Incidence, risk factors, and health service burden of sequelae of campylobacter and non-typhoidal salmonella infections in England, 2000-2015: A retrospective cohort study using linked electronic health records

Quantifying national burdens of foodborne disease-Four imperatives for global impact

Estimates of national burdens of the foodborne disease (FBD) inform country-level food safety policies, ranking infectious and non-infectious FBD hazards in terms of health and socioeconomic impact to mitigate FBD burdens. Using relevant publications on FBD burdens from scientific literature, this review contends that four major imperatives (health, economic, planetary boundaries, governance) argue for a sustainable programme to quantify national FBD burdens. FBD disproportionately affects children under five years of age, and low- and middle-income countries. The economic costs are significant and include medical care, child development, lost productivity and international trade losses. Climatic changes and environmental contamination cause socio-ecological disruptions, increasing risk factors for FBD. Good governance promotes food safety initiatives, addressing in part under-diagnosis and underreporting. Strengthening national policies on FBD surveillance and burden estimation can promote food safety policies and address the global and national imperatives for FBD control. Evidence-based educational and regulatory interventions for FBD can promote improvements in the health and socioeconomic circumstances of the most vulnerable.

Campylobacter jejuni ST353 and ST464 cause localized gut inflammation, crypt damage, and extraintestinal spread during large- and small-scale infection in broiler chickens

Campylobacter infections in humans and chickens are a significant burden to health services and the poultry industry. In the UK, over 75% of chicken products are Campylobacter-positive at retail, but the knowledge of the mechanisms responsible for extraintestinal spread into edible tissues remains incomplete. This work aimed to establish if two chicken-associated lineages of Campylobacter jejuni, ST353 and ST464, have the potential for extraintestinal spread. Large- and small-scale chicken colonization trials investigated the infection biology of C. jejuni ST353 (three strains) and ST464 (four strains). Both lineages strongly colonized the ileum and ceca and were detected in liver and spleen. C. jejuni ST353 and ST464 spleen load were significantly increased compared to C. jejuni M1 controls. Immune responses in cecal tonsils exhibited early induction of IFN-γ and suppressed TGFβ at 7 days post-infection with C. jejuni ST464. Histochemistry of gut tissue demonstrated significant decreases in intestinal crypt depth in ileal tissue with increasing severity relative to Campylobacter lineage, M1 Collapse

Key Words

• Campylobacter jejuni
• biomarkers
• broiler chicken
• cecal tonsil-derived cytokine production
• crypt depth
• gut damage
• gut health
• in vivo chicken infection

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MESH Headings

• Animals
• Chickens/microbiology
• Campylobacter jejuni/physiology
• Campylobacter jejuni/genetics
• Campylobacter Infections/veterinary
• Campylobacter Infections/microbiology
• Campylobacter Infections/pathology
• Campylobacter Infections/immunology
• Poultry Diseases/microbiology
• Poultry Diseases/pathology
• Poultry Diseases/immunology
• Cecum/microbiology
• Inflammation/microbiology
• Inflammation/veterinary
• Spleen/microbiology

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Grants

• BB019142/1 UKRI | Biotechnology and Biological Sciences Research Council (BBSRC)

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Affiliation(s)

Heather M. Chick Microbiology and Infectious Disease, Institute of Life Science, Swansea University Medical School, Swansea, United Kingdom
Lisa K. Williams Microbiology and Infectious Disease, Institute of Life Science, Swansea University Medical School, Swansea, United Kingdom Department of Animal and Agriculture, Hartpury University, Gloucester, United Kingdom
Nick Sparks Scotland’s Rural College (SRUC) Barony Campus, Dumfries, United Kingdom
Farina Khattak Monogastric Science Research Center, Scotland’s Rural College (SRUC), Edinburgh, United Kingdom
Paul Vermeij MSD Animal Health, Boxmeer, the Netherlands
Inge Frantzen MSD Animal Health, Boxmeer, the Netherlands
Mandy Peeters MSD Animal Health, Boxmeer, the Netherlands
Jetta J. E. Bijlsma MSD Animal Health, Boxmeer, the Netherlands
Daniel John Microbiology and Infectious Disease, Institute of Life Science, Swansea University Medical School, Swansea, United Kingdom
Timothy Ogunrin Microbiology and Infectious Disease, Institute of Life Science, Swansea University Medical School, Swansea, United Kingdom
Keioni Essex Microbiology and Infectious Disease, Institute of Life Science, Swansea University Medical School, Swansea, United Kingdom
Caroline Cayrou Genetics, Genomics, and Cancer Sciences, University of Leicester, Leicester, United Kingdom
Venkateswarlu Kanamarlapudi Cellular Biology, Institute of Life Science, Swansea University Medical School, Swansea, United Kingdom
Christopher D. Bayliss Genetics, Genomics, and Cancer Sciences, University of Leicester, Leicester, United Kingdom
Julian M. Ketley Genetics, Genomics, and Cancer Sciences, University of Leicester, Leicester, United Kingdom
Thomas J. Humphrey Microbiology and Infectious Disease, Institute of Life Science, Swansea University Medical School, Swansea, United Kingdom
Steven P. Rushton School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
Thomas S. Wilkinson Microbiology and Infectious Disease, Institute of Life Science, Swansea University Medical School, Swansea, United Kingdom

