Inactivation of Campylobacter jejuni by chlorine and monochloramine

Assessing the Health Impact of Disinfection Byproducts in Drinking Water

This study provides a comprehensive investigation of the impact of disinfection byproducts (DBPs) on human health, with a particular focus on DBPs present in chlorinated drinking water, concentrating on three primary DBP categories (aliphatic, alicyclic, and aromatic). Additionally, it explores pivotal factors influencing DBP formation, encompassing disinfectant types, water source characteristics, and environmental conditions, such as the presence of natural materials in water. The main objective is to discern the most hazardous DBPs, considering criteria such as regulation standards, potential health impacts, and chemical diversity. It provides a catalog of 63 key DBPs alongside their corresponding parameters. From this set, 28 compounds are meticulously chosen for in-depth analysis based on the above criteria. The findings strive to guide the advancement of water treatment technologies and intelligent sensory systems for the efficient water quality surveillance. This, in turn, enables reliable DBP detection within water distribution networks. By enriching the understanding of DBP-associated health hazards and offering valuable insights, this research is aimed to contribute to influencing policy-making in regulations and treatment strategies, thereby protecting public health and improving safety related to chlorinated drinking water quality.

Wilderness Medical Society Clinical Practice Guidelines on Water Treatment for Wilderness, International Travel, and Austere Situations: 2024 Update

To provide guidance to medical providers, wilderness users, and travelers, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for treating water in situations where the potability of available water is not assured, including wilderness and international travel, areas impacted by disaster, and other areas without adequate sanitation. The guidelines present the available methods for reducing or eliminating microbiological contamination of water for individuals, groups, or households; evaluation of their effectiveness; and practical considerations. The evidence base includes both laboratory and clinical publications. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according to the criteria published by the American College of Chest Physicians.

Optimization of the In Vitro Bactericidal Effect of a Mixture of Chlorine and Sodium Gallate against Campylobacter spp. and Arcobacter butzleri

ABSTRACT

Campylobacter spp. and Arcobacter butzleri are foodborne pathogens associated with the consumption of contaminated raw chicken meat. At the industry level, the combination of new and common antimicrobials could be used as a strategy to control the presence of pathogens in chicken carcasses. The objective of this study was to determine the bacteriostatic and bactericidal effects of a mixture of chlorine (Cl) and sodium gallate (SG) on a mixture of two Campylobacter species (Campylobacter jejuni and Campylobacter coli) and A. butzleri. Using a central composite experimental design, it was established that the optimum inhibitory SG-Cl concentration for Campylobacter spp. was 44 to 45 ppm. After 15 h of incubation, Campylobacter species growth was reduced by 37.5% and the effect of Cl was potentiated by SG at concentrations above 45 ppm. In the case of A. butzleri, optimum levels of 28 and 41 ppm were observed for SG and Cl, respectively; no synergism was reported, as this bacterium was more sensitive to lower Cl concentrations than Campylobacter. After a 20-min pretreatment with peracetic acid (50 ppm), the optimum condition to achieve a >1.0-Log CFU/mL reduction of Campylobacter spp. was exposure to 177 ppm of Cl and 44 ppm of SG for 56 min. As A. butzleri showed lower resistance to the bacteriostatic effect of the Cl-SG combination, it was assumed that optimum bactericidal conditions for Campylobacter spp. were effective to control the former; this was confirmed with subsequent validation of the model. The SG-Cl combination has bactericidal properties against Campylobacter and A. butzleri, and it may be a useful strategy to improve sanitary practices applied in the poultry industry.

HIGHLIGHTS

A cross-sectional study of the prevalence factors associated with fluoroquinolone resistant Campylobacter jejuni in broiler flocks in Canada

Campylobacter infections in humans are usually self-limiting; however, antibiotic intervention may be necessary in the case of severe infection. Fluoroquinolones are often the drug of choice for treatment of campylobacteriosis; however, resistance to these drugs can develop rapidly, complicating treatment protocols. Increasing resistance to fluoroquinolones in human infections has coincided with approval of use of fluoroquinolones in animals, therefore, isolation of fluoroquinolone resistant (FQr) Campylobacter in broiler flocks is concerning. This cross-sectional study utilized data collected from 2013-2018 by the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) on-farm surveillance program to investigate prevalence factors associated with the isolation of FQr C. jejuni from broiler faecal samples. Mixed effects logistic regression models accounting for clustering of flocks within hatcheries, with and without a fixed effect for the presence of flock level tetracycline resistance were used to assess prevalence factors among 536 C. jejuni isolates from 158 flocks. Both models indicated that the type of bird used (Ross versus Cobb or mixed), the use of virginiamycin as a feed additive, the use of traps to control rodent populations in the barn, and the total number of birds in the barn were significant prevalence factors for increased FQr C. jejuni in a flock. In the model where flock level tetracycline resistance was included as a fixed effect, the odds of FQr C. jejuni increased by 16 (95% CI: 3.74, 68), and the magnitude of the effect of each of the identified prevalence factors was larger. Both models indicated that methods of disinfection of water lines between production cycles is important, with the use of chlorine being protective in the model where tetracycline resistance was included as a fixed effect, and the use of hydrogen peroxide being a risk factor in the model where tetracycline resistance was not included as a fixed effect. The use of hot water to wash the barn between production cycles was also a significant protective factor in the model where tetracycline resistance was not included as a fixed effect. These results indicate that biosecurity and sanitation procedures play a role in the dissemination of FQr C. jejuni in broiler flocks. Future analysis should seek to understand the effect of different disinfectant products on the isolation of FQr C. jejuni. Gaining a better understanding of the management of these critical practices may allow for the reduction of this enteric pathogen in broiler flocks in Canada.

