Campylobacter Blog - Surveillance & analysis on Campylobacter news & outbreaks

March 31, 2005
Katie Pollack
Sun Contributor

In an effort to limit acute gastroenteritis, or food poisoning, the second most prevalent household illness, Cornell professors from the department of Population Medicine and Diagnostic Sciences have joined a research team which aims to identify the origin and transmission of pathogens that cause food-related illnesses.

Earlier this month, the United States Department of Agriculture formally announced the formation of the Food Safety Research and Response Network (FSRRN), funded by a $5 million grant from the USDA Cooperative State Research, Education and Extension Service. The research team is comprised of over 50 experts from 18 different campuses across the country.

Campylobacter jejuni (Pronounced "camp-e-low-back-ter j-june-eye") was not recognized as a cause of human foodborne illness prior to 1975. Now, the bacterial organism is known to be the most common cause of foodborne illness in the U.S.1 (Salmonella is the second most common cause).

Most cases Campylobacter infection occur as isolated, sporadic events, not as a part of the large outbreaks. Even though surveillance is very limited, over 10,000 cases are reported to the Centers for Disease Control and Prevention (CDC) each year. Active surveillance for cases indicates that over 17 cases for each 100,000 persons in the population (or about 46,000 cases) are diagnosed yearly.1 Undoubtedly, many more cases go undiagnosed and unreported, and estimates are that Campylobacter causes 2-4 million cases per year in the United States.4

Campylobacteriosis occurs more frequently in the summer months than in the winter. Although Campylobacter doesn't commonly cause death, it has been estimated that 100 persons with Campylobacter infections die each year from the infection. Recently, the CDC reported that Campylobacter infections related to raw or uncooked poultry fell by 28%.

By Judith Blake
Seattle Times staff reporter
March 23, 2005

The calls run the food-safety gamut:

ï A Seattle-area woman said she'd found walnuts in a packaged, pre-cut salad mix, though nuts were not listed in the ingredients. Her young son, who was severely allergic to walnuts, did not eat any of the nuts, but the woman worried that someone else might have an allergic reaction to the mislabeled product.

ï A man discovered mold on the meat-filled breakfast burrito he'd purchased at a convenience store.

ï A woman was dismayed to find larvae in an energy snack bar.

These are among the calls consumers have made to the new toll-free Food Safety Consumer Complaint Hotline (1-800-843-7890) launched in January by the Washington State Department of Agriculture.

Goal: to reduce the risk of food-borne illness by making it easier for consumers to lodge complaints and for officials to address them.

21/03/2005 - The US government is investing a further $2 million to enhance research on bovine spongiform encephalopathy (BSE) and $5 million to establish a Food Safety Research and Response Network.

"In a rapidly changing world marketplace, science is the universal language that must guide our rules and policies, rather than subjectivity or politics," said agriculture secretary Mike Johanns.

"Expanding our research efforts to improve the understanding of BSE and other food-related illness pathogens will strengthen the security of our nation's food supply. These projects will help improve food safety by enhancing our research partnerships with the academic community and establish another tool to aid our response to food-related disease outbreaks."

March 16, 2005

LOS ANGELES (AP) - County health officials said a study shows food-borne diseases have been reduced 13.1 percent because of the restaurant inspection and letter grading system imposed in 1998.

Dr. Jonathan Fielding, the county's public health director and an author of the study, said it was the first scientific proof that the grading system resulted in a "demonstrable public health benefit."

"What's really important here is we were able to show a reduction in hospitalizations due to food-borne illnesses, compared to state trends," Fielding said Thursday.

The study, published in the March issue of the Journal of Environmental Health, used hospital records for infections from bacteria such as salmonella and campylobacter. They analyzed 2,927 hospitalizations in the county.

Campylobacter is the second most common cause of foodborne illness in the United States after Salmonella. Over 3,000 cases were reported to the Centers for Disease Control and Prevention in 2003, or 12.6 cases for each 100,000 persons in the population. Many more cases go undiagnosed and unreported, with estimates as high as 2 to 4 million cases per year.

Poultry is the most common food implicated. Other foods include unpasteurized milk, undercooked meats, mushrooms, ground beef, cheese, pork, shellfish, and eggs. Most cases of Campylobacter infection occur as isolated, sporadic events, not as part of large outbreaks.

Other sources of Campylobacter that have been reported include children prior to toilet-training, especially in child care settings, and intimate contact with other infected individuals. C. jejuni is commonly present in the gastrointestinal tract of healthy cattle, pigs, chickens, turkeys, ducks, and geese, and direct animal exposure can lead to infection. Pets that may carry Campylobacter include birds, cats, dogs, hamsters, and turtles. The organism is also occasionally isolated from streams, lakes and ponds.

