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In August 2017, a cluster of four persons infected with genetically related strains of Shiga toxin-producing Escherichia coli (STEC) O157:H7 was identified. These strains possessed the Shiga toxin (stx) subtype stx2a, a toxin type known to be associated with severe clinical outcome. One person died after developing haemolytic uraemic syndrome. Interviews with cases revealed that three of the cases had been exposed to dogs fed on a raw meat-based diet (RMBD), specifically tripe. In two cases, the tripe had been purchased from the same supplier. Sampling and microbiological screening of raw pet food was undertaken and indicated the presence of STEC in the products. STEC was isolated from one sample of raw tripe but was different from the strain causing illness in humans. Nevertheless, the detection of STEC in the tripe provided evidence that raw pet food was a potential source of human STEC infection during this outbreak. This adds to the evidence of raw pet food as a risk factor for zoonotic transmission of gastrointestinal pathogens, which is widely accepted for Salmonella, Listeria and Campylobacter spp. Feeding RMBD to companion animals has recently increased in popularity due to the belief that they provide health benefits to animals. Although still rare, an increase in STEC cases reporting exposure to RMBDs was detected in 2017. There has also been an increased frequency of raw pet food incidents in 2017, suggesting an increasing trend in potential risk to humans from raw pet food. Recommendations to reduce the risk of infection included improved awareness of risk and promotion of good hygiene practices among the public when handling raw pet food.

New Zealand has a long-running campylobacter infection (campylobacteriosis) epidemic with contaminated fresh chicken meat as the major source. This is both the highest impact zoonosis and the largest food safety problem in the country. Adding to this burden is the recent rapid emergence of antibiotic resistance in these campylobacter infections acquired from locally-produced chicken. Campylobacteriosis rates halved in 2008, as compared with the previous 5 years, following the introduction of regulatory limits on allowable contamination levels in fresh chicken meat, with large health and economic benefits resulting. In the following decade, disease rates do not appear to have declined further. The cumulative impact would equate to an estimated 539 000 cases, 5480 hospitalisations, 284 deaths and economic costs of approximately US$380 million during the last 10 years (2009–2018). Additional regulatory interventions, that build on previously successful regulations in this country, are urgently needed to control the source of this epidemic.

Despite a sizeable evidence base for the risk of campylobacteriosis associated with eating chicken liver pâté, associated outbreaks continue to occur. In January 2017, six cases of campylobacteriosis reported having eaten a Christmas set-menu meal at the same hotel in North Yorkshire, England on the same day. A retrospective cohort study was undertaken to test the null hypothesis that consumption of individual food items was not associated with an increased risk of illness. There were 19 cases of campylobacteriosis linked to the outbreak; seven confirmed and 12 probable cases. Chicken liver pâté was the food item most strongly associated with illness (P < 0.001) with a corresponding high crude relative risk (12.95). This relationship was supported by multivariable analysis, sensitivity analyses and a clear dose–response relationship. Three cases reported an incubation period of

Campylobacteriosis is the most common notifiable disease in New Zealand. While the risk of campylobacteriosis has been found to be strongly associated with the consumption of undercooked poultry, other risk factors include rainwater-sourced drinking water, contact with animals and consumption of raw dairy products. Despite this, there has been little investigation of raw milk as a risk factor for campylobacteriosis. Recent increases in demand for untreated or ‘raw’ milk have also raised concerns that this exposure may become a more important source of disease in the future. This study describes the cases of notified campylobacteriosis from a sentinel surveillance site. Previously collected data from notified cases of raw milk-associated campylobacteriosis were examined and compared with campylobacteriosis cases who did not report raw milk consumption. Raw milk campylobacteriosis cases differed from non-raw milk cases on comparison of age and occupation demographics, with raw milk cases more likely to be younger and categorised as children or students for occupation. Raw milk cases were more likely to be associated with outbreaks than non-raw milk cases. Study-suggested motivations for raw milk consumption (health reasons, natural product, produced on farm, inexpensive or to support locals) were not strongly supported by cases. More information about the raw milk consumption habits of New Zealanders would be helpful to better understand the risks of this disease, especially with respect to increased disease risk observed in younger people. Further discussion with raw milk consumers around their motivations may also be useful to find common ground between public health concerns and consumer preferences as efforts continue to manage this ongoing public health issue.

In December 2016, Public Health England investigated an outbreak of campylobacteriosis in North West England, with 69 cases in total. Epidemiological, microbiological and environmental investigations associated the illness with the consumption of unpasteurised cows' milk from Farm X, where milk was predominantly sold from a vending machine. Campylobacter was detected in milk samples which, when sequenced, were identical in sequence type as pathogens isolated from cases (Clonal Complex ST-403, Sequence Type 7432). The farm was served with a Hygiene Emergency Prohibition Order to prevent further cases. To our knowledge, this is the first outbreak of campylobacter associated with unpasteurised milk in England since 1996. Our findings highlighted several important lessons, including that the current testing regime in England for unpasteurised milk is not fit for purpose and that the required warning label should include additional wording, underscoring the risk to vulnerable groups. There has been a substantial increase in both the volume of unpasteurised milk consumed in England and the use of vending machines to sell unpasteurised milk over the last 10 years, making unpasteurised milk more readily accessible to a wider population. The evidence generated from outbreaks like this is therefore critical and should be used to influence policy development.

