Source attribution of human campylobacteriosis using a meta-analysis of case-control studies of sporadic infections

Campylobacter assessment along the Spanish food chain: Identification of key points

AIMS

Campylobacteriosis, caused by Campylobacter spp., is one of the most important foodborne zoonotic diseases in the world and a common cause of gastroenteritis. In the European Union, campylobacteriosis is considered the most common zoonotic disease, with over 10,000 cases in 2020 alone. This high occurrence highlights the need of more efficient surveillance methods and identification of key points.

METHODS AND RESULTS

Herein, we evaluated and identified key points of Campylobacter spp. occurrence along the Spanish food chain during 2015-2020, based on the following variables: product, stage and region. We analysed a dataset provided by the Spanish Agency for Food Safety and Nutrition using a machine learning algorithm (random forests). Campylobacter presence was influenced by the three selected explanatory variables, especially by product, followed by region and stage. Among the studied products, meat, especially poultry and sheep, presented the highest probability of occurrence of Campylobacter, where the bacterium was present in the initial, intermediate and final stages (e.g., wholesale, retail) of the food chain. The presence in final stages may represent direct consumer exposure to the bacteria.

CONCLUSSIONS

By using the random forest method, this study contributes to the identification of Campylobacter key points and the evaluation of control efforts in the Spanish food chain.

Clinical manifestations and risk factors of campylobacter gastroenteritis in children in Taiwan

BACKGROUND

Campylobacteriosis is a common cause of bacterial gastroenteritis worldwide. This study aimed to investigate the potential risk factors, clinical and laboratory manifestations of children with campylobacteriosis under five years old in Taiwan.

METHODS

This retrospective case-control study was conducted in ten major hospitals in Taiwan from 2014 to 2017. Laboratory tests and stool specimen were collected and analyzed together with questionnaire survey. Multivariate stepwise logistic regression model was used for identification of risk factors.

RESULTS

A total of 64 campylobacteriosis cases were included with a median age of 25 months. We observed a less prolonged vomiting (p = 0.047), more bloody (p < 0.001) and mucoid (p = 0.005) stools, and lower AST levels (p = 0.020) in patients with campylobacteriosis. Lower parental educational attainment (p < 0.001), direct contact with acute gastroenteritis patients (p < 0.001), as well as diarrhea in the mutually cared children (p = 0.007) were linked to campylobacteriosis. Consumption of municipal water (p < 0.001), milk (OR 0.34, 95% CI 0.118-0.979), and soft beverages (OR 0.41, 95% CI 0.192-0.888) were identified as protective factors, while consuming takeout food (p = 0.032) and seafood (p = 0.019) increased risk of campylobacteriosis.

CONCLUSIONS

Shorter vomiting duration, bloody and mucoid stool, and less elevated AST levels are manifestations suggestive of campylobacteriosis. Risk factors of campylobacteriosis were low parental educational attainment, direct contact with acute gastroenteritis patients, diarrhea in mutually cared children, takeout food and seafood intake. Potential protective factors include municipal water, milk, and soft beverage intake.

Avian campylobacteriosis, prevalence, sources, hazards, antibiotic resistance, poultry meat contamination, and control measures: a comprehensive review

Avian campylobacteriosis is a vandal infection that poses human health hazards. Campylobacter is usually colonized in the avian gut revealing mild signs in the infected birds, but retail chicken carcasses have high contamination levels of Campylobacter spp. Consequently, the contaminated avian products constitute the main source of human infection with campylobacteriosis and result in severe clinical symptoms such as diarrhea, abdominal pain, spasm, and deaths in sensitive cases. Thus, the current review aims to shed light on the prevalence of Campylobacter in broiler chickens, Campylobacter colonization, bird immunity against Campylobacter, sources of poultry infection, antibiotic resistance, poultry meat contamination, human health hazard, and the use of standard antimicrobial technology during the chicken processing of possible control strategies to overcome such problems.

Pangenomic analyses of antibiotic-resistant Campylobacter jejuni reveal unique lineage distributions and epidemiological associations

Application of whole-genome sequencing (WGS) to characterize foodborne pathogens has advanced our understanding of circulating genotypes and evolutionary relationships. Herein, we used WGS to investigate the genomic epidemiology of Campylobacter jejuni, a leading cause of foodborne disease. Among the 214 strains recovered from patients with gastroenteritis in Michigan, USA, 85 multilocus sequence types (STs) were represented and 135 (63.1 %) were phenotypically resistant to at least one antibiotic. Horizontally acquired antibiotic resistance genes were detected in 128 (59.8 %) strains and the genotypic resistance profiles were mostly consistent with the phenotypes. Core-gene phylogenetic reconstruction identified three sequence clusters that varied in frequency, while a neighbour-net tree detected significant recombination among the genotypes (pairwise homoplasy index P<0.01). Epidemiological analyses revealed that travel was a significant contributor to pangenomic and ST diversity of C. jejuni, while some lineages were unique to rural counties and more commonly possessed clinically important resistance determinants. Variation was also observed in the frequency of lineages over the 4 year period with chicken and cattle specialists predominating. Altogether, these findings highlight the importance of geographically specific factors, recombination and horizontal gene transfer in shaping the population structure of C. jejuni. They also illustrate the usefulness of WGS data for predicting antibiotic susceptibilities and surveillance, which are important for guiding treatment and prevention strategies.

Preliminary Incidence and Trends of Infections Caused by Pathogens Transmitted Commonly Through Food - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2022

Each year, infections from major foodborne pathogens are responsible for an estimated 9.4 million illnesses, 56,000 hospitalizations, and 1,350 deaths in the United States (1). To evaluate progress toward prevention of enteric infections in the United States, the Foodborne Diseases Active Surveillance Network (FoodNet) conducts surveillance for laboratory-diagnosed infections caused by eight pathogens transmitted commonly through food at 10 U.S. sites. During 2020-2021, FoodNet detected decreases in many infections that were due to behavioral modifications, public health interventions, and changes in health care-seeking and testing practices during the COVID-19 pandemic. This report presents preliminary estimates of pathogen-specific annual incidences during 2022, compared with average annual incidences during 2016-2018, the reference period for the U.S. Department of Health and Human Services' Healthy People 2030 targets (2). Many pandemic interventions ended by 2022, resulting in a resumption of outbreaks, international travel, and other factors leading to enteric infections. During 2022, annual incidences of illnesses caused by the pathogens Campylobacter, Salmonella, Shigella, and Listeria were similar to average annual incidences during 2016-2018; however, incidences of Shiga toxin-producing Escherichia coli (STEC), Yersinia, Vibrio, and Cyclospora illnesses were higher. Increasing culture-independent diagnostic test (CIDT) usage likely contributed to increased detection by identifying infections that would have remained undetected before widespread CIDT usage. Reducing pathogen contamination during poultry slaughter and processing of leafy greens requires collaboration among food growers and processors, retail stores, restaurants, and regulators.

Intestinal Colonization of Campylobacter jejuni and Its Hepatic Dissemination Are Associated with Local and Systemic Immune Responses in Broiler Chickens

Campylobacter jejuni is an important foodborne pathogen. Despite the lack of clinical signs associated with its colonization in poultry, it has been reported to interact with the intestinal immune system. However, little is known about the interaction between C. jejuni and the chicken immune system, especially in the context of hepatic dissemination. Therefore, to follow up on our previous study showing intestinal colonization and hepatic spread of C. jejuni, cecal tonsils and liver samples were collected from these birds to determine the mRNA levels of chemokines and cytokines. Serum samples were also collected to determine serum amyloid A (SAA) concentrations and specific IgY titers. Lack of Th17 induction was observed in the cecal tonsils of only the liver-contaminated groups. This hepatic dissemination was accompanied by innate, Th1 and Th2 immune responses in livers, as well as an increase in SAA concentrations and specific IgY levels in sera. Campylobacter appears to be able to restrain the induction of the chicken gut immunity in particular conditions, possibly enhancing its hepatic dissemination and thus eliciting systemic immune responses. Although Campylobacter is often recognized as a commensal-like bacterium in chickens, it seems to modulate the gut immune system and induce systemic immunity.