Chlorine Induces Physiological and Morphological Changes on Chicken Meat Campylobacter Isolates

Broiler chickens frequently become colonized by Campylobacter species. As a consequence, Campylobacter, can enter the poultry meat supply chain and represents a significant risk for human public health. A number of on-farm biosecurity and processing measures are used to mitigate the load of Campylobacter on chicken meat. In many countries, chlorine is commonly used as a biocide in processing plants to reduce bacterial loads on poultry carcasses but there is limited evidence of its effectiveness on Campylobacter. In this study, 116 Campylobacter isolates (89 C. jejuni and 27 C. coli) were isolated from poultry meat carcasses prior to the inside/outside wash step and used in in vitro assays exploring the efficacy of chlorine. A high proportion of isolates exhibited MIC and MBC values of 128 ppm but organic material present in the broth likely affected this result. Thus, additional bactericidal assays (time kill and chlorine inactivation) were used to characterize the response of C. jejuni isolates to different concentrations of chlorine. At 10⁶ CFU, C. jejuni was found to be highly sensitive to concentrations of chlorine and was inhibited at low concentrations (0.2–2.0 ppm). At a higher bacterial load (10⁸ CFU), variation in the response of different C. jejuni isolates was observed. One isolate was growth inhibited at 1.8 ppm while another required 16 ppm. At 10⁸ CFU, C. jejuni could be resuscitated following exposure to chlorine highlighting a potential limitation of chlorine use. Analysis of UV leakage indicated that high chlorine concentrations resulted in increased 280 nm absorbance values suggesting bacterial membrane damage. Scanning electron and transmission electron microscopy were performed to characterize the morphological effects of chlorine exposure. Some effects of chlorine exposure included changes in shape (coccoid, or elongated), cellular degeneration, and shriveled bacterial cells. Interestingly, C. jejuni cells with normal morphology were also observed in the chlorine exposed group and represent a population of cells that could be resuscitated. This study is useful for the chicken meat industry and provides data for future optimization of chlorine use in reducing Campylobacter loads.

Systematic Review and Meta-Analysis of the Persistence and Disinfection of Human Coronaviruses and Their Viral Surrogates in Water and Wastewater

A systematic review and meta-analysis was conducted to identify decay rate constants (k) of human coronaviruses and their viral surrogates (i.e., animal coronaviruses and the enveloped bacteriophage Phi6) in water and wastewater and disinfection rates with exposure to free chlorine and germicidal ultraviolet light (UV254). Here, 73 k were identified, with only 12 for human coronaviruses, as opposed to animal coronaviruses or Phi6. In the absence of disinfectants, k increased with temperature. Between 22 and 25 °C, mean k for coronaviruses ranged from 0.19 ± 0.06 d-1 in laboratory buffer (n = 4) to 2.9 ± 0.03 d-1 in sterilized wastewater (n = 3), which are within the ranges observed for Phi6 and nonenveloped viruses. No free chlorine or UV254 disinfection studies for coronaviruses were identified that met the systematic review inclusion criteria, although evidence from the literature suggests that coronaviruses would be inactivated if disinfectant doses recommended for nonenveloped viruses were applied. Three disinfection experiments were identified for Phi6. However, given different genome compositions and virion structures between coronaviruses and Phi6, it is not clear whether Phi6 should be used as a surrogate for evaluating free chlorine or UV254k. Therefore, there is a critical need for additional studies that specifically evaluate disinfection kinetics of coronaviruses in the aqueous environment.

Wilderness Medical Society Clinical Practice Guidelines for Water Disinfection for Wilderness, International Travel, and Austere Situations

To provide guidance to clinicians, the Wilderness Medical Society convened experts to develop evidence-based guidelines for water disinfection in situations where the potability of available water is not ensured, including wilderness and international travel, areas affected by disaster, and other areas without adequate sanitation. The guidelines present the available methods for reducing or eliminating microbiologic contamination of water for individuals, groups, or households; evaluation of their effectiveness; and practical considerations. The evidence evaluation includes both laboratory and clinical publications. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks or burdens, according to the criteria published by the American College of Chest Physicians.