Diversified farms are operations that raise a variety of crops and/or multiple species of livestock, with the goal of utilising the products of one for the growth of the other, thus fostering a sustainable cycle. This type of farming reflects consumers' increasing demand for sustainably produced, naturally raised or pasture-raised animal products that are commonly produced on diversified farms. The specific objectives of this study were to characterise diversified small-scale farms (DSSF) in California, estimate the prevalence of Salmonella enterica and Campylobacter spp. in livestock and poultry, and evaluate the association between farm- and sample-level risk factors and the prevalence of Campylobacter spp. on DSSF in California using a multilevel logistic model. Most participating farms were organic and raised more than one animal species. Overall Salmonella prevalence was 1.19% (95% confidence interval (CI95) 0.6–2), and overall Campylobacter spp. prevalence was 10.8% (CI95 = 9–12.9). Significant risk factors associated with Campylobacter spp. were farm size (odds ratio (OR)10–50 acres: less than 10 acres = 6, CI95 = 2.11–29.8), ownership of swine (OR = 9.3, CI95 = 3.4–38.8) and season (ORSpring: Coastal summer = 3.5, CI95 = 1.1–10.9; ORWinter: Coastal summer = 3.23, CI95 = 1.4–7.4). As the number of DSSF continues to grow, evaluating risk factors and management practices that are unique to these operations will help identify risk mitigation strategies and develop outreach materials to improve the food safety of animal and vegetable products produced on DSSF.

In the absence of perfect reference standard, classical techniques result in biased diagnostic accuracy and prevalence estimates. By statistically defining the true disease status, latent class models (LCM) constitute a promising alternative. However, LCM is a complex method which relies on parametric assumptions, including usually a conditional independence between tests and might suffer from data sparseness. We carefully applied LCMs to assess new campylobacter infection detection tests for which bacteriological culture is an imperfect reference standard. Five diagnostic tests (culture, polymerase chain reaction and three immunoenzymatic tests) of campylobacter infection were collected in 623 patients from Bordeaux and Lyon Hospitals, France. Their diagnostic accuracy were estimated with standard and extended LCMs with a thorough examination of models goodness-of-fit. The model including a residual dependence specific to the immunoenzymatic tests best complied with LCM assumptions. Asymptotic results of goodness-of-fit statistics were substantially impaired by data sparseness and empirical distributions were preferred. Results confirmed moderate sensitivity of the culture and high performances of immunoenzymatic tests. LCMs can be used to estimate diagnostic tests accuracy in the absence of perfect reference standard. However, their implementation and assessment require specific attention due to data sparseness and limitations of existing software.

Studies estimating the human health impact of the foodborne disease often include estimates of the number of gastroenteritis hospitalisations. The aims of this study were to examine the degree to which hospital discharge data underreport hospitalisations due to bacterial gastroenteritis and to estimate the frequency of stool sample submission among patients presenting with gastroenteritis. Using linked laboratory and hospital discharge data from a healthcare organisation and its affiliated hospital, we examined the International Classification of Disease (ICD-9-CM) diagnosis codes assigned to hospitalised adults with culture-confirmedCampylobacter,Salmonella, orEscherichia coliO157 infections and determined the frequency of stool sample submission. Among 138 hospitalised patients with culture-confirmed infections, 43% ofCampylobacterpatients, 56% ofSalmonellapatients and 35% ofE. coliO157 patients had that pathogen-specific code listed on the discharge record. Among patients without their infection listed as a diagnosis, 65% were assigned a nonspecific gastroenteritis code. Submitting a specimen for culture ⩾3 days before discharge was significantly associated with having the pathogen-specific diagnosis listed. Of 6181 patients assigned a nonspecific gastroenteritis code, 69% had submitted a stool sample for bacterial culture. This study can be used to understand differences and adjust for the underreporting and underdiagnosed ofCampylobacter, SalmonellaandE. coliO157 in hospital discharge and surveillance data, respectively.

SUMMARYThe Foodborne Diseases Active Surveillance Network (FoodNet) conducts population-based surveillance forCampylobacterinfection. For 2010 through 2015, we compared patients withCampylobacter jejuniwith patients with infections caused by otherCampylobacterspecies.Campylobacter colipatients were more often >40 years of age (OR = 1·4), Asian (OR = 2·3), or Black (OR = 1·7), and more likely to live in an urban area (OR = 1·2), report international travel (OR = 1·5), and have infection in autumn or winter (OR = 1·2).Campylobacter upsaliensispatients were more likely female (OR = 1·6), Hispanic (OR = 1·6), have a blood isolate (OR = 2·8), and have an infection in autumn or winter (OR = 1·7).Campylobacter laripatients were more likely to be >40 years of age (OR = 2·9) and have an infection in autumn or winter (OR = 1·7).Campylobacter fetuspatients were more likely male (OR = 3·1), hospitalized (OR = 3·5), and have a blood isolate (OR = 44·1). International travel was associated with antimicrobial-resistantC. jejuni(OR = 12·5) andC. coli(OR = 12) infections. Species-level data are useful in understanding epidemiology, sources, and resistance of infections.