Observations supporting hypothetical commensalism and competition between two Campylobacter jejuni strains colonizing the broiler chicken gut

Campylobacter jejuni is the most prevalent bacterial foodborne pathogen in humans. Given the wide genetic diversity of C. jejuni strains found in poultry production, a better understanding of the relationships between these strains within chickens could lead to better control of this pathogen on farms. In this study, 14-day old broiler chickens were inoculated with two C. jejuni strains (10³ or 10⁷ CFU of D2008b and 10³ CFU of G2008b, alone or together) that were previously characterized in vitro and that showed an opposite potential to compete for gut colonization in broilers. Liver samples and ileal and cecal contents were collected and used to count total C. jejuni and to quantify the presence of each strain using a strain specific qPCR or PCR approach. Ileal tissue samples were also collected to analyze the relative expression level of tight junction proteins. While a 10³ CFU inoculum of D2008b alone was not sufficient to induce intestinal colonization, this strain benefited from the G2008b colonization for its establishment in the gut and its extraintestinal spread. When the inoculum of D2008b was increased to 10⁷ CFU - leading to its intestinal and hepatic colonization - a dominance of G2008b was measured in the gut and D2008b was found earlier in the liver for birds inoculated by both strains. In addition, a transcript level decrease of JAM2, CLDN5 and CLDN10 at 7 dpi and a transcript level increase of ZO1, JAM2, OCLN, CLDN10 were observed at 21 dpi for groups of birds having livers contaminated by C. jejuni. These discoveries suggest that C. jejuni would alter the intestinal barrier function probably to facilitate the hepatic dissemination. By in vitro co-culture assay, a growth arrest of D2008b was observed in the presence of G2008b after 48 h of culture. Based on these results, commensalism and competition seem to occur between both C. jejuni strains, and the dynamics of C. jejuni intestinal colonization and liver spread in broilers appear to be strain dependent. Further in vivo experimentations should be conducted to elucidate the mechanisms of commensalism and competition between strains in order to develop adequate on-farm control strategies.

Epidemiology of Campylobacter spp. isolated from stool in a tertiary hospital in Cantabria, Northern Spain, from 2016 to 2020

BACKGROUND

The incidence of Campylobacter coli has increased and with greater resistance to antibiotics than Campylobacter jejuni.

OBJECTIVES

To determine the epidemiology distribution of Campylobacter spp. in our health area, and the sensitivity to commonly tested antibiotics.

METHODS

Retrospective descriptive study of cases of campylobacteriosis (2016-2020) recovered from stool cultures as laboratory routine protocol. Sensitivity was tested following EUCAST recommendations.

RESULTS

Of 1319 campylobacteriosis (C. jejuni 87.7%, C. coli 12.3%) we found a decrease in C. jejuni cases in 2019, and an increase in C. coli. Statistically significant differences were seen in age and gender distribution. The resistance percentages have generally decreased, with higher percentages of resistance in C. coli than in C. jejuni, being significant for erythromycin.

CONCLUSIONS

There is not an increase of C. jejuni and its resistance but there is a not alarming increase of incidence of C. coli and its resistance in our health area.

Nearest-Neighbors Matching for Case-Control Study Analyses: Better Risk Factor Identification From a Study of Sporadic Campylobacteriosis in the United States

BACKGROUND

Case-control studies are commonly used to explore factors associated with enteric bacterial diseases. Control of confounding is challenging due to a large number of exposures of interest and the low frequencies of many of them.

METHODS

We evaluated nearest-neighbors matching in a case-control study (originally 1:1 matched, published in 2004) of sporadic Campylobacter infections that included information on 433 exposures in 2632 subjects during 1998-1999. We performed multiple imputations of missing data (m = 100) and calculated Gower distances between cases and controls using all possible confounders for each exposure in each dataset. We matched each case with ≤20 controls within a data-determined distance. We calculated odds ratios and population attributable fractions (PAFs).

RESULTS

Examination of pairwise correlation between exposures found very strong associations for 1046 pairs of exposures. More than 100 exposures were associated with campylobacteriosis, including nearly all risk factors identified using the previously published approach that included only 16 exposures and some less studied, rare exposures such as consumption of chicken liver and raw clams. Consumption of chicken and nonpoultry meat had the highest PAFs (62% and 59%, respectively).

CONCLUSIONS

Nearest-neighbors matching appear to provide an improved ability to examine rare exposures and better control for numerous highly associated confounders.

A statistical modelling approach for source attribution meta-analysis of sporadic infection with foodborne pathogens

Numerous source attribution studies for foodborne pathogens based on epidemiological and microbiological methods are available. These studies provide empirical data for modelling frameworks that synthetize the quantitative evidence at our disposal and reduce reliance on expert elicitations. Here, we develop a statistical model within a Bayesian estimation framework to integrate attribution estimates from expert elicitations with estimates from microbial subtyping and case-control studies for sporadic infections with four major bacterial zoonotic pathogens in the Netherlands (Campylobacter, Salmonella, Shiga toxin-producing E. coli [STEC] O157 and Listeria). For each pathogen, we pooled the published fractions of human cases attributable to each animal reservoir from the microbial subtyping studies, accounting for the uncertainty arising from the different typing methods, attribution models, and year(s) of data collection. We then combined the population attributable fractions (PAFs) from the case-control studies according to five transmission pathways (domestic food, environment, direct animal contact, human-human transmission and travel) and 11 groups within the foodborne pathway (beef/lamb, pork, poultry meat, eggs, dairy, fish/shellfish, fruit/vegetables, beverages, grains, composite foods and food handlers/vermin). The attribution estimates were biologically plausible, allowing the human cases to be attributed in several ways according to reservoirs, transmission pathways and food groups. All pathogens were predominantly foodborne, with Campylobacter being mostly attributable to the chicken reservoir, Salmonella to pigs (albeit closely followed by layers), and Listeria and STEC O157 to cattle. Food-wise, the attributions reflected those at the reservoir level in terms of ranking. We provided a modelling solution to reach consensus attribution estimates reflecting the empirical evidence in the literature that is particularly useful for policy-making and is extensible to other pathogens and domains.

Investigating the Campylobacter enteritis winter peak in Germany, 2018/2019

Surveillance of notified Campylobacter enteritis in Germany revealed a recurrent annual increase of cases with disease onset several days after the Christmas and New Year holidays ("winter peak"). We suspected that handling and consumption of chicken meat during fondue and raclette grill meals on the holidays were associated with winter peak Campylobacter infections. The hypothesis was investigated in a case-control study with a case-case design where notified Campylobacter enteritis cases served as case-patients as well as control-patients, depending on their date of disease onset (case-patients: 25/12/2018 to 08/01/2019; control-patients: any other date between 30/11/2018 and 28/02/2019). The study was conducted as an online survey from 21/01/2019 to 18/03/2019. Adjusted odds ratios (aOR) were determined in single-variable logistic regression analyses adjusted for age group and sex. We analysed 182 data sets from case-patients and 260 from control-patients and found associations of Campylobacter infections after the holidays with meat fondue (aOR 2.2; 95% confidence interval (CI) 1.2-3.8) and raclette grill meals with meat (aOR 1.5; 95% CI 1.0-2.4) consumed on the holidays. The associations were stronger when chicken meat was served at these meals (fondue with chicken meat: aOR 2.7; 95% CI 1.4-5.5; raclette grill meal with chicken meat: aOR 2.3; 95% CI 1.3-4.1). The results confirmed our initial hypothesis. To prevent Campylobacter winter peak cases in the future, consumers should be made more aware of the risks of a Campylobacter infection when handling raw meat, in particular chicken, during fondue or raclette grill meals on the holidays.