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Collaborators Collapse

Burden and Cost of Campylobacter Risk Factors in Australia

Campylobacter is a globally important pathogen with well-studied risk factors, but the burden of risk factors has not been quantified. We quantified the cost of illness attributable to specific domestic risk factors for C. jejuni and C. coli in Australia. We used data from a 2018-2019 case-control study to estimate odds ratios and attributable fractions for risk factors. We used data on national incidence, hospitalization, and premature mortality to quantify burden. We then applied costs related to healthcare utilization, pain and suffering, premature mortality, and lost productivity to each risk factor. In Australia, C. jejuni caused 83.0% of campylobacteriosis infections and chicken consumption resulted in the highest attributable fraction (30.0%), costing approximately US$110 million annually. The excess burden of campylobacteriosis associated with the use of proton-pump inhibitors (PPIs) was US$45 million, with almost half these costs due to disease in adults over 65 years of age. Contact with young dogs (US$30 million) and chicken feces (US$10 million) also contributed to costs and burden. Campylobacteriosis is a significant cost to Australia, particularly because of lost productivity. Effective cross-sectoral interventions to improve chicken meat safety and reduce inappropriate use of PPIs might have substantial economic and human benefits.

A review and meta-analysis of non-typhoidal Salmonella in Vietnam: Challenges to the control and antimicrobial resistance traits of a neglected zoonotic pathogen

Non-typhoidal Salmonella (NTS) is a food-borne zoonotic pathogen with important implications for human health. Despite its importance, the burden of NTS infections in Vietnam is unknown. We conducted a systematic review and a meta-analysis to describe the prevalence and phenotypic antimicrobial resistance (AMR) for NTS over time in Vietnam. Following PRISMA guidelines, we identified 72 studies from PubMed and Google Scholar containing data relevant to 'Salmonella', 'Salmonellosis', and 'Vietnam', or 'Viet Nam'. Of those, forty-two papers reporting prevalence of NTS, and twenty-six including data on phenotypic resistance were selected for meta-analysis. The prevalence of NTS ranged from 2% to 5% in humans and from 30% to 41% in samples from animals and the farm/slaughterhouse environment. Between 2000 and 2020 we observed a 27.3% (p = 0.044) increase in absolute terms in prevalence among individuals with enteric diseases and a 12.0% (p = 0.047) increase in aquaculture/seafood samples. The most commonly serovars identified across studies included S. Weltevreden (12.0%), followed by S. Typhimurium (10.1%), S. Derby (6.4%), S. London (5.8%), S. Anatum (4.4%), S. Rissen (3.9%), S. Enteritidis (3.7%), S. Albany (3.3%) and S. 4,[5],12:i:- (3.0%). Over the same period, there was an increasing trend in the pooled AMR prevalence for quinolones (15.6% relative increase), 3rd-, 4th-, and 5th-generation cephalosporins (23.7%), penicillins (16.1%), tetracyclines (12.9%), sulfonamides (8.8%), amphenicol (17.8%), and multidrug resistance (11.4%) (all p ≤ 0.014). A broad range of AMR genes (ARGs) were detected in both human and animal populations. The observed prevalence and AMR trends in Vietnam underscore the need of adopting a One Health strategy encompassing surveillance systems, research initiatives, and awareness campaigns to effectively address the challenges posed by NTS.