SUMMARYCampylobacterspp. is a commonly reported food-borne disease with major consequences for morbidity. In conjunction with predicted increases in temperature, proliferation in the survival of microorganisms in hotter environments is expected. This is likely to lead, in turn, to an increase in contamination of food and water and a rise in numbers of cases of infectious gastroenteritis. This study assessed the relationship ofCampylobacterspp. with temperature and heatwaves, in Adelaide, South Australia.We estimated the effect of (i) maximum temperature and (ii) heatwaves on dailyCampylobactercases during the warm seasons (1 October to 31 March) from 1990 to 2012 using Poisson regression models.There was no evidence of a substantive effect of maximum temperature per 1 °C rise (incidence rate ratio (IRR) 0·995, 95% confidence interval (95% CI) 0·993–0·997) nor heatwaves (IRR 0·906, 95% CI 0·800–1·026) onCampylobactercases. In relation to heatwave intensity, which is the daily maximum temperature during a heatwave, notifications decreased by 19% within a temperature range of 39–40·9 °C (IRR 0·811, 95% CI 0·692–0·952). We found little evidence of an increase in risk and lack of association betweenCampylobactercases and temperature or heatwaves in the warm seasons. Heatwave intensity may play a role in that notifications decreased with higher temperatures. Further examination of the role of behavioural and environmental factors in an effort to reduce the risk of increasedCampylobactercases is warranted.

SUMMARYCross-sectorial surveillance and general collaboration between the animal and the public health sectors are increasingly recognized as needed to better manage the impacts of zoonoses. From 2009, the Swiss established a Campylobacter mitigation system that includes human and poultry surveillance data-sharing within a multi-sectorial platform, in a ‘One Health’ approach. The objective of this study was to explore the economics of this cross-sectorial approach, including surveillance and triggered interventions. Costs and benefits of the One Health and of the uni-sectorial approach to Campylobacter surveillance were identified using an economic assessment framework developed earlier. Cost information of surveillance activities and interventions was gathered and disability-adjusted life years (DALYs) associated with the disease estimated for 2008 and 2013. In the first 5 years of this One Health approach to Campylobacter mitigation, surveillance contributed with information mainly used to perform risk assessments, monitor trends and shape research efforts on Campylobacter. There was an increase in costs associated with the mitigation activities following integration, due mainly to the allocation of additional resources to research and implementation of poultry surveillance. The overall burden of campylobacteriosis increased by 3·4–8·8% to 1751–2852 DALYs in 2013. In the timing of the analysis, added value associated with this cross-sectorial approach to surveillance of Campylobacter in the country was likely generated through non-measurable benefits such as intellectual capital and social capital.

SUMMARYCampylobactersp. are a globally significant cause of gastroenteritis. Although rates of infection in Australia are among the highest in the industrialized world, studies describing campylobacteriosis incidence in Australia are lacking. Using national disease notification data between 1998 and 2013 we examinedCampylobacterinfections by gender, age group, season and state and territory. Negative binomial regression was used to estimate incidence rate ratios (IRRs), including trends by age group over time, with post-estimation commands used to obtain adjusted incidence rates. The incidence rate for males was significantly higher than for females [IRR 1·20, 95% confidence interval (CI) 1·18–1·21], while a distinct seasonality was demonstrated with higher rates in both spring (IRR 1·18, 95% CI 1·16–1·20) and summer (IRR 1·17, 95% CI 1·16–1·19). Examination of trends in age-specific incidence over time showed declines in incidence in those aged

SUMMARYHuman campylobacteriosis is the most commonly reported gastrointestinal bacterial infection in the EU; poultry meat has been identified as the main source of infection. We tested the hypothesis that enhanced biosecurity and other factors such as welfare status, breed, the practice of partial depopulation and number of empty days between flocks may preventCampylobacterspp. caecal colonization of poultry batches at high levels (>123 000 c.f.u./g in pooled caecal samples). We analysed data from 2314 poultry batches sampled at slaughter in the UK in 2011–2013. We employed random-effects logistic regression to account for clustering of batches within farms and adjust for confounding. We estimated population attributable fractions using adjusted risk ratios. Enhanced biosecurity reduced the odds of colonization at partial depopulation [odds ratio (OR) 0·25, 95% confidence interval (CI) 0·14–0·47] and, to a lesser extent, at final depopulation (OR 0·47, 95% CI 0·25–0·89). An effect of the type of breed was also found. Under our assumptions, approximately 1/3 of highly colonized batches would be avoided if they were all raised under enhanced biosecurity or without partial depopulation. The results of the study indicate that on-farm measures can play an important role in reducing colonization of broiler chickens withCampylobacterspp. and as a result human exposure.

Utilising routine surveillance data, this study presents a method for generating a baseline comparison that can be used in future foodborne outbreak investigations following a case–case methodology. Salmonella and Campylobacter cases (2012–2015) from Maricopa County, AZ were compared to determine differences in risk factors, symptoms and demographics. For foods and other risk factors, adjusted odds ratios were developed using Campylobacter as the reference. Comparisons were also made for three major Salmonella subtypes, Typhimurium, Enteritidis and Poona as compared with Campylobacter. Salmonella cases were younger, while Campylobacter cases were more Hispanic and female. Campylobacter cases reported consuming peppers, sprouts, poultry, queso fresco, eggs and raw nuts more and reported contact with animal products, birds, visiting a farm or dairy, owning a pet, a sick pet, swimming in a river, lake or pond, or handling multiple raw meats more. Salmonella cases reported visiting a petting zoo and contact with a reptile more. There were significant variations by Salmonella subtype in both foods and exposures. We recommend departments conduct this analysis to generate a baseline comparison and a running average of relevant odds ratios allowing staff to focus on trace-back of contaminated food items earlier in the outbreak investigation process.