Differential impact of the COVID-19 pandemic on laboratory reporting of norovirus and Campylobacter in England: A modelling approach

Background

The COVID-19 pandemic has impacted surveillance activities for multiple pathogens. Since March 2020, there was a decline in the number of reports of norovirus and Campylobacter recorded by England’s national laboratory surveillance system. The aim is to estimate and compare the impact of the COVID-19 pandemic on norovirus and Campylobacter surveillance data in England.

Methods

We utilised two quasi-experimental approaches based on a generalised linear model for sequential count data. The first approach estimates overall impact and the second approach focuses on the impact of specific elements of the pandemic response (COVID-19 diagnostic testing and control measures). The following time series (27, 2015–43, 2020) were used: weekly laboratory-confirmed norovirus and Campylobacter reports, air temperature, conducted Sars-CoV-2 tests and Index of COVID-19 control measures stringency.

Results

The period of Sars-CoV-2 emergence and subsequent sustained transmission was associated with persistent reductions in norovirus laboratory reports (p = 0.001), whereas the reductions were more pronounced during pandemic emergence and later recovered for Campylobacter (p = 0.075). The total estimated reduction was 47% - 79% for norovirus (12–43, 2020). The total reduction varied by time for Campylobacter, e.g. 19% - 33% in April, 1% - 7% in August.

Conclusion

Laboratory reporting of norovirus was more adversely impacted than Campylobacter by the COVID-19 pandemic. This may be partially explained by a comparatively stronger effect of behavioural interventions on norovirus transmission and a relatively greater reduction in norovirus testing capacity. Our study underlines the differential impact a pandemic may have on surveillance of gastrointestinal infectious diseases.

Whole Resistome Analysis in Campylobacter jejuni and C. coli Genomes Available in Public Repositories

Campylobacter spp. are the most frequent agent of human gastroenteritis worldwide, and the spread of multidrug-resistant strains makes the clinical treatment difficult. The current study presents the resistome analysis of 39,798 Campylobacter jejuni and 11,920 Campylobacter coli genomes available in public repositories. Determinants of resistance to β-lactams (Be) and tetracyclines (Te) were the most frequent for both species, with resistance to quinolones (Qu) as the third most important on C. jejuni and to aminoglycosides (Am) on C. coli. Moreover, resistance to Te, Qu, and Am was frequently found in co-occurrence with resistance to other antibiotic families. Geographical differences on clonal complexes distribution were found for C. jejuni and on resistome genotypes for both C. jejuni and C. coli species. Attending to the resistome patterns by isolation source, three main clusters of genomes were found on C. jejuni genomes at antimicrobial resistance gene level. The first cluster was formed by genomes from human, food production animals (e.g., sheep, cow, and chicken), and food (e.g., dairy products) isolates. The higher incidence of tet(O), associated with tetracycline resistance, and the gyrA (T86I) single-nucleotide polymorphism (SNP), associated with quinolone resistance, among genomes from this cluster could be due to the intense use of these antibiotics in veterinary and human clinical settings. Similarly, a high incidence of tet(O) genes of C. coli genomes from pig, cow, and turkey was found. Moreover, the cluster based on resistome patterns formed by C. jejuni and C. coli genomes of human, turkey, and chicken origin is in agreement with previous observations reporting chicken or poultry-related environments as the main source of human campylobacteriosis infections. Most clonal complexes (CCs) associated with chicken host specialization (e.g., ST-354, ST-573, ST-464, and ST-446) were the CCs with the highest prevalence of determinants of resistance to Be, Qu, and Te. Finally, a clear trend toward an increase in the occurrence of Te and Qu resistance determinants on C. jejuni, linked to the spread of the co-occurrence of the bla_OXA–61 and tet(O)-tet(O/W/O) genes and the gyrA (T86I) SNP, was found from 2001 to date in Europe.

Mapping foodborne pathogen contamination throughout the conventional and alternative poultry supply chains

Recently, there has been a consumer push for natural and organic food products. This has caused alternative poultry production, such as organic, pasture, and free-range systems, to grow in popularity. Due to the stricter rearing practices of alternative poultry production systems, different types of levels of microbiological risks might be present for these systems when compared to conventional production systems. Both conventional and alternative production systems have complex supply chains that present many different opportunities for flocks of birds or poultry meat to be contaminated with foodborne pathogens. As such, it is important to understand the risks involved during each step of production. The purpose of this review is to detail the potential routes of foodborne pathogen transmission throughout the conventional and alternative supply chains, with a special emphasis on the differences in risk between the two management systems, and to identify gaps in knowledge that could assist, if addressed, in poultry risk-based decision making.

Epidemiologic Associations Vary Between Tetracycline and Fluoroquinolone Resistant Campylobacter jejuni Infections

Campylobacter jejuni is the leading cause of bacterial gastroenteritis and antibiotic resistant C. jejuni are a serious threat to public health. Herein, we sought to evaluate trends in C. jejuni infections, quantify resistance frequencies, and identify epidemiological factors associated with infection. Campylobacter jejuni isolates (n = 214) were collected from patients via an active surveillance system at four metropolitan hospitals in Michigan between 2011 and 2014. The minimum inhibitory concentration for nine antibiotics was determined using microbroth dilution, while demographic and clinical data were used for the univariate and multivariate analyses. Over the 4-year period, a significant increase in the recovery of C. jejuni was observed (p ≤ 0.0001). Differences in infection rates were observed by hospital and several factors were linked to more severe disease. Patients residing in urban areas, for instance, were significantly more likely to be hospitalized than rural residents as were patients over 40 years of age and those self-identifying as non-White, highlighting potential disparities in disease outcomes. Among the 214 C. jejuni isolates, 135 (63.1%) were resistant to at least one antibiotic. Resistance was observed for all nine antibiotics tested yielding 11 distinct resistance phenotypes. Tetracycline resistance predominated (n = 120; 56.1%) followed by resistance to ciprofloxacin (n = 49; 22.9%), which increased from 15.6% in 2011 to 25.0% in 2014. Resistance to two antibiotic classes was observed in 38 (17.8%) isolates, while multidrug resistance, or resistance to three or more classes, was observed in four (1.9%). Notably, patients with ciprofloxacin resistant infections were more likely to report traveling in the past month (Odds Ratio (OR): 3.0; 95% confidence interval (CI): 1.37, 6.68) and international travel (OR: 9.8; 95% CI: 3.69, 26.09). Relative to patients with only tetracycline resistant infections, those with ciprofloxacin resistance were more likely to travel internationally, be hospitalized and have an infection during the fall or summer. Together, these findings show increasing rates of infection and resistance and highlight specific factors that impact both outcomes. Enhancing understanding of factors linked to C. jejuni resistance and more severe infections is critical for disease prevention, particularly since many clinical laboratories have switched to the use of culture-independent tests for the detection of Campylobacter.

Recency-Weighted Statistical Modeling Approach to Attribute Illnesses Caused by 4 Pathogens to Food Sources Using Outbreak Data, United States

Foodborne illness source attribution is foundational to a risk-based food safety system. We describe a method for attributing US foodborne illnesses caused by nontyphoidal Salmonella enterica, Escherichia coli O157, Listeria monocytogenes, and Campylobacter to 17 food categories using statistical modeling of outbreak data. This method adjusts for epidemiologic factors associated with outbreak size, down-weights older outbreaks, and estimates credibility intervals. On the basis of 952 reported outbreaks and 32,802 illnesses during 1998–2012, we attribute 77% of foodborne Salmonella illnesses to 7 food categories (seeded vegetables, eggs, chicken, other produce, pork, beef, and fruits), 82% of E. coli O157 illnesses to beef and vegetable row crops, 81% of L. monocytogenes illnesses to fruits and dairy, and 74% of Campylobacter illnesses to dairy and chicken. However, because Campylobacter outbreaks probably overrepresent dairy as a source of nonoutbreak campylobacteriosis, we caution against using these Campylobacter attribution estimates without further adjustment.

