Determinants of sporadic Campylobacter infections in Denmark: a nationwide case-control study among children and young adults
Received 13 June 2018
Accepted for publication 14 September 2018
Published 21 November 2018 Volume 2018:10 Pages 1695—1707
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 3
Editor who approved publication: Professor Vera Ehrenstein
Katrin Gaardbo Kuhn,1 Eva Møller Nielsen,2 Kåre Mølbak,1,3 Steen Ethelberg1
1Infectious Disease Epidemiology & Prevention, Statens Serum Institut, Copenhagen, Denmark; 2Bacteria, Parasites & Fungi, Statens Serum Institut, Copenhagen, Denmark; 3Institute of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
Background: Each year more than 4,000 cases of campylobacteriosis are reported in Denmark, making it the most common bacterial gastrointestinal infection. Here we describe a case-control study to identify sources of infection with a focus on environmental factors.
Methods: From January to December 2016, we conducted a prospective case-control study among Danish persons aged 1–30 years. Participants were invited by letter to complete an online questionnaire. Crude and adjusted ORs were calculated and final parsimonious multivariate models developed using logistic regression.
Results: The study recruited 1366 cases and 4,418 controls, of whom 65% and 66%, respectively, completed the questionnaire. A multivariate model for domestically acquired cases showed, among others, increased risk of infection with bathing in fresh water (OR=5.1), contact to beach sand (OR=1.8), owning a pet dog with diarrhea (OR=4.6), and eating minced beef (OR=2.6) or chicken (OR=2.5). The model for children highlighted similar risk factors but also included bathing in a paddling pool (OR=13.6) and eating fresh strawberries (OR=5.3). A separate analysis for persons reporting foreign travel showed increased infection risk when traveling to Asia, Africa, or Turkey and that eating from street kitchens and having contact to water during traveling were also risk factors.
Conclusion: Environmental factors and animal contact account for a sizeable proportion of domestic Campylobacter infections in the age group studied. The study also re-confirmed handling/consumption of chicken as an important risk factor while highlighting minced beef as a potential new risk factor. Overall, these results contribute to a better understanding of the transmission dynamics of Campylobacter and will be used to improve national guidelines for prevention of infection.
Keywords: Campylobacter, determinants, case-control, environment, food
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