A novel nanoparticle-based fluorescent sandwich immunoassay for specific detection of Salmonella Typhimurium

The diseases caused by foodborne pathogens have a serious impact on human health and social stability. Conventional detection methods can involve long assay times and complex pretreatment steps, making them unsuitable for rapid, large-scale analysis of food samples. We constructed a novel nano-fluorescence sandwich immunosorbent immunoassay (nano-FSIA) to rapidly detect Salmonella Typhimurium in food, based on strong covalent binding between streptavidin and biotin. We used antibodies coupled to large particle-size fluorescent microspheres as fluorescent probes for direct quantitative analysis of S. typhimurium in milk. The optimized parameters were determined, and specificity and sensitivity were validated in phosphate-buffered saline (PBS) and milk. The results demonstrated a wide dynamic detection range for S. typhimurium (103-108 colony forming units [CFU]/mL), with the limit of detection in PBS and milk at 234 and 346 CFU/mL, respectively. The results of nano-FSIA were consistent with those of plate counts and enzyme-linked immunosorbent assays, providing an effective and promising single-bacterium counting method for the rapid detection of Salmonella.

Physicochemical, microbiological, and sensory characteristics of "Sui Wu'u" traditional pork products from Bajawa, West Flores, Indonesia

Background and Aim

Sui Wu'u is a traditional meat preservation product from Bajawa, a region in East Nusa Tenggara. It is made by mixing pork with salt and corn flour, which is then stored in a bamboo container (tuku) for months. After 6 months of storage, this study examined the physicochemical, microbiological, and sensory properties of Sui Wu'u.

Materials and Methods

Sui Wu'u products were prepared using the traditional recipe from the Bajawa community. Fresh pork (pork belly and backfat), corn flour, and salt were purchased from local/traditional markets at proportions of 65%, 30%, and 5%, respectively. The physicochemical, amino acid, fatty acid profile, microbiological, and sensory properties of Sui Wu'u were evaluated after being stored for 6 months in a bamboo container (tuku).

Results

The results indicated that these Sui Wu'u were mainly characterized by high-fat levels, followed by protein. The pH value, salt content, moisture content, and water activity were 4.72%, 1.72%, 6.11%, and 0.62%, respectively. Minerals (K, P, Se, and Zn) and vitamin B6, as well as amino acids, such as leucine, phenylalanine, lysine (essential amino acids), glycine, proline, glutamic acid, and alanine (non-essential amino acids), are present in Sui Wu'u. The fatty acid profile was dominated by monounsaturated fatty acids (MUFA) (21.69%), saturated fatty acids (SFA) (17.78%), and polyunsaturated fatty acids (PUFA) (5.36%). Monounsaturated fatty acids, oleic acid (C18:1n9) was the most abundant fatty acid in Sui Wu'u, followed by palmitic acid SFA (C16:0); MUFA stearic acid (C18:0); and PUFA linoleic (C18:2n-6). The microbiological characteristics of Sui Wu'u showed no detectable microorganisms (<10 CFU/g) for Salmonella, total E. coli and total Staphylococcus, and average values of 4.4 × 105 CFU/g for total microbes, which were still below the maximum limit of microbial contamination according to the regulations of the Food and Drug Supervisory Agency of the Republic of Indonesia. The sensory assessment indicated that panelists highly preferred (rated as very like) Sui Wu'u for all sensory attributes.

Conclusion

The physicochemical, microbiological, and sensory characteristics of Sui Wu'u after 6 months of storage indicated that it still provides essential nutrients for the body and is quite safe for consumption. The stability of Sui Wu'u's shelf life can be attributed to the appropriate combination of pork, salt, corn flour, bamboo packaging (tuku), and storage temperature. The high-fat content in Sui Wu'u can be reduced by increasing the proportion of lean meat. Ensuring strict sanitation during the manufacturing process, using high-quality pork, salt, corn flour, and proper packaging with bamboo can further improve the safety of Sui Wu'u for consumption.

Health care utilizations and costs of Campylobacter enteritis in Germany: A claims data analysis

OBJECTIVE

The number of reported cases of Campylobacter enteritis (CE) remains on a high level in many parts of the world. The aim of this study was to analyze the health care utilizations and direct and indirect costs of CE and sequelae of patients insured by a large health insurance with 26 million members in Germany.