Consumer practices and prevalence of Campylobacter, Salmonella and norovirus in kitchens from six European countries

About 40% of foodborne infections are acquired in the home. The aim of the present study was to track contamination of pathogens during domestic food preparation and link the contamination to preparation practices. Research participants from 87 households in six European countries were observed and interviewed during shopping and preparation of a chicken and vegetable meal. The presence of Salmonella spp., Campylobacter spp. and norovirus on raw chicken, kitchen surfaces, cloths and sponges was determined. The prevalence of Campylobacter on raw chicken varied from 8.3% in Norway (NO) to 80% in France (FR) and Portugal (PT), with a mean prevalence of 57%. Campylobacter was found on half of the products that had been frozen and appeared to be less prevalent on chicken from supermarkets than other sources. Salmonella was found in 8.6% of raw chicken samples, exclusively from Hungary (HU). A relationship between observed practices and spread of pathogens to kitchen surfaces was found only for the use of cutting boards for chicken and/or vegetables. After food preparation, Campylobacter and Salmonella were isolated from 23% (samples derived from HU, RO, UK) and 8.7% (HU), respectively of cutting boards. Research participants in France and Portugal were more likely to buy products that fitted their recipe, with less need for using cutting boards. Using the same board and knife for vegetables after using it for chicken and without washing with detergent was common in Portugal and Romania, but not in the other countries. Contamination with Campylobacter to other kitchen surfaces or washing utensils were found in five households (UK, RO, PT). Rinsing chicken in sinks was common in three countries (PT, HU, RO), and washing vegetables in the same sink was also usual. Prevalence of Norovirus was low, with detection in one out of 451 samples. The participants' awareness of the risk posed by pathogens from raw chicken differed among the six countries, with higher awareness in Norway and the UK than the other countries studied. In conclusion, practices intended to avoid cross-contamination from chicken to kitchen surfaces and washing utensils are not established among consumers in all European countries. Nevertheless, cross-contamination events that disseminate infectious doses of pathogens seems to be rare, probably due to the relatively low levels of pathogens in food combined with food preferences. Food safety interventions must consider the national food culture, preferences, practices and the prevalence and levels of pathogens in food. Emphasis should be on providing and promoting chicken products with lower risk (prevalence of pathogens, ready-to-cook) and safe use of cutting boards.

A pilot study revealing host-associated genetic signatures for source attribution of sporadic Campylobacter jejuni infection in Egypt

Campylobacter jejuni (C. jejuni), is considered among the most common bacterial causes of human bacterial gastroenteritis worldwide. The epidemiology and the transmission dynamics of campylobacteriosis in Egypt remain poorly defined due to the limited use of high-resolution typing methods. In this pilot study, we evaluated the discriminatory power of multiple typing 'gene-by-gene based' techniques to characterize C. jejuni obtained from different sources and estimate the relative contribution of different potential sources of C. jejuni infection in Egypt. Whole genome sequencing (WGS) was performed on 90 C. jejuni isolates recovered from clinical samples, retail chicken, and dairy products in Egypt from 2017 to 2018. Comparative genomic analysis was performed using conventional seven-locus multilocus sequence typing (MLST), ribosomal MLST (rMLST), core genome MLST (cgMLST), allelic variation in 15 host-segregating (HS) markers, and comparative genomic fingerprinting (CGF40). The probabilistic source attribution was performed via STRUCTURE software using MLST, CGF40, cgMLST and allelic variation in HS markers. Comparison of the discriminatory power of the aforementioned genotyping methods revealed cgMLST to be the most discriminative method, followed by HS markers. The source attribution analysis showed the role of retail chicken as a source of infection among clinical cases in Egypt when HS and cgMLST were used (64.2% and 52.3% of clinical isolates were assigned to this source, respectively). Interestingly, the cattle reservoir was also identified as a contributor to C. jejuni infection in Egypt; 35.8% and 47.7% of clinical isolates were assigned to this source by HS and cgMLST, respectively. Here, we provided evidence of the importance of using WGS typing methods to facilitate source tracking of C. jejuni. Our findings suggest the importance of non-poultry sources, together with the previously reported role of retail chicken in human campylobacteriosis in Egypt that can provide insights to inform national control measures.

Current Perspectives and Potential of Probiotics to Limit Foodborne Campylobacter in Poultry

Poultry has been one of the major contributors of Campylobacter related human foodborne illness. Numerous interventions have been applied to limit Campylobacter colonization in poultry at the farm level, but other strategies are under investigation to achieve more efficient control. Probiotics are viable microbial cultures that can establish in the gastrointestinal tract (GIT) of the host animal and elicit health and nutrition benefits. In addition, the early establishment of probiotics in the GIT can serve as a barrier to foodborne pathogen colonization. Thus, probiotics are a potential feed additive for reducing and eliminating the colonization of Campylobacter in the GIT of poultry. Screening probiotic candidates is laborious and time-consuming, requiring several tests and validations both in vitro and in vivo. The selected probiotic candidate should possess the desired physiological characteristics and anti-Campylobacter effects. Probiotics that limit Campylobacter colonization in the GIT rely on different mechanistic strategies such as competitive exclusion, antagonism, and immunomodulation. Although numerous research efforts have been made, the application of Campylobacter limiting probiotics used in poultry remains somewhat elusive. This review summarizes current research progress on identifying and developing probiotics against Campylobacter and presenting possible directions for future research efforts.

The Prevalence of Campylobacter in Live Cattle, Turkey, Chicken, and Swine in the United States and Canada: A Systematic Review and Meta-Analysis

Campylobacter cause gastroenteritis in humans and may be shed in the feces of livestock and poultry species, including cattle, chicken, turkey, and swine. However, a synthesis of the prevalence on farms in the United States and Canada is currently lacking. Thus, our objective was to conduct a systematic review and meta-analysis to estimate the prevalence of Campylobacter coli, Campylobacter jejuni, and Campylobacter spp. on livestock and poultry farms operated under commercial conditions in the United States and Canada. The relevant literature was identified and examined for eligibility based on a priori inclusion and exclusion criteria. Relevant data were extracted, and a meta-analysis was performed. The data were transformed using the Freeman-Tukey arcsine transformation to stabilize the variance. A separate meta-analysis was performed for each animal species, level of sampling (individual versus pooled), and species of Campylobacter, for a total of 29 meta-analyses. C. jejuni and Campylobacter spp. were present in all livestock and poultry species of interest, whereas C. coli was found in all species of interest with the exception of chickens. Furthermore, substantial heterogeneity was observed in most meta-analyses. In an attempt to account for this, subgroup analyses were performed on potential moderators. However, with the exception of beef cattle, where studies in feedlot cattle reported a consistently higher prevalence compared with adult cattle on pasture, significant heterogeneity remained in the majority of meta-analyses after accounting for potential moderators. The results of this review can be used to inform future risk assessment, consumer and producer awareness, and resource allocation, and identify gaps for future research.

Peptidase PepP is a novel virulence factor of Campylobacter jejuni contributing to murine campylobacteriosis

Mechanisms of host-pathogen interactions resulting in immunopathological responses upon human Campylobacter jejuni infection are not completely understood, but the recent availability of murine infection models mimicking key features of campylobacteriosis helps solving this dilemma. During a screen for proteases expressed by C. jejuni, we identified a peptidase of the M24 family as a potential novel virulence factor, which was named PepP. The gene is strongly conserved in various Campylobacter species. A constructed deletion mutant ΔpepP of C. jejuni strain 81-176 grew as efficiently compared to isogenic wild-type (WT) or pepP complemented bacteria. To shed light on the potential role of this protease in mediating immunopathological responses in the mammalian host, we perorally challenged microbiota-depleted IL-10-/- mice with these strains. All strains stably colonized the murine gastrointestinal tract with comparably high loads. Remarkably, pepP deficiency was associated with less severe induced malaise, with less distinct apoptotic and innate immune cell responses, but also with more pronounced proliferative/regenerative epithelial cell responses in the large intestine at d6post-infection. Furthermore, pro-inflammatory mediators were lower in the colon, ileum, and mesenteric lymph nodes of mice that had been challenged with the ΔpepP mutant compared to the WT or pepP complemented strains. This also held true for extra-intestinal organs including liver, kidneys, and lungs, and, strikingly, to systemic compartments. Taken together, protease PepP is a novel virulence determinant involved in mediating campylobacteriosis. The finding that apoptosis in the colon is significantly diminished in mice infected with the pepP mutant highlights the epithelial layer as the first and main target of PepP in the intestine.

