Pre-exposure anti-Campylobacter jejuni immunoglobulin a levels associated with reduced risk of Campylobacter diarrhea in adults traveling to Thailand.

Abstract

Abstract. Diarrhea history questionnaires were administered to 369 U.S. military volunteers before and after deployment to Thailand. Additionally, blood samples obtained from a subset of 221 volunteers 1-3 weeks previously and 3-4 weeks after their deployment were tested by enzyme-linked immunosorbent assay for immunoglobulin A to Campylobacter jejuni. Stool samples from personnel (including volunteers) contracting diarrhea in Thailand were cultured for enteric pathogens. Overall, 35.2% (130 of 369) of questionnaire respondents reported one or more diarrhea episodes during their trip. Volunteers with pretravel anti-C. jejuni reciprocal titers Յ 450 were 1.6 times as likely to have had diarrhea during their stay in Thailand compared with those with pretravel titers Ͼ 450 (39.7% versus 25.3%; P ϭ 0.05). The symptomatic seroconversion, or attributable Campylobacter diarrhea attack rate, for the 1-month exercise was 12.7% (28 of 221). The symptomatic seroconversion rate in nonimmune (titer Յ 450) volunteers was 17.1%, whereas that in immune volunteers was only 4.0% (P ϭ 0.002). Campylobacter jejuni or C. coli were recovered from 32.9% (56 of 170) of stool samples cultured and were the most commonly identified enteropathogens. Campylobacter diarrhea was associated with elevated temperatures, fecal red cells, and fecal white blood cells. The results of this study show that Campylobacter continues to represent a significant health threat to Western travelers to Thailand, but many of these travelers have preexisting Campylobacter immunity that protects them from clinically significant Campylobacter enteritis.

Immunity to Campylobacter: its role in risk assessment and epidemiology

“…This is due to a higher environmental burden, poorer standards of food preparation hygiene and possibly the presence of "new" Campylobacter types. The number of travelers suffering enteritis on return home, varies with both the countries of origin and of travel, but Campylobacter is a frequent cause (Mattila et al 1992;Ekdahl and Giesecke 2004), particularly in Southeast Asia (Riddle et al 2006;Walz et al 2001). As mentioned previously, the symptoms of campylobacteriosis experienced have the same spectrum regardless of whether the infection was acquired abroad or at home suggesting that strain virulence properties are not geographically distinct.…”

“…Similarly, among U.S. expatriates living in Thailand, Campylobacter was isolated more frequently from diarrheic stools if the patients had lived there less than 1 year (Gaudio et al 1996). Moreover, Walz et al (2001) found that those U.S. military volunteers, who had low pre-travel anti-C. jejuni titers, before deployment to Thailand, were more likely to have had diarrhea during their tour of duty compared with those with high pre-travel titers.…”

“…This is not due to strain differences, because individuals traveling from industrialized to developing regions experience the same symptoms of campylobacteriosis abroad as they do at home (Walz et al 2001 diarrhea, were generally infected with multiple strains and frequently re-infected without symptoms with new strains, of different HS and HL serotypes.…”

Assessment of the Duration of Protection in Campylobacter jejuni Experimental Infection in Humans

“…Reduced C. jejuni-associated diarrhea rates correlated with increased levels of Campylobacter-specific IgA antibody in chronic consumers of raw milk on dairy farms compared to individuals exposed to raw milk for the first time, as well as a lower risk of diarrhea for travelers to regions where C. jejuni is hyperendemic (10,11,51). Black and colleagues performed the initial study of an experimental C. jejuni infection in humans (5a, 7).…”

Recrudescent Campylobacter jejuni Infection in an Immunocompetent Adult following Experimental Infection with a Well-Characterized Organism

“…These data are consistent with clinical observations of inflammatory diarrhea. For humoral immunity, a large number of trials have demonstrated the production of Campylobacter-specific antibodies in response to infection or exposure; however, it is unknown which (if any) antibodies represent correlates of immunity (24,40,41,46). In our subjects, IgG (plasma and antibody-secreting cell) responses were not uniformly positive in all subjects; IgG may be less critical for the control of this nonsystemic infection.…”