METHODS

Claims data of insurants with at least one CE diagnosis in 2017 (n = 13,150) were provided, of which 9,945 were included in the analysis of health care utilizations and costs. If medical services were not diagnosis-linked, CE-associated costs were estimated in comparison to up to three healthy controls per CE patient. Indirect costs were calculated by multiplying the work incapacities by the average labor costs. Total costs of CE in Germany were extrapolated by including all officially reported CE cases in 2017 using Monte Carlo simulations.

RESULTS

Insurants showed a lower rate of 56 CE diagnoses per 100,000 than German surveillance data for 2017, but with a similar age, gender and regional distribution. Of those CE cases, 6.3% developed post-infectious reactive arthritis, Guillain-Barré syndrome (GBS), inflammatory bowel disease (IBD) and/or irritable bowel syndrome (IBS). Health care utilizations differed depending on CE severity, age and gender. Average CE-specific costs per patient receiving outpatient care were € 524 (95% CI 495-560) over a 12-month period, whereas costs per hospitalized CE case amounted to € 2,830 (2,769-2,905). The analyzed partial costs of sequelae ranged between € 221 (IBS) and € 22,721 (GBS) per patient per 12 months. Total costs of CE and sequelae extrapolated to Germany 2017 ranged between € 74.25 and € 95.19 million, of which 10-30% were due to sequelae.

CONCLUSION

CE is associated with a substantial economic burden in Germany, also due to care-intensive long-lasting sequelae. However, uncertainties remain as to the causal relationship of IBD and IBS after CE.

Quantitative Determination of Campylobacter on Broilers along 22 United Kingdom Processing Lines To Identify Potential Process Control Points and Cross-Contamination from Colonized to Uncolonized Flocks

ABSTRACT

As part of a program to reduce numbers of the human pathogen Campylobacter on retail chickens, 22 broiler processing lines, representing more than 90% of UK production, were characterized by enumerating Campylobacter on pooled neck skins after exsanguination, scalding, defeathering, evisceration, crop removal, inside-outside washing, and air-chilling stages of processing. Sixteen of the processing lines investigated showed significant (P < 0.05) reductions in Campylobacter numbers because of carcass scalding. However, in all of these lines, the following defeathering stage caused a significant increase in Campylobacter contamination that effectively negated the reductions caused by scalding. On four processing lines, primary chilling also caused a significant reduction in numbers of Campylobacter. On three lines, there was a significant microbiological benefit from inside-outside washing. The stages where Campylobacter numbers were reduced require further investigation to determine the specific mechanisms responsible so that the observed pathogen reductions can be optimized and then more widely implemented. The transfer of up to 4 log CFU Campylobacter per g of neck skin from a colonized flock to a following uncolonized flock was observed. Cross-contamination was substantial and still detectable after 5,000 carcasses from an uncolonized flock had been processed. Numbers of Campylobacter recovered from the uncolonized flocks were highest on the first of the uncolonized birds to pass along the line, and in general, the numbers declined as more uncolonized birds were processed. Air sampling recovered low numbers at the processing stages monitored, indicating that airborne transmission was unlikely to be the primary transfer mechanism operating for cross-contamination between flocks.

HIGHLIGHTS

Predicting Hospital Readmission for Campylobacteriosis from Electronic Health Records: A Machine Learning and Text Mining Perspective

(1) Background: This study investigates influential risk factors for predicting 30-day readmission to hospital for Campylobacter infections (CI). (2) Methods: We linked general practitioner and hospital admission records of 13,006 patients with CI in Wales (1990–2015). An approach called TF-zR (term frequency-zRelevance) technique was presented to evaluates how relevant a clinical term is to a patient in a cohort characterized by coded health records. The zR is a supervised term-weighting metric to assign weight to a term based on relative frequencies of the term across different classes. Cost-sensitive classifier with swarm optimization and weighted subset learning was integrated to identify influential clinical signals as predictors and optimal model for readmission prediction. (3) Results: From a pool of up to 17,506 variables, 33 most predictive factors were identified, including age, gender, Townsend deprivation quintiles, comorbidities, medications, and procedures. The predictive model predicted readmission with 73% sensitivity and 54% specificity. Variables associated with readmission included male gender, recurrent tonsillitis, non-healing open wounds, operation for in-gown toenails. Cystitis, paracetamol/codeine use, age (21–25), and heliclear triple pack use, were associated with a lower risk of readmission. (4) Conclusions: This study gives a profile of clustered variables that are predictive of readmission associated with campylobacteriosis.