Determinants of Food Thermometer Use and Poultry Washing among Canadian Consumers

ABSTRACT

Previous surveys have found that few Canadians report using a food thermometer to check cooking doneness, and many report rinsing or washing poultry prior to cooking. A cross-sectional survey study was conducted to investigate the sociodemographic and psychosocial determinants of the reported use of these behaviors among Canadians. A questionnaire was developed, guided by the Theoretical Domains Framework, and pretested through 10 cognitive interviews. The questionnaire was administered in English and French on 18 November 2019, to an online panel of 524 Canadian consumers. Logistic and ordinal regression models were constructed to evaluate determinants of consumers' reported thermometer ownership (yes or no) and thermometer use and poultry washing frequencies (each measured on a 5-point Likert scale). Nearly two-thirds of respondents (64%; n = 333) reported owning a food thermometer. Thermometer ownership was more common among males (odds ratio [OR] = 1.48, 95% confidence interval [CI] = 1.02, 2.15) and those with higher income categories. Nearly 45% of these respondents (n = 147) reported often or always using their thermometer to check cooking doneness. The frequency of engaging in this behavior was best determined by four psychosocial constructs: behavioral intentions, beliefs about consequences, self-efficacy, and habits. Nearly two-thirds of respondents (64%; n = 333) reported often or always washing their poultry before cooking it. This behavior was more frequently reported by males (OR = 1.51, 95% CI = 1.002, 2.28). It was also predicted by six psychosocial constructs: behavioral intentions, beliefs about consequences, self-efficacy, social influences, social responsibility, and habits. Habits had the largest influence on both behaviors. The study results can inform the development of more targeted food safety education and outreach initiatives to improve these behaviors among Canadians.

HIGHLIGHTS

Survey of the U.S. Broiler Industry Regarding Pre- and Postharvest Interventions Targeted To Mitigate Campylobacter Contamination on Broiler Chicken Products

ABSTRACT

Campylobacter is one of the most commonly reported foodborne pathogens in the United States. Because poultry is considered a major source of Campylobacter infections in humans, reduction of Campylobacter contamination in poultry products is likely the most important and effective public health strategy for reducing the burden of campylobacteriosis in humans. A comprehensive on-line survey was conducted of key stakeholders in the U.S. broiler industry, including broiler farm managers (n = 18), poultry veterinarians (n = 18), and processing plant managers (n = 20), to assess the current pre- and postharvest Campylobacter interventions and control measures practiced by the industry for reducing Campylobacter contamination of broiler products. The survey also included information regarding each respondent's understanding of Campylobacter transmission and ecology in relation to broiler production. The results revealed that a majority of the establishments included in the survey are following the U.S. Department of Agriculture, Food Safety and Inspection Service guidelines for controlling Campylobacter contamination in broiler flocks and on carcasses. However, establishments appeared to be putting more effort into Salmonella control than into Campylobacter control both on the farm and in the processing plant. A majority of the respondents responded that current interventions are not effective for reducing Campylobacter contamination, especially on the farm. Many respondents did not understand the risk factors associated with Campylobacter colonization in broiler flocks and on carcasses. Continued educational and training programs for key stakeholders in the U.S. broiler industry are needed to increase awareness of the issues associated with Campylobacter infection in broiler chickens and of the fact that Campylobacter infection is a multifaceted problem that requires efforts from both the pre- and postharvest sectors.

HIGHLIGHTS

A meta-analysis of case-control studies examining sporadic campylobacteriosis in Australia and New Zealand from 1990 to 2016

OBJECTIVE

We conducted a meta-analysis of case-control studies to identify locally relevant risk factors for sporadic campylobacteriosis in Australia and New Zealand.

METHODS

We searched Medline, Web of Science, ProQuest and Google Scholar using PRISMA guidelines. Reference lists and grey literature were hand-searched. Meta-analyses were conducted in the R package 'metafor' using published odds ratios and 95% confidence intervals.

RESULTS

We identified 325 articles, from which we included 10 that described case-control studies. Four risk factors were statistically significant in the meta-analysis: eating undercooked poultry (OR=4.28, 95%CI 3.09-5.93); eating poultry cooked outside the home (OR=2.13, 95%CI 1.66-2.72); having pet chickens (OR=3.29, 95%CI 2.12-5.10); and overseas travel (OR=5.55, 95%CI 3.20-9.63). Among children, having pet dogs showed elevated but not significant risk (OR=1.57, 95%CI 0.99-2.49).

CONCLUSIONS

We identified consumption of chicken meat and contact with domestic chickens as important risk factors for campylobacteriosis in Australia and New Zealand. Implications for public health: While consumption of chicken meat is a well-known risk factor for campylobacteriosis, zoonotic transmission is often overlooked. This research indicates a greater need for public health awareness surrounding zoonotic campylobacteriosis, especially for young children.

Food Attribution and Economic Cost Estimates for Meat- and Poultry-Related Illnesses

ABSTRACT

The economic burden of foodborne illness has been estimated to be as high as US$90 billion annually. For policy purposes, it is often important to understand not only the overall cost of illness but also the costs associated with individual products or groups of products. In this study, I estimate the cost of foodborne illnesses from 29 pathogens associated with nongame meat and poultry products that are regulated by the U.S. Department of Agriculture. To complete this, I merge results from a food attribution model with results from an illness model and an economic burden of illness model. The food attribution model uses outbreak and expert elicitation data to attribute foods to pathogens. The illness model is a replication of the 2011 study published by the Centers for Disease Control and Prevention. The economic cost model is an updated version of previously published studies that include costs for medical care, lost productivity, loss of life, and pain and suffering. The primary attribution model, based largely on Interagency Food Safety Analytics Collaboration assumptions, estimates that meat and poultry products are vectors for 30.9% of all foodborne illnesses. This translates into 2.9 million annual illnesses, yielding economic costs of up to $20.3 billion. The costliest food-pathogen pairs include Campylobacter spp. in poultry ($6.9 billion), Salmonella spp. in chicken and pork ($2.8 and $1.9 billion, respectively), and Toxoplasma gondii in pork ($1.9 billion). Results based on alternative attribution and economic model assumptions are also presented, generating meat and poultry attribution estimates ranging from 27.1 to 36.7% and economic costs of $8.1 to $22.5 billion.

HIGHLIGHTS

Worldwide meta-analysis of the prevalence of Campylobacter in animal food products

The objective of this meta-analysis was to summarize available information on the prevalence of thermotolerant Campylobacter in different animal food products. A number of multilevel random-effect meta-analysis models were fitted to estimate mean prevalence of thermotolerant Campylobacter and to compare them among animal food products (cattle, pigs, broiler, hen, goat, sheep). The mean prevalence of Campylobacter spp. in animal food products was 29.6% (95% CI 27.6%-31%), and the mean prevalence of C. jejuni and C. coli were 19.3% and 9.7%, respectively. The prevalence of Campylobacter spp. was higher in products whose sources were broiler meat (p-estimate = 47.8%; 95% CI 44.9%-50.6%). C. jejuni was mainly observed in broiler meat where prevalence estimate (p-estimate) was 33.7% (95% CI 30.7%-36.8%). On the other hand, C. coli was observed in broiler meat (p-estimate = 14.1%; 95% CI 12.3%-16.1%) and sheep meat (p-estimate = 11.0%; 95% CI 3.6%-29.1%). The animal food products with the lowest prevalence of Campylobacter spp. were milk and dairy products (p-estimate = 3.5%; 95% CI 1.8%-6.5%), eggs (p-estimate = 4.0%; 95% CI 1.4%-10.7%), sausage (p-estimate = 9.4%; 95% CI 3.3%-24.0%), This meta-analysis concluding that C. jejuni is the most prevalent species worldwide and broiler meat is the main contamination source for human. The prevalence of Campylobacter species has public health importance and national authorities must monitor the situation in each country with the aim to establish the appropriate risk management measures.