Efficacy of Flushing and Chlorination in Removing Microorganisms from a Pilot Drinking Water Distribution System

To ensure delivery of microbiologically safe drinking water, the physical integrity of the distribution system is an important control measure. During repair works or an incident the drinking water pipe is open and microbiologically contaminated water or soil may enter. Before taking the pipe back into service it must be cleaned. The efficacy of flushing and shock chlorination was tested using a model pipe-loop system with a natural or cultured biofilm to which a microbial contamination (Escherichia coli, Clostridium perfringens spores and phiX174) was added. On average, flushing removed 1.5–2.7 log microorganisms from the water, but not the biofilm. In addition, sand added to the system was not completely removed. Flushing velocity (0.3 or 1.5 m/s) did not affect the efficacy. Shock chlorination (10 mg/L, 1–24 h) was very effective against E. coli and phiX174, but C. perfringens spores were partly resistant. Chlorination was slightly more effective in pipes with a natural compared to a cultured biofilm. Flushing alone is thus not sufficient after high risk repair works or incidents, and shock chlorination should be considered to remove microorganisms to ensure microbiologically safe drinking water. Prevention via hygienic working procedures, localizing and isolating the contamination source and issuing boil water advisories remain important, especially during confirmed contamination events.

Individual based modeling and analysis of pathogen levels in poultry chilling process

Pathogen control during poultry processing critically depends on more enhanced insight into contamination dynamics. In this study we build an individual based model (IBM) of the chilling process. Quantifying the relationships between typical Canadian processing specifications, water chemistry dynamics and pathogen levels both in the chiller water and on individual carcasses, the IBM is shown to provide a useful tool for risk management as it can inform risk assessment models. We apply the IBM to Campylobacter spp. contamination on broiler carcasses, illustrating how free chlorine (FC) sanitization, organic load in the water, and pre-chill carcass pathogen levels affect pathogen levels of post-chill broilers. In particular, given a uniform distribution of Campylobacter levels on incoming poultry we quantify the efficacy of FC control in not only reducing pathogen levels on average, but also the variation of pathogen levels on poultry exiting the chill tank. Furthermore, we demonstrate that the absence/presence of FC input dramatically influences when, during a continuous chilling operation, cross-contamination will be more likely.

Enhancement of bactericidal effects of sodium hypochlorite in chiller water with food additive grade calcium hydroxide

An alkaline agent, namely food additive grade calcium hydroxide (FdCa(OH)₂) in solution at 0.17%, was evaluated for its bactericidal efficacies in chiller water with sodium hypochlorite (NaOCl) at a concentration of 200 ppm total residual chlorine. Without organic material presence, NaOCl could inactivate Salmonella Infantis and Escherichia coli within 5 sec, but in the presence of fetal bovine serum (FBS) at 0.5%, the bactericidal effects of NaOCl were diminished completely. FdCa(OH)₂ solution required 3 min to inactivate bacteria with or without 5% FBS. When NaOCl and FdCa(OH)₂ were mixed at the final concentration of 200 ppm and 0.17%, respectively, the mixed solution could inactivate bacteria at acceptable level (10³ reduction of bacterial titer) within 30 sec in the presence of 0.5% FBS. The mixed solution also inhibited cross-contamination with S. Infantis or E. coli on chicken meats. It was confirmed and elucidated that FdCa(OH)₂ has a synergistic effect together with NaOCl for inactivating microorganisms.

Non food-related risk factors of campylobacteriosis in Canada: a matched case-control study

BACKGROUND

Campylobacteriosis is a prominent bacterial gastrointestinal infection worldwide with several transmission pathways. Its non-foodborne routes have been less documented and quantified. The study aimed to quantitatively explore the role of potential risk factors not directly associated with food for sporadic cases of C. jejuni infection in Canada.

METHODS

This retrospective matched case-control study was built on an enhanced campylobacteriosis surveillance system and on a survey of healthy people and their behaviour with regards to potential risk factors for gastrointestinal infections that occurred in the same area in Canada. Eighty-five cases were individually matched by age and season to 170 controls.

RESULTS

Through conditional logistic regression, risk factors were found only among water-related factors (drinking untreated water, using tap filter, drinking water from well and swimming in natural water), whereas drinking bottled water was protective. Among the 32 non-water related factors explored, 12 were surprisingly 'protective' factors without relevant explanation for that effect (for example gardening, attending a barbecue, eating food from a fast-food restaurant), suggesting that human infection by Campylobacter may be more frequently acquired at home than outside the home.

CONCLUSIONS

This study confirms and quantifies the importance of the waterborne transmission of campylobacteriosis. People are encouraged to drink only treated water and to avoid the ingestion of natural water as much as possible while swimming or playing in water. Globally, general hygiene and proper food handling and cooking practices at home should continue to be encouraged.

