years) (OR 2.4, 95% CI 1.6-3.7), consumption of undercooked meat (OR 2.2, 95% CI 1.1-4.1) and use of antibiotics (OR 1.9, 95% CI 1.0-3.4). Use of proton pump inhibitors (OR 11.2, 95% CI 3.9-31.9) and playing in a sandbox (OR 4.4, 95% CI 1.8-10.7) were the only risk factors for S. Typhimurium DT104 salmonellosis. This study confirms known risk factors for salmonellosis. However, playing in a sandbox was a predominant new risk factor for S. Typhimurium salmonellosis in children [population attributable risk (PAR) 14%], and especially for S. Typhimurium DT104 (PAR 32%).

In 2009, a 1-year retrospective survey was performed in The Netherlands to estimate the incidence and the disease burden of infectious intestinal disease (IID) in the community, to study the selection of patients consulting a general practitioner and to identify potential risk factors for IID in the community. A questionnaire was sent to 6000 persons selected at random from the population registries of 28 municipalities, with 500 persons being approached per month. A total of 1975 (33%) persons participated. The incidence rate of IID was 964/1000 person-years. Potential risk factors associated with IID in the community were young age (0-4 years) [odds ratio (OR) 3.9, 95% confidence interval (CI) 1.5-10.5], having asthma as a child (OR 3.4, 95% CI 1.1-10.3) and use of gastric acid suppressive medication by persons aged ≥ 45 years (OR 2.8, 95% CI 1.4-5.6). Of the 146 cases with IID, 11 (8%) consulted a physician. Cases with a long duration of symptoms, blood in the stool, children with IID and cases with a low level of education were more likely to consult a physician. Two cases had a stool sample taken and one was admitted to hospital. In conclusion, IID is common and has a significant burden of illness in The Netherlands. Our data indicate that about 15.9 million episodes of IID occur in The Netherlands per year. The incidence rate is substantially higher than the rate of 283/1000 person-years as estimated in 1999 in The Netherlands. This is probably largely due to the retrospective nature of the present study and, to a lesser extent, to differences in case definitions.

We studied the role of host genetics in the susceptibility to severe Salmonella and Campylobacter infections and chronic sequelae of these infections. Participants of a previous case-control study were sent a buccal swab kit and a questionnaire about occurrence of chronic sequelae. Single nucleotide polymorphisms (SNPs) in the TLR4 (rs4986790), IFNG (rs2430561 and rs1861493), STAT1 (rs1914408), IL1B (rs16944), NRAMP (SLC11A1 rs2276631), JUN (rs11688) and VDR (rs10735810) genes were determined. In total, 687 controls, 457 Campylobacter cases and 193 Salmonella cases participated. None of the SNPs were associated with Campylobacter or Salmonella infections. None of the participants developed Guillain-Barré, Miller-Fisher or Reiter's syndrome. Reactive arthritis occurred in 5% and 2% of cases and controls, respectively. Campylobacter cases more frequently experienced gastroenteritis episodes than controls. Campylobacter or Salmonella infection in women, use of proton pump inhibitors and an SNP in the IFNG gene were independent risk factors for reactive arthritis. Another SNP in the IFNG gene and use of proton pump inhibitors were risk factors for recurrent episodes of gastroenteritis. In conclusion, reactive arthritis and recurrent gastroenteritis episodes are common after infection and host genetic factors play a role in susceptibility to these long-term health effects.

In order to add to the limited data available about the incidence of invasive Listeria monocytogenes infection in the Netherlands, two studies were conducted. In the first study, data on hospital patients with listeriosis in the period 1995-2003 were obtained from the National Medical Registration (study 1). In the second study, hospital discharge letters for patients whose Listeria isolates were received by the Netherlands Reference Laboratory for Bacterial Meningitis (NRLBM) in the period 1999-2003 were retrieved (study 2). Serotyping and pulsed-field gel electrophoresis (PFGE) were used to subtype the various strains of Listeria. These reviews revealed 283 hospital patients and 159 patients with Listeria isolates. Discharge letters were received for 107 (67%) patients. The mean annual incidence of listeriosis in both studies was 2.0 per million inhabitants. The main clinical manifestations were meningitis (incidence: 0.9 and 1.0 per million in studies 1 and 2, respectively) and septicaemia (incidence: 0.08 and 1.0 per million, respectively). Listeriosis in pregnancy was rare (incidence: 1.3 and 2.4 per 100,000 pregnancies over 24 weeks of gestation, respectively). Predisposing conditions were present in 47 and 71% of the patients in studies 1 and 2, respectively. The mortality due to listeriosis was 18%. Serotypes 4b, 1/2a, and 1/2b were responsible for 96% of the cases of human listeriosis. Listeriosis is rare in the Netherlands, but its clinical course is severe and the resulting mortality is high. Therefore, the current recommendations for pregnant women to avoid high-risk foods should be continued. These dietary recommendations should also be given to individuals with predisposing conditions, since they, too, are at risk of Listeria infection.