Guillain Barré syndrome (GBS), which is triggered by autoantibodies produced in response to antigenic stimuli such as certain infections and vaccinations, is the most common cause of acute flaccid paralysis worldwide. Campylobacter, the most common bacterial enteric infection in the USA, is reported to be the most commonly diagnosed antecedent of GBS, yet little information is available about the risk of post-Campylobacter GBS. Data collected through active, population-based surveillance in the Emerging Infections Program during the 2009–2010 novel Influenza A (H1N1) vaccination campaign allowed us to compare confirmed and probable GBS cases to non-cases to determine whether antecedent Campylobacter infection (or a diarrhoeal illness consistent with campylobacteriosis) was more common among cases and to assess the risk of GBS following Campylobacter infection. We estimate that 8–12% of GBS cases in the USA are attributable to Campylobacter infection (or a diarrhoeal illness consistent with campylobacteriosis), with 434–650 cases of post-diarrhoeal GBS annually and about 49 cases of GBS per 100 000 Campylobacter infections. These results provide updated estimates for post-Campylobacter GBS incidence in the USA and highlight an important benefit of effective measures to prevent Campylobacter infections.

SUMMARYThe aim of this study was to examine the population structure, transmission and spatial relationship between genotypes of Shiga toxin-producingEscherichia coli(STEC) andCampylobacter jejuni, on 20 dairy farms in a defined catchment. Pooled faecal samples (n= 72) obtained from 288 calves were analysed by real-time polymerase chain reaction (rtPCR) forE. coliserotypes O26, O103, O111, O145 and O157. The number of samples positive forE. coliO26 (30/72) was high compared toE. coliO103 (7/72), O145 (3/72), O157 (2/72) and O111 (0/72). EighteenE. coliO26 and 53C. jejuniisolates were recovered from samples by bacterial culture.E. coliO26 andC. jejuniisolates were genotyped using pulsed-field gel electrophoresis and multilocus sequence typing, respectively. AllE. coliO26 isolates could be divided into four clusters and the results indicated thatE. coliO26 isolates recovered from calves on the same farm were more similar than isolates recovered from different farms in the catchment. There were 11 different sequence types ofC. jejuniisolated from the cattle and 22 from water. An analysis of the population structure ofC. jejuniisolated from cattle provided evidence of clustering of genotypes within farms, and among groups of farms separated by road boundaries.

SUMMARYCampylobacter jejuniis responsible for most foodborne bacterial infections worldwide including Australia. The aim of this study was to investigate a combination of typing methods in the characterization ofC. jejuniisolated from clinical diarrhoeal samples (n= 20) and chicken meat (n= 26) in order to identify the source of infection and rank isolates based on their relative risk to humans. Sequencing of theflaAshort variable region demonstrated that 86% of clinical isolates had genotypes that were also found in chicken meat. A polymerase chain reaction binary typing system identified 27 different codes based on the presence or absence of genes that have been reported to be associated with various aspects ofC. jejunipathogenicity, indicating that not all isolates may be of equal risk to human health. The lipooligosaccharide (LOS) of theC. jejuniisolates was classified into six classes (A, B, C, E, F, H) with 10·4% remaining unclassified. The majority (72·7%) of clinical isolates possessed sialylated LOS classes. Sialylated LOS classes were also detected in chicken isolates (80·7%). Antimicrobial tests indicated a low level of resistance, with no phenotypic resistance found to most antibiotics tested. A combination of typing approaches was useful to assign isolates to a source of infection and assess their risk to humans.

SUMMARYEnteric pathogens are commonly known to be transmitted through food or water; however, contact with animals is another important transmission route. This study estimated the annual burden of illness attributable to animal contact for eight enteric pathogens in Canada. Using data from a Canadian expert elicitation on transmission routes, the proportion of enteric illnesses attributable to animal contact was estimated for each pathogen to estimate the annual number of illnesses, hospitalizations and deaths in Canada. For each estimate, a mean and probability intervals were generated. Of all illnesses caused by these eight pathogens, 16% were estimated attributable to animal contact. This estimate translates to 86 000 (31 000–166 000) illnesses, 488 (186–890) hospitalizations and 12 (2–28) deaths annually for the eight pathogens combined.Campylobacterspp. is the leading cause of illnesses annually, with an estimated 38 000 (14 000–71 000) illnesses occurring each year, followed by non-typhoidalSalmonellaspp. (17 000, 6000–32 000). The majority of hospitalizations were attributable to non-typhoidalSalmonellaspp. (36%) andCampylobacterspp. (31%). Non-typhoidalSalmonellaspp. (28%) andListeria monocytogenes(31%) were responsible for the majority of the estimated deaths. These results identify farm animal and pet/pet food exposure as key pathways of transmission for several pathogens. The estimated burden of illness associated with animal contact is substantial.