Preharvest Food Safety in Broiler Chicken Production

Preharvest food safety in broiler production is a systematic approach to control the introduction, propagation, and dissemination of Salmonella and Campylobacter from breeder flocks to the end of their progeny (broilers) life cycle. New and revised more stringent performance standards for these pathogens at the processing plant level require continuous evaluation of the preharvest management practices and intervention strategies used by the poultry industry. The implementation of stricter biosecurity plans, vaccination of breeder flocks for Salmonella , and usage of feed that is free of animal by-products are some of the measures recommended to control the pathogens. Interventions shown to be effective in experimental settings need to be assessed for their cost-effectiveness and efficiency when applied at the farm level.

Quantification of pathogen inactivation efficacy by free chlorine disinfection of drinking water for QMRA

To support the implementation of quantitative microbial risk assessment (QMRA) for managing infectious risks associated with drinking water systems, a simple modeling approach for quantifying Log10 reduction across a free chlorine disinfection contactor was developed. The study was undertaken in three stages: firstly, review of the laboratory studies published in the literature; secondly, development of a conceptual approach to apply the laboratory studies to full-scale conditions; and finally implementation of the calculations for a hypothetical case study system. The developed model explicitly accounted for variability in residence time and pathogen specific chlorine sensitivity. Survival functions were constructed for a range of pathogens relying on the upper bound of the reported data transformed to a common metric. The application of the model within a hypothetical case study demonstrated the importance of accounting for variable residence time in QMRA. While the overall Log10 reduction may appear high, small parcels of water with short residence time can compromise the overall performance of the barrier. While theoretically simple, the approach presented is of great value for undertaking an initial assessment of a full-scale disinfection contactor based on limited site-specific information.

Environmentally Transmitted Pathogens

This chapter describes a variety of pathogens found in the environment that are capable of infecting humans and causing disease. Different classes of pathogens are discussed including bacteria, parasites and viruses. For each pathogen, data are provided on the incidence of the organism in a particular environmental matrix such as water, food or municipal waste. In addition, we discuss: the disease caused by the particular microbe; the mode of transmission; the incubation time needed within the host prior to the onset of disease; and the duration of illness. Fate and transport of pathogens in the environment are also described. A variety of bacterial pathogens are discussed including waterborne and waterbased bacteria. Parasites discussed include protozoa, nematodes, cestodes and trematodes. For viruses, both enteric and respiratory viruses are included.

The role of environmental reservoirs in human campylobacteriosis

Campylobacteriosis is infection caused by the bacteria Campylobacter spp. and is considered a major public health concern. Campylobacter spp. have been identified as one of the most common causative agents of bacterial gastroenteritis. They are typically considered a foodborne pathogen and have been shown to colonise the intestinal mucosa of all food-producing animals. Much emphasis has been placed on controlling the foodborne pathway of exposure, particularly within the poultry industry, however, other environmental sources have been identified as important contributors to human infection. This paper aims to review the current literature on the sources of human exposure to Campylobacter spp. and will cover contaminated poultry, red meat, unpasteurised milk, unwashed fruit and vegetables, compost, wild bird faeces, sewage, surface water, ground water and drinking water. A comparison of current Campylobacter spp. identification methods from environmental samples is also presented. The review of literature suggests that there are multiple and diverse sources for Campylobacter infection. Many environmental sources result in direct human exposure but also in contamination of the food processing industry. This review provides useful information for risk assessment.

Campylobacter infection associated with consumption of duck liver pâté: a retrospective cohort study in the setting of near universal exposure

SUMMARY

A retrospective cohort study was performed following several reported cases of gastrointestinal illness after a catered event. The attack rate was 45/77 (58·4%) by clinical case definition, with four individuals confirmed to have Campylobacter. There was near universal exposure to most foodstuffs served; consumption of duck liver pâté [relative risk (RR) 2·53, 95% confidence interval (CI) 1·05-6·10], mixed leaf salad (RR 2·91, 95% CI 1·22-6·92) and table water (RR undefined, P < 0·01) were associated with illness in univariate analysis, with only the latter associated in the final multivariable model (P < 0·001). Samples of cooked duck liver pâté subsequently prepared using identical methods at the venue were contaminated with Campylobacter jejuni and C. coli; water sampling was negative. Making inferences about causation in the presence of near universal exposures in this study required consideration of the limitations of statistical analysis, with the most compelling evidence of the causal role of inadequately prepared duck liver pâté provided by environmental investigation.

Microbiological quality of water immersion-chilled and air-chilled broilers

Carcass chilling during broiler processing is a critical step in preventing growth of pathogenic and spoilage bacteria. The objective of this study was to compare the microbiological quality of air- and water-chilled broiler carcasses processed at the same commercial facility. For each of four replications, 15 broilers were collected from the same commercial processing line after evisceration, after spraying with cetylpyridinium chloride (a cationic disinfectant), and after air chilling or water immersion chilling (WIC). All carcasses were quantitatively examined for mesophilic aerobic bacteria, Escherichia coli, coliforms, and Campylobacter as well as for the presence of Salmonella and Campylobacter. No significant differences (P > 0.05) were seen between air and water chilling for E. coli or coliforms or for the incidence of Salmonella and Campylobacter. Lower numbers of Campylobacter were recovered from WIC than from air-chilled carcasses (P < 0.05), but the incidence of Campylobacter on WIC carcasses was similar, suggesting that some Campylobacter organisms were injured rather than killed during WIC. In-line spraying with the disinfectant effectively decreased the incidence of Salmonella and Campylobacter on prechilled carcasses; however, cells presumably injured by the sanitizer recovered during chilling. Therefore, on-farm intervention strategies remain critically important in minimizing the spread of microbial contaminants during processing.