Dogs and Cats: Reservoirs for Highly Diverse Campylobacter jejuni and a Potential Source of Human Exposure

Assessing the carriage of Campylobacter in animal reservoirs is essential to better understand Campylobacter epidemiology. Here, we evaluated the prevalence of thermophilic Campylobacter spp. in dogs and cats, hereafter defined as pets, and characterized Campylobacter jejuni (C. jejuni) isolates to assess their genetic diversity and their potential link with isolates from other animals or human cases. During a 6-month period, 304 feces samples were collected from pets. A significantly higher prevalence of thermophilic Campylobacter spp. was found in dogs compared with cats, as well as in dogs ≤ 1-year-old compared with older dogs. C. jejuni was the predominant species found in pets, and its genomic characterization revealed a high genetic diversity. Genotypes comparison with previously characterized isolates revealed a partial overlap between C. jejuni isolates from pets, chicken, cattle, and clinical cases. This overlap suggests the potential role of livestock and humans in pets' exposure to Campylobacter, or vice versa. The isolation of pets' specific profiles may suggest the existence of other sources of pet contamination or imply that pets may constitute a reservoir for Campylobacter. Because of the proximity between humans and pets, along with their frequent carriage of C. jejuni, human exposure to Campylobacter from pets can be more important than previously thought.

Cooking chicken at home: Common or recommended approaches to judge doneness may not assure sufficient inactivation of pathogens

About one third of foodborne illness outbreaks in Europe are acquired in the home and eating undercooked poultry is among consumption practices associated with illness. The aim of this study was to investigate whether actual and recommended practices for monitoring chicken doneness are safe. Seventy-five European households from five European countries were interviewed and videoed while cooking chicken in their private kitchens, including young single men, families with infants/in pregnancy and elderly over seventy years. A cross-national web-survey collected cooking practices for chicken from 3969 households. In a laboratory kitchen, chicken breast fillets were injected with cocktails of Salmonella and Campylobacter and cooked to core temperatures between 55 and 70°C. Microbial survival in the core and surface of the meat were determined. In a parallel experiment, core colour, colour of juice and texture were recorded. Finally, a range of cooking thermometers from the consumer market were evaluated. The field study identified nine practical approaches for deciding if the chicken was properly cooked. Among these, checking the colour of the meat was commonly used and perceived as a way of mitigating risks among the consumers. Meanwhile, chicken was perceived as hedonically vulnerable to long cooking time. The quantitative survey revealed that households prevalently check cooking status from the inside colour (49.6%) and/or inside texture (39.2%) of the meat. Young men rely more often on the outside colour of the meat (34.7%) and less often on the juices (16.5%) than the elderly (>65 years old; 25.8% and 24.6%, respectively). The lab study showed that colour change of chicken meat happened below 60°C, corresponding to less than 3 log reduction of Salmonella and Campylobacter. At a core temperature of 70°C, pathogens survived on the fillet surface not in contact with the frying pan. No correlation between meat texture and microbial inactivation was found. A minority of respondents used a food thermometer, and a challenge with cooking thermometers for home use was long response time. In conclusion, the recommendations from the authorities on monitoring doneness of chicken and current consumer practices do not ensure reduction of pathogens to safe levels. For the domestic cook, determining doneness is both a question of avoiding potential harm and achieving a pleasurable meal. It is discussed how lack of an easy "rule-of-thumb" or tools to check safe cooking at consumer level, as well as national differences in contamination levels, food culture and economy make it difficult to develop international recommendations that are both safe and easily implemented.

Global and regional source attribution of Shiga toxin-producing Escherichia coli infections using analysis of outbreak surveillance data

Shiga toxin-producing Escherichia coli (STEC) infections pose a substantial health and economic burden worldwide. To target interventions to prevent foodborne infections, it is important to determine the types of foods leading to illness. Our objective was to determine the food sources of STEC globally and for the six World Health Organization regions. We used data from STEC outbreaks that have occurred globally to estimate source attribution fractions. We categorised foods according to their ingredients and applied a probabilistic model that used information on implicated foods for source attribution. Data were received from 27 countries covering the period between 1998 and 2017 and three regions: the Americas (AMR), Europe (EUR) and Western-Pacific (WPR). Results showed that the top foods varied across regions. The most important sources in AMR were beef (40%; 95% Uncertainty Interval 39-41%) and produce (35%; 95% UI 34-36%). In EUR, the ranking was similar though with less marked differences between sources (beef 31%; 95% UI 28-34% and produce 30%; 95% UI 27-33%). In contrast, the most common source of STEC in WPR was produce (43%; 95% UI 36-46%), followed by dairy (27%; 95% UI 27-27%). Possible explanations for regional variability include differences in food consumption and preparation, frequency of STEC contamination, the potential of regionally predominant STEC strains to cause severe illness and differences in outbreak investigation and reporting. Despite data gaps, these results provide important information to inform the development of strategies for lowering the global burden of STEC infections.

Campylobacter gastroenteritis in children in north-eastern Israel comparison with other common pathogens

Gastroenteritis is common among children. Campylobacter jejuni is one of the main causative bacterial pathogens, together with Shigella, Salmonella and invasive Escherichia coli. Campylobacteriosis is a zoonotic, usually self-limited disease that does not always require antibiotic treatment. In cases of protracted diarrhoea in healthy children or immunocompromised patients, antibiotic treatment is recommended, and the drug of choice is still macrolides, with very low resistance rates in Campylobacter species. However, it is crucial to isolate the causative organism, because some cases, such as Shigella encephalitis, call for initiation of empiric antibiotic treatment. In this study, we compared the incidence, epidemiology, clinical findings and laboratory results of gastroenteritis with dysentery caused by these organisms in children in our area. C. jejuni was found to be the leading pathogen in children hospitalized with bacterial gastroenteritis, followed by Shigella and Salmonella. Macrolides were the drug of choice for Campylobacter, and ceftriaxone and ciprofloxacin were the best empiric treatments for Shigella and Salmonella, respectively.

Animal agriculture exposures among Minnesota residents with zoonotic enteric infections, 2012-2016

Prospective, population-based surveillance to systematically ascertain exposures to food production animals or their environments among Minnesota residents with sporadic, domestically acquired, laboratory-confirmed enteric zoonotic pathogen infections was conducted from 2012 through 2016. Twenty-three percent (n = 1708) of the 7560 enteric disease cases in the study reported an animal agriculture exposure in their incubation period, including 60% (344/571) of Cryptosporidium parvum cases, 28% (934/3391) of Campylobacter cases, 22% (85/383) of Shiga toxin-producing Escherichia coli (STEC) O157 cases, 16% (83/521) of non-O157 STEC cases, 10% (253/2575) of non-typhoidal Salmonella enterica cases and 8% (9/119) of Yersinia enterocolitica cases. Living and/or working on a farm accounted for 61% of cases with an agricultural exposure, followed by visiting a private farm (29% of cases) and visiting a public animal agriculture venue (10% of cases). Cattle were the most common animal type in agricultural exposures, reported by 72% of cases. The estimated cumulative incidence of zoonotic enteric infections for people who live and/or work on farms with food production animals in Minnesota during 2012–2016 was 147 per 10 000 population, vs. 18.5 per 10 000 for other Minnesotans. The burden of enteric zoonoses among people with animal agriculture exposures appears to be far greater than previously appreciated.