SUMMARYThis observational study aims to investigate the microbiological quality of commercially prepared lightly cooked foods with a major component of food of animal origin and collected as would be served to a consumer. A total of 356 samples were collected from catering (92%), retail (7%) or producers (1%) and all were independent of known incidents of foodborne illness. Using standard methods, all samples were tested for: the presence of Campylobacter spp. and Salmonella spp. and enumerated for levels of, Bacillus spp. including B. cereus, Clostridium perfringens, Listeria spp. including L. monocytogenes, Staphylococcus aureus, Escherichia coli, Enterobacteriacea and aerobic colony count (ACC). Results were interpreted as unsatisfactory, borderline or satisfactory according to the Health Protection Agency guidelines for assessing the microbiological safety of ready-to-eat foods placed on the market. Amongst all samples, 70% were classified as satisfactory, 18% were borderline and 12% were of unsatisfactory microbiological quality. Amongst the unsatisfactory samples, six (2%) were potentially injurious to health due to the presence of: Salmonella spp. (one duck breast); Campylobacter spp. (two duck breast and one chicken liver pâté); L. monocytogenes at 4·3 × 103 cfu (colony-forming units)/g (one duck confit with foie gras ballotin) and C. perfringens at 2·5 × 105 cfu/g (one chicken liver pâté). The remaining unsatisfactory samples were due to high levels of indicator E. coli, Enterobacteriaceae or ACC.

SUMMARYIt is important to assess the suitability of sentinel sites for human disease; however, there have been few publications documenting the process of formal evaluation. We describe an approach to examining the representativeness of a single sentinel site employed for campylobacteriosis surveillance and source attribution, utilizing a selection of data sources and statistical comparisons of demographic, epidemiological and pathogen genotyping data across selected regions of New Zealand. Our findings showed that while this region captured the national variability in many variables, for example by containing sizable urban and rural populations, the relative frequency of these features did vary from other regions of New Zealand. We discuss the value of choosing a sentinel site that represents the national distribution of key variables, compared to a site that captures the broad features of the wider population, but provides greater power for the monitoring of sub-populations.

SUMMARYThis study assesses the contribution of different sources of human campylobacteriosis in Denmark using two different source-attribution approaches. In total, 794 non-human isolates and 406 isolates from human cases (domestic, travel related, and cases with unknown travel history) were collected. Isolates were characterized by multilocus sequence typing,flaAtyping and susceptibility to antibiotics. Both models used indicate that the major burden of human campylobacteriosis in Denmark originates from the domestic broiler chicken reservoir. The second most important reservoir was found to be cattle. The Asymmetric Island model attributed 52% [95% credibility interval (CrI) 37–67] to Danish chicken, 17% (95% CrI 3–33) to imported chicken, and 17% (95% CrI 7–28) to cattle. Similarly, theCampylobactersource-attribution model apportioned 38% (95% CrI 28–47) to Danish chicken, 14% (95% CrI 10–18) to imported chicken, and 16% (95% CrI 7–25) to cattle. The addition offlaAtype as an extra discriminatory typing parameter did not change the attribution of cases markedly.

SUMMARYThe faecal-pat prevalence (as estimated by culture) ofCampylobacter fetusfrom cattle and sheep on 19 farms in rural Lancashire was investigated using standardCampylobacterculture techniques and PCR during a 2-year longitudinal study.C. fetuswas isolated from 9·48% [95% confidence interval (CI) 8·48–10·48] of cattle faecal pats and 7·29% (95% CI 6·21–9·62) of sheep faecal pats. There was evidence of significant differences in shedding prevalence between geographical regions; cows in geographical zone 3 had an increased risk of sheddingC. fetuscompared to cows in geographical zones 1 and 2 (OR 6·64, 95% CI 1·67–26·5,P = 0·007), as did cows at pasture (OR 1·66, 95% CI 1·01–2·73,P = 0·046) compared to when housed. Multiple logistic regression modelling demonstrated underlying seasonal periodicity in both species.

SUMMARYA foodborne outbreak with 49 cases (22 culture positive forCampylobactersp.) following a wedding party in the East of England was investigated. A retrospective cohort study identified an association between consumption of chicken liver pâté and infection withCampylobacter jejuni/coli. There was a statistically significant association between dose (amount of chicken liver pâté eaten) and the risk of disease [‘tasted’: odds ratio (OR) 1·5, 95% confidence interval (CI) 0·04–∞; ‘partly eaten’: OR 8·4, 95% CI 1·4–87·5; ‘most or all eaten’: OR 36·1, 95% CI 3·3–2119). The local authority found evidence that the preparation of chicken livers breached Food Standards Agency's guidelines. This epidemiological investigation established a clear dose–response relationship between consumption of chicken liver pâté and the risk of infection withCampylobacter. The continuing need to raise public awareness of the risk to human health posed by undercooked chicken liver is evident.

SUMMARYWe comparedCampylobacter jejuni/colimultilocus sequence types (STs) from pets (dogs/cats) and their owners and investigated risk factors for pet-associated human campylobacteriosis using a combined source-attribution and case-control analysis. In total, 132/687 pet stools wereCampylobacter-positive, resulting in 499 strains isolated (320C. upsaliensis/helveticus, 100C. jejuni, 33C. hyointestinalis/fetus, 10C. lari, 4C. coli, 32 unidentified). There were 737 human and 104 petC. jejuni/colistrains assigned to 154 and 49 STs, respectively. Dog, particularly puppy, owners were at increased risk of infection with pet-associated STs. In 2/68 casesvs.0·134/68 expected by chance, a pet and its owner were infected with an identical ST (ST45, ST658). Although common sources of infection and directionality of transmission between pets and humans were unknown, dog ownership significantly increased the risk for pet-associated humanC. jejuni/coliinfection and isolation of identical strains in humans and their pets occurred significantly more often than expected.