An observational study on the effectiveness of point-of-use chlorination

Although the efficacy of chlorine disinfection under controlled laboratory conditions is well known, the effectiveness of chlorine under field point-of-use (POU) conditions is still not clearly understood and may be impacted by a variety of factors. This study evaluated the effectiveness of POU chlorine disinfection in rural Ecuador under typical use conditions and compared this effectiveness with the efficacy in controlled laboratory conditions. While reductions of indicator organisms were slightly higher in households that used chlorination, no significant differences were seen between households employing POU chlorination and the households with no chlorination (1-1.5 log10 median reductions for chlorinating households and 0.31-0.55 log10 for nonchlorinating households, depending on the indicator organism). In contrast, significant reduction of all test organisms was found when simulating POU conditions in the laboratory. This study demonstrates that POU chlorination can be considerably less effective under actual field conditions than would be predicted based on its laboratory efficacy (3-5 log10 median reductions for chlorinated and 0-0.3 log10 for nonchlorinated samples). Human factors (including improper storage and chlorine dosing) and uncontrolled water quality effects are hypothesized to impact significantly the effectiveness of chlorine disinfection.

Environmentally Transmitted Pathogens

Pathogenic microorganisms usually originate from an infected host or directly from the environment; however, only a small proportion of these microbes cause infection. This chapter discusses the pathogens that are transmitted through the environment such as bacteria, viruses, and protozoa. Many human pathogens can be transmitted only by direct or close contact with an infected person or animal such as herpesvirus. Virus transmission by the airborne route may be both direct and indirect inhalation of infectious droplets or through contact with contaminated fomites. Water-borne diseases—such as yellow fever, dengue, filariasis, malaria, onchocerciasis, and sleeping sicknessare transmitted by insects that breed in water or live near water. The common bacterial pathogens transmitted through water include Salmonella, Escherichia coli, Shigella, Campylobacter, Yersinia, Vibrio, Helicobacter, and Legionella. Opportunistic pathogens are also numerous in the environment, and the most important opportunistic pathogen is Pseudomonas aeruginosa. Viruses are a leading cause of gastroenteritis and water-borne outbreaks may be caused by norovirus, hepatitis A virus, Coxsackie virus, echovirus, and adenoviruses. Respiratory diseases are also associated with a large number of viruses such as rhinoviruses, coronaviruses, parainfluenza viruses, respiratory syncytial virus (RSV), influenza virus, and adenovirus. Generally, viral and protozoan pathogens survive longer in the environment than enteric bacterial pathogens.

Survival and Inactivation ofArcobacterspp., a Current Status and Future Prospect

Arcobacter spp. has been isolated from food of animal origin (particularly meats) and from various kind of water. Despite its phylogenetically related neighbor Campylobacter, Arcobacter is regarded as an emerging foodborne pathogen. Since Arcobacter differs in its phenotypic characteristics, the physical and chemical treatments designed for elimination of campylobacters from food and environment needs to be verified. This review focuses on the occurrence, and mainly on susceptibility to various physical and chemical treatments for inactivation of Arcobacter spp. The existing studies have been critically discussed and new challenges were proposed for further studies.

Incidence and ecology of Campylobacter jejuni and coli in animals

Since its initial emergence in the 1970s, Campylobacter has become one of the most common causative agents of bacterial foodborne illness. Campylobacter species readily colonize the gastrointestinal tracts of domestic, feral and wild animals and while they rarely cause clinical disease in food animals, they can produce severe acute gastroenteritis in humans. Prevalence of Campylobacter in food animals can exceed 80% thus challenging processors to employ post-harvest pathogen reduction strategies. Reduction of pathogens before arrival to the abattoir is also of interest because the implementation of pre-harvest interventions may compliment existing post-harvest control techniques to further diminish possible retail sources of infection. Such multiple hurdle approaches that simultaneously utilize pre- and post-harvest control techniques are expected to be the most effective approach for decreasing human illness associated with foodborne pathogens.