The influence of gut microbiome on progression of overactive bladder symptoms: a community-based 3-year longitudinal study in Aomori, Japan

PURPOSE

To assess the influence of gut microbiome on overactive bladder (OAB) symptoms progression.

METHODS

This was a 3-year longitudinal study, Hirosaki in Japan. We assessed OAB symptoms and reviewed the medication records of each subject in 2016. We extracted 16S rRNA genes from fecal samples and analyzed gut microbiomes via next-generation sequencing. We evaluated the changes in urinary urgency (UU) and/or urgent urinary incontinence (UUI) from 2016 to 2019. We defined UU/UUI-progression as exacerbation of UU and/or UUI. We compared the clinical backgrounds and microbiota structure between UU/UUI-progression subjects and non-progression (controls). We assessed the impact of gut microbiome on the UU/UUI-progression via multivariate logistic regression analyses.

RESULTS

Of 669 subjects, 126 were UU/UUI-progression subjects. These subjects had a higher age and prevalence of proton pump inhibitor (PPI) use (14% vs. 5.4%, P = 0.003), irritable bowel syndrome, sleep disturbance, and metabolic syndrome than those without. We found the different microbiota structures between subjects with UU/UUI-progression and those without. A higher relative abundance of genus Streptococcus (harmful bacterial genus for human health) appeared in UU/UUI-progression subjects (3.8% vs. 2.3%, P < 0.001). Multivariate analysis revealed that age ≥ 65 years, current smoking, sleep disturbance, metabolic syndrome, and genus Streptococcus (Odds ratio: 1.05, P = 0.029) were independent risk factors for UU/UUI-progression. PPI use turned to be a significant risk factor on a multivariate analysis without including genus Streptococcus.

CONCLUSIONS

Gut microbiome might be associated with a risk for OAB symptoms progression. PPI use might cause gut dysbiosis and increase this risk.

Electronic Health Record Network Research in Infectious Diseases

With the marked increases in electronic health record (EHR) use for providing clinical care, there have been parallel efforts to leverage EHR data for research. EHR repositories offer the promise of vast amounts of clinical data not easily captured with traditional research methods and facilitate clinical epidemiology and comparative effectiveness research, including analyses to identify patients at higher risk for complications or who are better candidates for treatment. These types of studies have been relatively slow to penetrate the field of infectious diseases, but the need for rapid turnaround during the COVID-19 global pandemic has accelerated the uptake. This review discusses the rationale for her network projects, opportunities and challenges that such networks present, and some prior studies within the field of infectious diseases.

Long-term use of proton pump inhibitors as a risk factor for various adverse manifestations

The long-term use of proton pump inhibitors (PPIs) can lead to increased gastric pH, hypochlorhydria and in some cases to achlorhydria when compared to other acid-suppressing agents like histamine-2 (H2) receptor blockers and antacids. These consequences by the use of long-term PPIs may lead to significant vitamin (B₁₂ and C) and mineral (iron, calcium and magnesium) deficiencies which needs gastric acid for their absorption and bioavailability. Long-term use of PPIs by the pregnant patients may impose a potential risk of congenital malformations. Various studies have recommended the life style modifications and antacid use as first choice among pregnant womens by preserving PPIs (omeprazole as a safe choice of PPI) for severe conditions of gastroesophageal reflux disease. The long-term acid suppression by PPIs can also lead to enteric, respiratory and urinary tract infections. The hypochlorhydria by chronic PPIs use may induce hypergastrinemia, which ultimately mediates the gastric polyps, gastric carcinoids and gastric cancer. The concomitant use of PPIs with antiplatelet drugs like clopidogrel can impose the patients to major adverse cardiac events. This review has enlisted the comprehensive information regarding the adverse effects induced by long-term use of PPIs and their possible relations. Considerable studies like case-control, randomized trials, cohort studies and meta-analysis were reported in supporting these adverse effects. The clinicians and patients should be cautious about these effects so that they can avoid the serious outcomes. PPIs should be avoided for long-term use mainly in older adults unless there is a proper indication.