Whole-Genome Sequencing to Detect Numerous Campylobacter jejuni Outbreaks and Match Patient Isolates to Sources, Denmark, 2015-2017

In industrialized countries, the leading cause of bacterial gastroenteritis is Campylobacter jejuni. However, outbreaks are rarely reported, which may reflect limitations of surveillance, for which molecular typing is not routinely performed. To determine the frequency of genetic clusters among patients and to find links to concurrent isolates from poultry meat, broiler chickens, cattle, pigs, and dogs, we performed whole-genome sequencing on 1,509 C. jejuni isolates from 774 patients and 735 food or animal sources in Denmark during 2015-2017. We found numerous clusters; 366/774 (47.3%) clinical isolates formed 104 clusters of >2 isolates. A total of 41 patient clusters representing 199/366 (54%) patients matched a potential source, primarily domestic chickens/broilers. This study revealed serial outbreaks and numerous matches to concurrent food and animal isolates and highlighted the potential of whole-genome sequencing for improving routine surveillance of C. jejuni by enhancing outbreak detection, source tracing, and potentially prevention of human infections.

Comparison of relative expressions of genes involved in iron acquisition and regulation in fluoroquinolone-resistant and wild-type Campylobacter jejuni

Campylobacteriosis caused by C. jejuni is a serious yet common foodborne disease in the U.S. The prevalence of fluoroquinolone-resistant C. jejuni from poultry has continued to increase despite the withdrawal of fluoroquinolone use in the U.S. poultry industry in 2005. To date, no clear selective pressures that explain this effect have been documented. In this study, we investigated limited bioavailability of iron in poultry and enhanced iron uptake and regulation as potential indirect selective pressures conferring fitness advantages in fluoroquinolone-resistant C. jejuni compared to its susceptible wild-type counterpart. Five fluoroquinolone-susceptible C. jejuni isolates were selected from litter collected from commercial broiler farms. Using antibiotic selection, five fluoroquinolone-resistant strains were created. Relative expressions of six genes involved in iron acquisition and regulation were compared between the resistant and susceptible strains using RT-qPCR under normal and iron-limiting conditions. High variability in the relative gene expressions was observed among the strains, with only one resistant strain showing the consistent upregulation of the measured genes compared to the matching susceptible wild-type. Our results suggest that the hypothesis tested in the study may not be an adequate explanation of the molecular mechanism behind the enhanced fitness of fluoroquinolone-resistant C. jejuni compared to susceptible C. jejuni. This study highlights the need for a better understanding of the complex ecology and dynamics of fluoroquinolone resistance in C. jejuni in poultry environment and warrants an examination of fluoroquinolone-resistant C. jejuni strains recovered from the natural broiler chicken environment.

Antimicrobial resistance patterns and molecular resistance markers of Campylobacter jejuni isolates from human diarrheal cases

The aim of this study is to characterize the antimicrobial resistance of Campylobacter jejuni recovered from diarrheal patients in Belgium, focusing on the genetic diversity of resistant strains and underlying molecular mechanisms of resistance among Campylobacter jejuni resistant strains isolated from diarrheal patients in Belgium. Susceptibility profile of 199 clinical C. jejuni isolates was determined by minimum inhibitory concentrations against six commonly-used antibiotics (ciprofloxacin, nalidixic acid, tetracycline, streptomycin, gentamicin, and erythromycin). High rates of resistance were observed against nalidixic acid (56.3%), ciprofloxacin (55.8%) and tetracycline (49.7%); these rates were similar to those obtained from different national reports in broilers intended for human consumption. Alternatively, lower resistance rates to streptomycin (4.5%) and erythromycin (2%), and absolute sensitivity to gentamicin were observed. C. jejuni isolates resistant to tetracycline or quinolones (ciprofloxacin and/or nalidixic acid) were screened for the presence of the tetO gene and the C257T mutation in the quinolone resistance determining region (QRDR) of the gyrase gene gyrA, respectively. Interestingly, some of the isolates that displayed phenotypic resistance to these antimicrobials lacked the corresponding genetic determinants. Among erythromycin-resistant isolates, a diverse array of potential molecular resistance mechanisms was investigated, including the presence of ermB and mutations in the 23S rRNA gene, the rplD and rplV ribosomal genes, and the regulatory region of the cmeABC operon. Two of the four erythromycin-resistant isolates harboured the A2075G transition mutation in the 23S rRNA gene; one of these isolates exhibited further mutations in rplD, rplV and in the cmeABC regulatory region. This study expands the current understanding of how different genetic determinants and particular clones shape the epidemiology of antimicrobial resistance in C. jejuni in Belgium. It also reveals many questions in need of further investigation, such as the role of other undetermined molecular mechanisms that may potentially contribute to the antimicrobial resistance of Campylobacter.

Campylobacteriosis in the Nordic countries from 2000 to 2015: Trends in time and space

Aims: This study aimed to describe the demographic and geographic patterns of campylobacteriosis in Denmark, Finland, Norway and Sweden during 2000-2015. Methods: All Campylobacter infections notified to national authorities in the four countries during the study period were included. Background data for each notification consisted of patient age, sex, geographical location, presumed origin of infection and date of sample taken or date of sample received in the laboratory. These data were analysed in order to investigate annual trends, age group and sex patterns, as well as variations in the geographical and seasonal distribution of infections. Results: During the study period, a total of 164,001 Campylobacter infections, excluding travel-related cases, were registered, representing a mean annual incidence of 42.3 cases/100,000 population (ranging from 28.5 in Norway to 60.4 in Denmark). The incidence increased significantly from 2004 onwards in all countries, apart from Denmark. Males had higher infection rates in general. The highest incidences were observed in 0-4 year olds and those aged 20-29 years, apart from in Finland where there was no peak of infections in children aged 0-4 years. Seasonality of disease was distinct in all four countries, showing peaks of infection between July and August. In Sweden and Norway, incidences of campylobacteriosis were significantly higher in municipalities with high degrees of coastline or inland water. Conclusions: Campylobacter in the Nordic countries mostly follows known patterns with respect to demography and seasonality. Our study demonstrates new insights concerning geographical patterns of disease, highlighting possible future vulnerable population groups and locations.

Critical Orientation in the Jungle of Currently Available Methods and Types of Data for Source Attribution of Foodborne Diseases

With increased interest in source attribution of foodborne pathogens, there is a need to sort and assess the applicability of currently available methods. Herewith we reviewed the most frequently applied methods for source attribution of foodborne diseases, discussing their main strengths and weaknesses to be considered when choosing the most appropriate methods based on the type, quality, and quantity of data available, the research questions to be addressed, and the (epidemiological and microbiological) characteristics of the pathogens in question. A variety of source attribution approaches have been applied in recent years. These methods can be defined as top–down, bottom–up, or combined. Top–down approaches assign the human cases back to their sources of infection based on epidemiological (e.g., outbreak data analysis, case-control/cohort studies, etc.), microbiological (i.e., microbial subtyping), or combined (e.g., the so-called ‘source-assigned case-control study’ design) methods. Methods based on microbial subtyping are further differentiable according to the modeling framework adopted as frequency-matching (e.g., the Dutch and Danish models) or population genetics (e.g., Asymmetric Island Models and STRUCTURE) models, relying on the modeling of either phenotyping or genotyping data of pathogen strains from human cases and putative sources. Conversely, bottom–up approaches like comparative exposure assessment start from the level of contamination (prevalence and concentration) of a given pathogen in each source, and then go upwards in the transmission chain incorporating factors related to human exposure to these sources and dose-response relationships. Other approaches are intervention studies, including ‘natural experiments,’ and expert elicitations. A number of methodological challenges concerning all these approaches are discussed. In absence of an universally agreed upon ‘gold’ standard, i.e., a single method that satisfies all situations and needs for all pathogens, combining different approaches or applying them in a comparative fashion seems to be a promising way forward.