Serological methods and selective agars to enumerate Campylobacter from broiler carcasses: data from inter- and intralaboratory analyses

Routine analytical means to estimate Campylobacter numbers per milliliter of carcass rinses are needed in high-sample-throughput poultry laboratories. We compared three serological confirmatory tests that were amenable to such a setting when used in conjunction with Campy-Line and Campy-Cefex Campylobacter selective agars. Pre- and post-chlorinated chiller carcass rinse samples were obtained and held on ice, then analyzed 24 h later in two separate laboratories. Presumptive counts on both pre- and postchiller samples from between laboratories on individual agars and between both agars were highly correlated. Agreement among the three serological tests was nearly complete. The use of a premeasured and dried latex anti-Campylobacter antibody agglutination test format was superior to that of either a liquid latex agglutination format or a direct phosphate-buffer microscopic technique in terms of practicality as was the inclusion of an unarmed latex control to detect auto agglutination. A routine procedure for Campylobacter level estimation was suggested. This procedure, when used in conjunction with a serological confirmatory step, should provide processors with a means to assess reductions in numbers per milliliter of carcass rinses versus strictly presence-absence testing.

Coping with hygiene in South Africa, a water scarce country

The burden of infectious diseases may be reduced by adopting effective infection control measures. Some of these are dependent on the provision of adequate and safe water supplies for maintenance of basic standards of personal, domestic and healthcare hygiene. Consequences of scarce, and sometimes unsafe, waters supplies in South Africa are highlighted with reference to healthcare-associated infections, community acquired infectious intestinal diseases and domestic practices as infection sources. Availability of water in more than 67% of South African municipal hospitals and primary health care facilities (delivered by water tanker in 12.5% of satellite clinics, 5% from river or dam sources, 12.4% relying on rainwater) does not necessarily guarantee that it's quality is safe for utilisation. In the Northern Province and Mpumalanga, water needs to be purified prior to usage in 14.4 and 33% of satellite clinics respectively. Simple, low maintenance and low-cost interventions to maximise use and safety of limited water resources may be implemented: micro-organism (S. dysenteriae) inactivation by direct UV-exposure in sunlight abundant environments, water purification by filtration mechanisms and making use of iron pots in the community for pasteurisation, decontamination and boiling procedures. Education is paramount in promoting healthy domestic food handling practices, changing cultural perceptions of hygiene, hand-washing technique and mechanisms of domestic environmental decontamination. Water provision cannot be separated from other inter-related factors such as sanitation. Although the present government has taken initiatives to reduce the number of people not having access to water by 50% in 2002, provision of sanitation has been slower (>38% inadequate sanitation in 2002). Adoption of integrated environmental management approaches in conjunction with community participation (WASH Campaign--2002), by the government, aims to address the sanitation problems.

Effectiveness of chemical sanitizers against Campylobacter jejuni-containing biofilms

Survival of Campylobacter jejuni in mixed-culture biofilms was determined after treatment with chemical sanitizers including chlorine, quaternary ammonia, peracetic acid (PAA), and a PAA/peroctanoic acid mixture (PAA/POA). Biofilm-producing bacteria (gram-positive rods, Y1 and W1) were isolated from chicken house nipple drinkers. A meat plant isolate (Pseudomonas sp.) was also included as a biofilm producer. Two-day-old biofilms grown on polyvinyl chloride (PVC) plastic coupons in R2A broth at 12 degrees C were incubated with 10(6) CFU/ml C jejuni for 6 h to allow attachment. The coupons were then rinsed and incubated in fresh media for an additional 24 h. C. jejuni-containing biofilms were detached by vortexing with glass beads in modified brucella broth, which was then enumerated for C. jejuni on selective/differential media. The presence of biofilm enhanced (P < 0.01) the attachment and survival of C. jejuni After the 24-h incubation, only 20 CFU/cm2 of C. jejuni were recovered from the control without biofilms compared to 2,500 to 5,000 CFU/cm2 in samples with preexisting biofilms. The presence of biofilm microflora decreased (P < 0.01) the effectiveness of sanitizers against C. jejuni. Chlorine was the most effective sanitizer since it completely inactivated C. jejuni in the biofilms after treatment at 50 ppm for 45 s. C. jejuni in biofilms was susceptible to all sanitizers tested but was not completely inactivated by treatment with quaternary ammonia, PAA, or PAA/POA mixture at 50 and 200 ppm for 45 s.

In vitro study on the effect of organic acids on Campylobacter jejuni/coli populations in mixtures of water and feed

Gastroenteritis caused by Campylobacter spp. infection has been recognized as one of the important public health problems in the developed countries. Outbreaks mostly originate from the consumption of contaminated poultry or infected water. The aim of this study was to determine the bactericidal activity on Campylobacter spp. of organic acids individually and in combinations at different pH levels and times and to compare bactericidal activities with activities of commercially available products. Ten strains of Campylobacter spp. were added in a mixture of water with commercial broiler feed, separately adjusted by four acids: formic, acetic, propionic, and hydrochloric acids, into pH 4.0, 4.5, 5.0, and 5.5. A combination of three organic acids was used in two different formulation ratios: formic:acetic:propionic at 1:2:3 and 1:2:5, at pH 4.0, 4.5, 5.0, and 5.5. All organic acids showed the strongest bactericidal effect on Campylobacter at pH 4.0. In contrast, at pH 5.0 and 5.5, the bactericidal activity of the four acids was low. The combination of organic acids showed a synergistic bactericidal activity at pH 4.5. Interestingly, the effect of the combined organic acids was stronger than the commercial products. Morphological cell changes were studied by transmission electron microscopy to determine the effect of the organic acids on the cell structure of Campylobacter. Some loss of outer membranes of the bacteria could be found in treated groups. Therefore, it can be concluded that organic acids, individually or in combination, have a strong bactericidal effect on Campylobacter spp. Routine application of organic acids to the water supply on poultry farms could prevent or diminish Campylobacter transmission.