SUMMARYCampylobacteriosis is the commonest cause of bacterial enteritis in England yet the epidemiology of apparently sporadic cases is not well understood. Here we evaluated the feasibility of applying a space-time cluster detection method to routine laboratory surveillance data in the North East of England by simulating prospective weekly space-time cluster detection using SaTScan as if it had been performed for 2008–2011. From the 209 simulated weekly runs using a circular window, 20 distinct clusters were found which contained a median of 30 cases (interquartile range 15–66) from a median population of ∼134 000 persons. This corresponds to detection of a new cluster every 10 weeks. We found significant differences in age, sex and deprivation score distributions between areas within clusters compared to those without. The results of this study suggest that space-time detection ofCampylobacterclusters could be used to find groups of cases amenable to epidemiological investigation.

SUMMARYRising numbers of campylobacteriosis case notifications in Switzerland resulted in an increased attention to acute gastroenteritis (AG) in general. Patients with a laboratory-confirmed Campylobacter infection perceive their disease as severe and around 15% of these patients are hospitalized. This study aimed at estimating healthcare costs due to AG and campylobacteriosis in Switzerland. We used official health statistics, data from different studies and expert opinion for estimating individual treatment costs for patients with different illness severity and for extrapolating overall costs due to AG and campylobacteriosis. We estimated that total Swiss healthcare costs resulting from these diseases amount to €29–45 million annually. Data suggest that patients with AG consulting a physician without a stool diagnostic test account for €9·0–24·2 million, patients with a negative stool test result for Campylobacter spp. for €12·3 million, patients testing positive for Campylobacter spp. for €1·8 million and hospitalized campylobacteriosis patients for €6·5 million/year. Healthcare costs of campylobacteriosis are high and most likely increasing in Switzerland considering that campylobacteriosis case notifications steadily increased in the past decade. Costs and potential cost savings for the healthcare system should be considered when designing sectorial and cross-sectorial interventions to reduce the burden of human campylobacteriosis in Switzerland.

SUMMARYThis study was conducted to examine the incidence trend of campylobacteriosis in Michigan over a 10-year period and to investigate risk factors and clinical outcomes associated with infection. Campylobacter case data from 2004 to 2013 was obtained from the Michigan Disease Surveillance System. We conducted statistical and spatial analyses to examine trends and identify factors linked to campylobacteriosis as well as ecological associations using animal density data from the National Agricultural Statistics Service. An increasing trend of Campylobacter incidence and hospitalization was observed, which was linked to specific age groups and rural residence. Cases reporting ruminant contact and well water as the primary drinking source had a higher risk of campylobacteriosis, while higher cattle density was associated with an increased risk at the county level. Additional studies are needed to identify age-specific risk factors and examine prevalence and transmission dynamics in ruminants and the environment to aid in the development of more effective preventive strategies.

SUMMARYHuman campylobacteriosis exhibits a distinctive seasonality in temperate regions. This paper aims to identify the origins of this seasonality. Clinical isolates [typed by multi-locus sequence typing (MLST)] and epidemiological data were collected from Scotland. Young rural children were found to have an increased burden of disease in the late spring due to strains of non-chicken origin (e.g. ruminant and wild bird strains from environmental sources). In contrast the adult population had an extended summer peak associated with chicken strains. Travel abroad and UK mainland travel were associated with up to 17% and 18% of cases, respectively. International strains were associated with chicken, had a higher diversity than indigenous strains and a different spectrum of MLST types representative of these countries. Integrating empirical epidemiology and molecular subtyping can successfully elucidate the seasonal components of human campylobacteriosis. The findings will enable public health officials to focus strategies to reduce the disease burden.

SUMMARYIn industrialized countries, acute infectious enteric diseases are usually mild, but they can also cause death. They do so, however, at different ages. Using 2004–2008 German notification data, we computed and compared crude and premature mortality [three different measures of years of potential life lost (YPLL)] of illnesses caused by Campylobacter spp., Listeria monocytogenes, norovirus, rotavirus, non-typhoidal Salmonella spp., and Shiga toxin-producing E. coli (STEC). Among ∼1·5 million notified illnesses, those caused by norovirus were the most frequent. The highest annual mortality was registered for salmonellosis (0·55/1 000 000 population), but listeriosis accounted for the highest number of YPLL (n=4245). Disregarding death at advanced age (i.e. >70 years), STEC illness (n=757) and rotavirus gastroenteritis (n=648) ranked second and third, following listeriosis (n=2306). Routine surveillance captures only a fraction of all incident cases and deaths, under-ascertaining the true burden of disease. Weighting death by age permits a different view on the disease burden individual enteric pathogens cause and particularly underscores the public health importance of listeriosis prevention.

SUMMARYWe estimated the true incidence of campylobacteriosis and salmonellosis in the European Union (EU) in 2009. The estimate was based on disease risks of returning Swedish travellers, averaged over the years 2005–2009, and anchored to a Dutch population-based study on incidence and aetiology of gastroenteritis. For the 27 EU member states the incidence of campylobacteriosis was about 9·2 (95% CI 2·8–23) million cases, while the incidence of salmonellosis was 6·2 (95% CI 1·0–19) million cases. Only 1/47 (95% CI 14–117) cases of campylobacteriosis and one 1/58 (95% CI 9–172) cases of salmonellosis were reported in the EU. The incidence rate of campylobacteriosis in EU member states varied between 30 and 13 500/100 000 population and was significantly correlated with the prevalence of Campylobacter spp. in broiler chickens. The incidence rate of salmonellosis in EU member states varied between 16 and 11 800/100 000 population and was significantly correlated with the prevalence of Salmonella Enteritidis in laying hens.