Symptoms of Campylobacter infection

The incubation period for Campylobacteriosis (the time between exposure to the bacteria and onset of the first symptom) is typically two to five days, but onset may occur in as few as two days or as long as 10 days after ingestion of the bacteria. The illness usually lasts no more than one week but severe cases may persist for up to three weeks, and about 25% of individuals experience relapses of symptoms.

Diarrhea is the most consistent and prominent manifestation of Campylobacter infection and is often bloody. Typical symptoms also include fever, nausea, vomiting, abdominal pain, headache, and muscle pain.†A majority of cases are mild, do not require hospitalization, and are self-limited.†However, Campylobacter jejuni infection can be severe and life-threatening.†It may cause appendicitis or infect other organs as well as the blood stream. It is estimated that about one in 1,000 cases of Campylobacter infection results in death. Death is more common when other diseases (for example, cancer, liver disease, and immune deficiency diseases) are present.

Diagnosis of Campylobacter infection

Health care providers can look for bacterial causes of diarrhea by asking a laboratory to culture a stool sample from an ill person. Campylobacter is usually a self-limited illness; the affected person should drink plenty of fluids as long as the diarrhea lasts in order to maintain hydration. Antidiarrheal medications such as loperamide may allay some symptoms. Specific treatment with antibiotics is sometimes indicated, particularly in severe cases, and may shorten the course of the illness. Macrolide antibiotics (erythromycin, clarithromycin, or azithromycin) are the most effective agents. Fluoroquinolone antibiotics (ciprofloxacin, levofloxacin, gatifloxacin, or moxifloxacin) can also be used, but resistance to this class of drugs has been rising, at least in part due to their use in poultry feed. Consultation with a health care provider is recommended prior to taking anti-diarrheal medications or antibiotics.

Complications of Campylobacter infection

Long-term consequences and complications can sometimes result from a Campylobacter infection. Some people may develop a rare disease that affects the nerves of the body following infection. This disease is called Guillain-BarrÈ syndrome (GBS). It begins several weeks after the diarrheal illness, may last for weeks to months, and often requires intensive care. Full recovery is common but some affected individuals may be left with mild to severe neurological damage. Two therapies, intravenous immunoglobulin infusions and plasma exchange, may improve the rate of recovery in patients with GBS.

Miller Fisher Syndrome (MFS) is a related neurological syndrome that can occur with a Campylobacter infection. In MFS, the nerves of the head are affected more than the nerves of the body. Another chronic condition that may be associated with Campylobacter infection is a form of reactive arthritis called Reiter's syndrome (RS). RS typically affects large weight-bearing joints such as the knees and the lower back. It is a complication that is strongly associated with a particular genetic make-up; persons who have the human lymphocyte antigen B27 (HLA-B27) are most susceptible.

Preventing Campylobacter infection

The single most important and reliable step to preventing Campylobacter infection is to adequately cook all poultry products. Make sure that the thickest part of the bird (the center of the breast) reaches 180 degrees F or higher. It is recommended that the temperature reaches at least 165 degrees F for stuffing and 170 degrees F for ground poultry products, and that thighs and wings be cooked until juices run clear. Do not cook stuffing inside the bird.

Transport meat and poultry home from the market in the coolest part of the vehicle (generally the trunk in winter and cab in summer). Defrost meat and poultry in the refrigerator. Place the item on a low shelf, on a wide pan, lined with paper towel; ensure that drippings do not land on foods below. If there is not enough time to defrost in the refrigerator, use the microwave.

Rapidly cool leftovers. Never leave food out at room temperature (either during preparation or after cooking) for more than 2 hours.

Avoid raw milk products.

Wash fruits and vegetables carefully, particularly if they are eaten raw. If possible, vegetables and fruits should be peeled.

Wash hands thoroughly using soap and water, concentrate on fingertips and nail creases, and dry completely with a disposable paper towel after contact with pets, especially puppies, or farm animals; before and after preparing food, especially poultry; and after changing diapers or having contact with an individual with an intestinal infection. Children should wash their hands on arrival home from school or daycare.

March 02, 2005
Bug of the Month for March: CAMPYLOBACTER
The Bacteria

Q: What is Campylobacter?

A: Campylobacter [pronounced "kamp-e-lo-back-ter"] bacteria are commonly found in the intestinal tracts of cats, dogs, poultry, cattle, swine, rodents, monkeys, wild birds, and some humans. The bacteria pass through feces to cycle through the environment and are also in untreated water. Campylobacter jejuni, the strain associated with most reported human infections, may be present in the body without causing illness.

Q: Why are we hearing more about Campylobacter?

A: During the 1980's, public health authorities began to learn more about the prevalence of the bacteria in the environment, the illness it can cause, and laboratory techniques for identifying the bacteria. As individual states within the United States increase their reporting of illnesses to CDC, research continues on the organism and the disease.