Effect of drinking water chlorination on Campylobacter spp. colonization of broilers

The main source for Campylobacter spp. transmission from the environment to broiler chickens is still unclear. One implicated reservoir for the organism has been untreated broiler drinking water. This study was conducted with broilers first using experimental conditions (isolation units) and second under commercial conditions. We compared the rate of intestinal colonization in chickens provided 2 to 5 parts per million (ppm) chlorinated drinking water in relation to the frequency of colonization in chickens given unsupplemented drinking water. No significant difference (P > 0.05) was detected in isolation frequency or level of Campylobacter spp. colonization in birds provided chlorinated drinking water and control birds provided water without supplemental chlorine. In the isolation unit experiments, 86.3% (69/80) of the control and 85.0% (68/80) of the treated birds were colonized at levels corresponding to an average of 10(5.2) and 10(5.1) log colony-forming units (cfu) Campylobacter spp./g of cecal contents, respectively. Additionally, two sets of paired 20,000 bird broiler houses, with and without chlorination (2-5 ppm chlorine), were monitored in a commercial field trial. Effectiveness of chlorination was judged by prevalence of Campylobacter spp. in fecal droppings (960 samples) taken from the flocks in treated and control houses. Birds from the control houses were 35.5% (175/493) Campylobacter spp. positive, while 45.8% (214/467) of the samples from the houses having chlorinated drinking water yielded the organism. Chlorination of flock drinking water at the levels tested in this study was not effective in decreasing colonization by Campylobacter spp. under commercial production practices presently used in the United States.

Water disinfection for international and wilderness travelers

Acquisition of waterborne disease is a substantial risk for international travelers to countries with inadequate sanitation facilities. It also poses smaller but still significant risks for wilderness travelers who rely on surface water in developed countries with low rates of diarrheal illness, such as the United States. This article reviews the etiology and risks associated with waterborne disease that might be encountered by both types of travelers. It also summarizes--and makes recommendations for--the various water-treatment methods available to travelers for reducing their risk of contracting waterborne disease.

Effect of oxidizing disinfectants (chlorine, monochloramine, and ozone) on Helicobacter pylori

The susceptibility of Helicobacter pylori to disinfectants was compared to that of Escherichia coli. H. pylori is more resistant than E. coli to chlorine and ozone but not monochloramine. H. pylori may be able to tolerate disinfectants in distribution systems and, therefore, may be transmitted by a waterborne route.

Survival and death of Salmonella typhimurium and Campylobacter jejuni in processing water and on chicken skin during poultry scalding and chilling

Salmonella Typhimurium and Campylobacter jejuni were inoculated in scalding water, in chilled water, and on chicken skins to examine the effects of scalding temperature (50, 55, and 60 degrees C) and the chlorine level in chilled water (0, 10, 30, and 50 ppm), associated with the ages of scalding water (0 and 10 h) and chilled water (0 and 8 h), on bacterial survival or death. After scalding at 50 and 60 degrees C, the reductions of C. jejuni were 1.5 and 6.2 log CFU/ml in water and <1 and >2 log CFU/cm2 on chicken skins; the reductions of Salmonella Typhimurium were <0.5 and >5.5 log CFU/ml in water and <0.5 and >2 log CFU/cm2 on skins, respectively. The age of scalding water did not significantly (P > 0.05) affect bacterial heat sensitivity. However, the increase in the age of chilled water significantly (P < 0.05) reduced the chlorine effect. In 0-h chilled water. C. jejuni and Salmonella Typhimurium were reduced by 3.3 and 0.7 log CFU/ml, respectively, after treatment with 10 ppm of chlorine and became nondetectable with 30 and 50 ppm of chlorine. In 8-h chilled water, the reduction of C. jejuni and Salmonella Typhimurium was <0.5 log CFU/ml with 10 ppm of chlorine and ranged from 4 to 5.5 log CFU/ml with 50 ppm of chlorine. Chlorination of chilled water did not effectively reduce the bacteria attached on chicken skins. The D-values of Salmonella Typhimurium and C. jejuni were calculated for the prediction of their survival or death in the poultry scalding and chilling.

Frequency of isolation of Campylobacter from roasted chicken samples from Mexico City

The presence of Campylobacter spp. was investigated in 100 samples of roasted chicken tacos sold in well-established commercial outlets and semisettled street stands in Mexico City. From 600 colonies displaying Campylobacter morphology only 123 isolates were positive. From these isolates, 51 (41%) were identified as C. jejuni, 23 (19%) as C. coli, and 49 (40%) as other species of this genus. All of the 27 positive samples came from one location where handling practices allowed cross-contamination of the cooked product. The results indicate that these ready-to-consume products are contaminated with these bacteria, representing a potential risk for consumers, especially in establishments lacking adequate sanitary measures to prevent cross-contamination.