SUMMARYCampylobacterspp. is a widespread and important cause of human illness worldwide. Disease is frequently associated with foodborne transmission, but other routes of exposure, such as direct contact with live animals and person-to-person transmission, are also recognized. Identifying the most important sources of human disease is essential for prioritizing food safety interventions and setting public health goals. Numerous case-control studies of sporadic infections of campylobacteriosis have been published. These studies investigated a variety of potential risk factors for disease, often using different methodologies and settings. Systematic reviews (SRs) consist of a formal process for literature review focused on a specific research question, and include the identification of relevant literature, quality assessment of relevant studies, summarization or statistical analysis of data, and conclusions. With the objective of identifying the most important risk factors for human sporadic campylobacteriosis, we performed a SR of case-control studies of human sporadic cases and a meta-analysis of the obtained results. A combined SR focusing onSalmonellaandCampylobacterstudies was performed and the results analysed separately. From 1295 identified references, 131 passed the relevance screening, 73 passed the quality assessment stage, and data was extracted from 72 studies. Of these, 38 focused on campylobacteriosis. Information on exposures of cases and controls, and estimated odds ratios for investigated risk factors were collected and analysed. In the meta-analysis, heterogeneity between the studies and possible sources of bias were investigated, and pooled odds ratios for identified risk factors were estimated. Results suggest that travelling abroad, eating undercooked chicken, environmental sources, and direct contact with farm animals were significant risk factors for campylobacteriosis. Sub-analyses by geographical region, age group, and study period were performed, and differences were discussed.

SUMMARYJapanese weather data for areas that produced Campylobacter spp.-positive chicken products were compared with those for areas producing negative samples. Regarding samples produced during the period of rising temperature (spring and summer), the mean weekly air temperatures for Campylobacter-positive samples were higher than those for negative samples for the period of the week in which the samples were purchased (18·7°C vs. 13·1°C, P=0·006) to a 12-week lag (12 weeks before purchasing samples; 7·9°C vs. 3·4°C, P=0·009). Significant differences in weekly mean minimum humidity and sunshine duration per day were also observed for 1- and 2-week lag periods. We postulated that the high air temperature, high humidity and short duration of sunshine for the chicken-rearing period increased Campylobacter colonization in chickens during the period of rising temperature. Consequently, the number of Campylobacter-contaminated chicken products on the market in Japan may fluctuate because of the climatic conditions to which reared chickens are exposed.

SUMMARYCampylobacteriosis is a leading cause of acute bacterial gastroenteritis. An ecological study was undertaken to explore the association between environmental characteristics and incidence of campylobacteriosis in relation to four age groups and two seasonal periods. A multi-level Poisson regression model was used for modelling at the municipal level. High ruminant density was positively associated with incidence of campylobacteriosis, with a reduced effect as people become older. High poultry density and presence of a large poultry slaughterhouse were also associated with higher incidence, but only for people aged 16–34 years. The effect of ruminant density, poultry density, and slaughterhouses were constant across seasonal periods. Other associations were detected with population density and average daily precipitation. Close contacts with farm animals are probably involved in the associations observed. The specificity of age and season on this important disease must be considered in further studies and in the design of preventive measures.

SUMMARYFrom July 2008 until May 2009, 240 client-owned pet dogs from seven veterinary clinics in the Region of Waterloo, Ontario, Canada participated in a study to determine pet-related management factors that may be associated with the presence ofCampylobacterspp. in dogs. The prevalence ofCampylobacterspp. carriage in our study population of pet dogs was 22%, with 19% of the dogs positive forC. upsaliensis, and 3% positive forC. jejuni. A significant risk factor from multivariable logistic regression models for bothCampylobacterspp. andC. upsaliensiscarriage was having homemade cooked food as the dog's diet or added to its diet, and a significant sparing factor for both models was treatment with antibiotics in the previous month. Increasing age of the dog decreased the odds ofCampylobacterspp. andC. upsaliensiscarriage. Based on the high prevalence ofCampylobacter, and specificallyC. upsaliensis, further research concerning pet dogs as a risk factor for campylobacteriosis in humans is warranted.

SUMMARYMulti-locus sequence typing was performed on 1003Campylobacter jejuniisolates collected in a 2-year longitudinal study of 15 dairy farms and four sheep farms in Lancashire, UK. There was considerable farm-level variation in occurrence and prevalence of clonal complexes (CC). Clonal complexes ST61, ST21, ST403 and ST45 were most prevalent in cattle while in sheep CC ST42, ST21, ST48 and ST52 were most prevalent. CC ST45, a complex previously shown to be more common in summer months in human cases, was more prevalent in summer in our ruminant samples. Gene flow analysis demonstrated a high level of genetic heterogeneity at the within-farm level. Sequence-type diversity was greater in cattle compared to sheep, in cattle at pasturevs. housed, and in isolates from farms on the Pennines compared to the Southern Fylde. Sequence-type diversity was greatest in isolates belonging to CC ST21, ST45 and ST206.