Human campylobacteriosis: A public health concern of global importance

Campylobacter species are among the leading cause of bacterial foodborne and waterborne infections. In addition, Campylobacter is one of the major causative agent of bacterial gastrointestinal infections and the rise in the incidence of Campylobacter infections have been reported worldwide. Also, the emergence of some Campylobacter species as one of the main causative agent of diarrhea and the propensity of these bacteria species to resist the actions of antimicrobial agents; position them as a serious threat to the public health. This paper reviews Campylobacter pathogenicity, infections, isolation and diagnosis, their reservoirs, transmission pathways, epidemiology of Campylobacter outbreaks, prevention and treatment option, antibiotics resistance and control of antibiotics use.

Strain-Specific Differences in Survival of Campylobacter spp. in Naturally Contaminated Turkey Feces and Water

Campylobacter jejuni and Campylobacter coli are leading causes of human foodborne illness, with poultry as a major vehicle. Turkeys are frequently colonized with Campylobacter, but little is known about Campylobacter survival in turkey feces, even though fecal droppings are major vehicles for Campylobacter within-flock transmission as well as for environmental dissemination. Our objective was to examine survival of Campylobacter, including different strains, in freshly excreted feces from naturally colonized commercial turkey flocks and in suspensions of turkey feces in water from the turkey house. Fecal and water suspensions were stored at 4°C, and Campylobacter populations were enumerated on selective media at 48-h intervals. C. jejuni and C. coli isolates were characterized for resistance to a panel of antibiotics, and a subset was subtyped using multilocus sequence typing. Campylobacter was recovered from feces and water for up to 16 days. Analysis of 548 isolates (218 C. jejuni and 330 C. coli) revealed that C. jejuni survived longer than C. coli in feces (P = 0.0005), while the reverse was observed in water (P < 0.0001). Strain-specific differences in survival were noted. Multidrug-resistant C. jejuni isolates of sequence type 1839 (ST-1839) and the related ST-2935 were among the longest-surviving isolates in feces, being recovered for up to 10 to 16 days, while multidrug-resistant C. coli isolates of ST-1101 were recovered from feces for only up to 4 days. Data on Campylobacter survival upon excretion from the birds can contribute to further understanding of the transmission dynamics of this pathogen in the poultry production ecosystem.IMPORTANCE Campylobacter jejuni and Campylobacter coli are leading foodborne pathogens, with poultry as a major reservoir. Due to their growth requirements, these Campylobacter spp. may be unable to replicate once excreted by their avian hosts, but their survival in feces and the environment is critical for transmission in the farm ecosystem. Reducing the prevalence of Campylobacter-positive flocks can have major impacts in controlling both contamination of poultry products and environmental dissemination of the pathogens. However, understanding the capacity of these pathogens to survive in transmission-relevant vehicles such as feces and farmhouse water remains poorly understood, and little information is available on species- and strain-associated differences in survival. Here, we employed model conditions to investigate the survival of C. jejuni and C. coli from naturally colonized turkey flocks, and with diverse genotypes and antimicrobial resistance profiles, in turkey feces and in farmhouse water.

The prevalence of Campylobacter species in broiler flocks and their environment: assessing the efficiency of chitosan/zinc oxide nanocomposite for adopting control strategy

There is a growing trend to implement biosecurity measures in small commercial broiler flocks and trying to replace ineffective antimicrobial with alternative materials to interevent a strategy for the control of Campylobacter bacteria in these farms. This study was designed to determine the prevalence rate of Campylobacter spp. in broiler flocks and their environment. Thereafter, assess the efficiency of chitosan, zinc oxide nanoparticles (ZnO NPs), and chitosan/ZnO NPs composite against Campylobacter strains to adopt a novel control strategy based on the ability to use those nanocomposites. A total of 220 samples were collected from broiler flocks, their environment, and farm attendants that direct contact with birds. All samples were subjected to microbiological investigation for isolation, then molecular identification of bacteria using PCR. ZnO NPs and chitosan/ZnO NPs composite were synthesized then characterized by transmission electron microscopy (TEM), scanning electron microscopy (SEM), Fourier-transform infrared spectrum (FT-IR), and X-ray diffraction (X-RD). The efficiency of testing compounds was examined against 30 strains of Campylobacter coli (C. coli) to determine the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). The highest percentages of C. coli were isolated from the manure storage area, and broiler litter followed by flies, and feeders (66.7, 53.3, 40.0, and 33.3%, respectively). Both chitosan/ZnO NPs and ZnO NPs at a concentration of 0.5 μg/mL and 1.5 μg/mL, respectively showed complete efficiency (100%) against C. coli compared with chitosan compound. In conclusion, manure storage area and broiler litter represented the main reservoir of Campylobacter bacterial contaminant followed by flies in broiler poultry farms. Chitosan/ZnO NPs composite can be used in any biosecurity program of poultry farms as an alternative to ineffective antimicrobial agents.

A systematic review of source attribution of human campylobacteriosis using multilocus sequence typing

BackgroundCampylobacter is a leading global cause of bacterial gastroenteritis, motivating research to identify sources of human infection. Population genetic studies have been increasingly applied to this end, mainly using multilocus sequence typing (MLST) data.ObjectivesThis review aimed to summarise approaches and findings of these studies and identify best practice lessons for this form of genomic epidemiology.MethodsWe systematically reviewed publications using MLST data to attribute human disease isolates to source. Publications were from January 2001, when this type of approach began. Searched databases included Scopus, Web of Science and PubMed. Information on samples and isolate datasets used, as well as MLST schemes and attribution algorithms employed, was obtained. Main findings were extracted, as well as any results' validation with subsequent correction for identified biases. Meta-analysis is not reported given high levels of heterogeneity.ResultsOf 2,109 studies retrieved worldwide, 25 were included, and poultry, specifically chickens, were identified as principal source of human infection. Ruminants (cattle or sheep) were consistently implicated in a substantial proportion of cases. Data sampling and analytical approaches varied, with five different attribution algorithms used. Validation such as self-attribution of isolates from known sources was reported in five publications. No publication reported adjustment for biases identified by validation.ConclusionsCommon gaps in validation and adjustment highlight opportunities to generate improved estimates in future genomic attribution studies. The consistency of chicken as the main source of human infection, across high income countries, and despite methodological variations, highlights the public health importance of this source.

The role of parameterization in comparing source attribution models based on microbial subtyping for salmonellosis

Source attribution methods attribute human cases of a zoonotic disease to a certain source putatively responsible for this disease. Identifying and quantifying the contribution of different sources to human infections is important for taking appropriate actions for reducing the exposure of the consumer to zoonotic pathogens. One widely used method is the microbial subtyping approach, whose principle is to compare the frequency of pathogen subtypes from different sources (e.g. animals or food) with the frequency of these subtypes in human cases. This paper studies the relationship between a Bayesian microbial subtyping approach described by Hald and coworkers subsequently modified by David and coworkers, here called the Hald model, and a frequentist approach known as the "Dutch model." The comparison between the Bayesian and frequentist model is done for two data sets on salmonellosis in Germany from different time periods (year 2004-2007 and 2010-2011). The results of both approaches are in good agreement with each other for the used data. It is shown here mathematically that a certain parameterization can be used to transform the probabilistic Hald model into a deterministic form, which is equivalent to the Dutch model. That certain parameterization secures independence of the model outcomes from the choice of so-called unique subtypes (which are unique in the sense that they are found exclusively in one of the sources). It is shown that deviating from that certain parameterization leads variations in the model outcome dependent on which unique subtypes are chosen in the process of modelling.

Campylobacter jejuni bacteremia in a patient with asplenia and enteritis

Campylobacter bacteremia is an unusual presentation of a common infectious disease such as enteritis. We provide key teaching points about its presentation, risk factors, diagnosis and treatment.