Isolation of Arcobacter butzleri from ground water

Arcobacter butzleri was isolated from a contaminated ground water source. These organisms, previously designated as aerotolerant Campylobacter, were capable of surviving in the ground water environment. Specific DNA probes were used to characterize the isolates in the initial identification and survival studies. Arcobacter butzleri was found to be sensitive to chlorine inactivation.

Inactivation of Helicobacter pylori by chlorination

Three strains of Helicobacter pylori were studied to determine their resistance to chlorination. The organisms were readily inactivated by free chlorine and should therefore be controlled by disinfection practices normally employed in the treatment of drinking water.

Campylobacter incidence on a chicken farm and the spread of Campylobacter during the slaughter process

To get a better understanding of the epidemiology of Campylobacter, a chicken farm was studied for 16 weeks with samplings in each flock weekly from input until the flock became colonized with Campylobacter or slaughtered. Samples were taken from fresh droppings and from drinkers during the rearing period, as well as from the environment in empty houses. The spread of Campylobacter during the slaughter process was also surveyed. No Campylobacter was found in samples from newly-hatched or one-week-old chickens or their drinkers. All flocks but one were colonized at two to five weeks of age. All Campylobacter isolates belonged to the same sero- and biotype; C. jejuni Penner 2. The spread of Campylobacter in the flock was rapid and usually all samples were positive once colonization had been proven. C. jejuni was isolated from flies in ante-rooms as well as from air in chicken units in houses with positive chicken flocks. Samples were taken at slaughter when some of the Campylobacter positive flocks from the farm were slaughtered. Campylobacter were isolated from all sampled equipment along the processing line, from the chicken transport crates to the chillers, as well as from the air.

Survival of coliforms and bacterial pathogens within protozoa during chlorination

The susceptibility of coliform bacteria and bacterial pathogens to free chlorine residuals was determined before and after incubation with amoebae and ciliate protozoa. Viability of bacteria was quantified to determine their resistance to free chlorine residuals when ingested by laboratory strains of Acanthamoeba castellanii and Tetrahymena pyriformis. Cocultures of bacteria and protozoa were incubated to facilitate ingestion of the bacteria and then were chlorinated, neutralized, and sonicated to release intracellular bacteria. Qualitative susceptibility of protozoan strains to free chlorine was also assessed. Protozoa were shown to survive and grow after exposure to levels of free chlorine residuals that killed free-living bacteria. Ingested coliforms Escherichia coli, Citrobacter freundii, Enterobacter agglomerans, Enterobacter cloacae, Klebsiella pneumoniae, and Klebsiella oxytoca and bacterial pathogens Salmonella typhimurium, Yersinia enterocolitica, Shigella sonnei, Legionella gormanii, and Campylobacter jejuni had increased resistance to free chlorine residuals. Bacteria could be cultured from within treated protozoans well after the time required for 99% inactivation of free-living cells. All bacterial pathogens were greater than 50-fold more resistant to free chlorine when ingested by T. pyriformis. Escherichia coli ingested by a Cyclidium sp., a ciliate isolated from a drinking water reservoir, were also shown to be more resistant to free chlorine. The mechanism that increased resistance appeared to be survival within protozoan cells. This study indicates that bacteria can survive ingestion by protozoa. This bacterium-protozoan association provides bacteria with increased resistance to free chlorine residuals which can lead to persistence of bacteria in chlorine-treated water. We propose that resistance to digestion by predatory protozoa was an evolutionary precursor of pathogenicity in bacteria and that today it is a mechanism for survival of fastidious bacteria in dilute and inhospitable aquatic environments.

Microbial resistance to disinfectants: mechanisms and significance

Drinking water disinfection provides the final barrier to transmission of a wide variety of potentially waterborne infectious agents including pathogenic bacteria, viruses, and protozoa. These agents differ greatly in their innate resistance to inactivation by disinfectants, ranging from extremely sensitive bacteria to highly resistant protozoan cysts. The close similarity between microorganism inactivation rates and the kinetics of chemical reactions has long been recognized. Ideally, under carefully controlled conditions, microorganism inactivation rates simulate first-order chemical reaction rates, making it possible to predict the effectiveness of disinfection under specific conditions. In practice, changes in relative resistance and deviations from first-order kinetics are caused by a number of factors, including microbial growth conditions, aggregation, and association with particulate materials. The net effect of all these factors is a reduction in the effectiveness and predictability of disinfection processes. To ensure effective pathogen control, disinfectant concentrations and contact times greater than experimentally determined values may be required. Of the factors causing enhanced disinfection resistance, protection by association with particulate matter is the most significant. Therefore, removal of particulate matter is an important step in increasing the effectiveness of disinfection processes.