1.15.2005

Raw and undercooked poultry and meat, raw milk and untreated water are sources for Campylobacter, the most common bacterial cause of diarrhea in the United States, according the U.S. Public Health Service.

But finding how these bacteria that happily co-exist with chickens and turkeys burrow their way into intestinal cells to eat and make people sick in the process should provide direction on how to stop them, say Drs. Stuart A. Thompson and Christopher M. Burns. "The basic problem with Campylobacter is that we don't know how it causes disease," says Dr. Thompson, who recently received his third National Institutes of Health grant to answer this question and develop a vaccine. "To understand how to treat a bacterium, you have to understand how it causes disease."

Bacteria affects 18 people in December at the Sturgeon Bay restaurant
By Deb Fitzgerald
For The News-Chronicle

The well water at the Mill Supper Club in Sturgeon Bay is suspected to have caused the illnesses of eight people who tested positive for campylobacter, a common bacterial cause of diarrheal sickness.

As a result of the illnesses and subsequent state and county investigations, Don and Shelly Petersilka, owners of the restaurant at the northern intersection of States 42 and 57, have opted to replace their pre-1950s well with a new one.

"I'm extremely sorry people got sick," Don said. "Nobody feels worse about it than Shelly and I do." The events leading to the decision to drill a new well began on four different nights in December, when 18 people at four separate dining parties became ill. Only 13 of those people had stool samples examined by a doctor. Of those who were tested, eight were positive for campylobacter, according to Rhonda Kolberg, director of the Door County Public Health Department.

On August 29, 1996, the Jackson County Health Department (JCHD) in southwestern Oklahoma notified the Oklahoma State Department of Health (OSDH) of a cluster of Campylobacter jejuni infections that occurred during August 16-20 among persons who had eaten lunch at a local restaurant on August 15. This report summarizes the investigation of these cases and indicates that C. jejuni infection was most likely acquired from eating lettuce cross-contaminated with raw chicken. This report also emphasizes the need to keep certain foods and cooking utensils separate during food handling.

A case was defined as illness in a person who had eaten lunch at the restaurant on August 15, 1996, and had onset of diarrhea (i.e., three or more loose stools during a 24-hour period) or vomiting during August 16-20. Of 25 persons available for interview who had eaten lunch at the restaurant on August 15, a total of 14 (56%) had had an illness that met the case definition. The median age of patients was 33 years (range: 5-52 years); 10 (71%) were female. All patients reported diarrhea; 13 (93%), fever; 13 (93%), abdominal cramps; 11 (79%), nausea; five (36%), vomiting; and three (21%), visible blood in their stools. The median incubation period was 3 days (range: 1-5 days). Two (14%) patients were hospitalized. Stool specimens were collected from 10 patients; all yielded C. jejuni. No food items were available for testing.

Hazards of Healthy Living: Bottled Water and Salad Vegetables as Risk Factors for Campylobacter Infection

Meirion R. Evans, C. Donald Ribeiro, and Roland L. Salmon
University of Wales College of Medicine, Cardiff, United Kingdom; Cardiff Public Health Laboratory, Cardiff, United Kingdom; and Public Health Laboratory Service Communicable Disease Surveillance Centre (Wales), Cardiff, United Kingdom

Campylobacter is the most common cause of bacterial gastroenteritis worldwide, yet the etiology of this infection remains only partly explained. In a retrospective cohort study, we compared 213 sporadic campylobacter case-patients with 1,144 patients with negative fecal samples. Information was obtained on food history, animal contact, foreign travel, leisure activities, medical conditions, and medication use. Eating chicken, eating food from a fried chicken outlet, eating salad vegetables, drinking bottled water, and direct contact with cows or calves were all independently associated with infection. The population-attributable fractions for these risk factors explained nearly 70% of sporadic campylobacter infections. Eating chicken is a well-established risk factor, but consuming salad and bottled water are not. The association with salad may be explained by cross-contamination of food within the home, but the possibility that natural mineral water is a risk factor for campylobacter infection could have wide public health implications.

by Audrey Hingley

When it comes to food poisoning, big outbreaks make headlines. E. coli in apple juice and alfalfa sprouts. Listeria in cheese and hot dogs. Salmonella in eggs and on poultry. But the most frequently diagnosed food-borne bacterium rarely makes the news. The name of the unsung bug? Campylobacter.

"Most Campylobacter infections are sporadic and not associated with an outbreak, but we know it causes up to 4 million human infections a year," says Frederick J. Angulo, D.V.M., an epidemiologist with the national Centers for Disease Control and Prevention.

Federal and state health experts have long recognized that Campylobacter causes disease in animals. Conclusive proof that the bacteria also causes human disease emerged in the 1970s, and by 1996, Campylobacter was sitting atop the bacterial heap as the number one cause of all domestic food-borne illness. (See "Tracking Down Trouble: Bacteria That Cause Food-Borne Illness.")