SUMMARYThe annual number of episodes of clinical gastroenteritis caused byCampylobacterspp. in The Netherlands is estimated to be 75 000, i.e. once per 200 person life-years. This number is based on extrapolation of culture results from population-based studies. The number of culture-confirmed cases ofCampylobacterinfection peaks in the first 3 years of life and again between the ages of 20 and 25 years. The seroepidemiology ofCampylobacterdescribes the relationship between age and exposure toCampylobacterand reflects both symptomatic and asymptomatic infections. Using a validated ELISA system, antibodies toCampylobacterwere measured in an age-stratified sample (n=456) of the PIENTER serum collection of the Dutch general population. The seroprevalence ofCampylobacterIgG antibodies increased with age, reaching almost 100% at age 20 years. Antibody levels steadily increased with age until young adulthood, suggesting repeated exposure toCampylobacter. In conclusion, seroepidemiological data demonstrated repeated exposures toCampylobacterthroughout life, most of which do not lead to clinical symptoms. From young adulthood, >95% of the population in The Netherlands had serological evidence for exposure toCampylobacter.

SUMMARYDespite the frequency of Campylobacter as the principal cause of bacterial gastroenteritis in the UK, outbreaks attributed to this pathogen are rare. One hundred and fourteen general foodborne outbreaks of campylobacteriosis were reported to the Health Protection Agency from 1992 to 2009 with most occurring in food service establishments (64%, 73/114). Poultry meat (38%, 43/114) was the most commonly reported vehicle of infection, of which poultry liver pâté, and undercooking, were strongly associated with this pathogen. Notably, the number of outbreaks of campylobacteriosis linked to consumption of poultry liver pâté in England and Wales increased significantly from 2007 (74% as opposed to 12%, PCampylobacter-contaminated products.

Campylobacteris the primary agent of human bacterial gastroenteritis worldwide. In contrast to temperate zones, weather effects onCampylobacterprevalence in broilers under tropical conditions are under-researched. We examined the association between weather andCampylobacterprevalence in slaughtered broilers in Sri Lanka, a tropical country with weather variations led by monsoons. Each month (October 2009–July 2011), 20–30 broiler batches referring to two semi-automated slaughterhouses from five Sri Lankan provinces were tested forCampylobactercontamination and analysed in relation to temperature, humidity and rainfall. Overall prevalence was 63.8% (95% CI 59.6–67.9%,n= 542), peaking in September–November. Each 1 °C increase in monthly mean temperature up to 26 °C increasedCampylobacter-positive batches by 16.4% (95% CI 0.4–35.1%). For each 10 mm increase in monthly total rainfall up to 300 mm,Campylobacter-positive batches increased significantly by 0.8% (0.1–1.5%) at 1-month lag. For each 1% increase in relative humidity up to 80% at 1- and 2-month lags,Campylobacter-positive batches increased of respectively 4.2% (1.9–6.7%) and 4.0% (1.5–6.5), and decreased by 3.6% (2.6–4.6%) and 4.0% (2.6–5.4%) for unit increases above 80%. These results suggest that even in tropical countries without marked seasons, there are weather effects possibly reflectingCampylobacterpotential to colonise its preferred host and/or survive in the environment.

SUMMARYOne of the largest reported campylobacteriosis outbreaks in Canada occurred in June 2007 in British Columbia, associated with a mountain bike race that took place in muddy conditions. A retrospective cohort study was conducted and environmental samples were collected and tested. There were 537 racers included in the study and 225 racers (42%) reported diarrhoeal illness after the race.C. jejuniclinical isolates (n=14) were found to be identical by multi-locus sequence typing. Although univariate analysis suggested water consumption and mud exposure as significant risk factors, multivariate analysis revealed that on direct ingestion mud was significantly associated with illness (OR 4·08, 95% CI 2·03–8·21). Contaminated mud was thus the most likely source ofCampylobacterinfection. We identified other unpublished reports of outbreaks associated with bike races in rainy or muddy conditions; these underscore the importance of educating racers and raising public awareness of the risks of mud ingestion.

SUMMARYThe annual incidence in 14 361 campylobacteriosis cases reported in Finland in 2002–2005 varied between 61 and 76/100 000 population. The mean incidence was highest (148/100 000) in the 25–29 years age group and lowest (range 21–24/100 000) in children aged 5–14 years and patients aged ⩾75 years. The number of domestic cases was low in winter and peaked in summer. A total of 622 strains isolated from domestic infections and 785 foreign travel-related strains were serotyped. Serotypes Pen 3 and Pen 37 had the strongest association with travel-related infections (96%,P70% domestic within each serotype,P

SUMMARYThis study was performed to investigate space–time patterns ofCampylobacterspp. colonization in broiler flocks in Norway. Data on theCampylobacterspp. status at the time of slaughter of 16 054 broiler flocks from 580 farms between 2002 and 2006 was included in the study. Spatial relative risk maps together with maps of space–time clustering were generated, the latter by using spatial scan statistics. These maps identified the same areas almost every year where there was a higher risk for a broiler flock to test positive forCampylobacterspp. during the summer months. A modifiedK-function analysis showed significant clustering at distances between 2·5 and 4 km within different years. The identification of geographical areas with higher risk forCampylobacterspp. colonization in broilers indicates that there are risk factors associated withCampylobacterspp. colonization in broiler flocks varying with region and time, e.g. climate, landscape or geography. These need to be further explored. The results also showed clustering at shorter distances indicating that there are risk factors forCampylobacterspp. acting in a more narrow scale as well.