Domestic and travel-related foodborne gastrointestinal illness in a population health survey

What is the qualitative evidence concerning the risks, diagnosis, management and consequences of gastrointestinal infections in the community in the United Kingdom? A systematic review and meta-ethnography

BACKGROUND

Gastrointestinal (GI) infections cause a significant public health burden worldwide and in the UK with evidence pointing to socio-economic inequalities, particularly among children. Qualitative studies can help us understand why inequalities occur and contribute to developing more effective interventions. This study had two aims: 1. Conduct a systematic review to determine the extent and nature of UK qualitative evidence on gastrointestinal infections; 2. Use meta-ethnography to examine the influences of the differing social contexts in which people live.

METHODS

MEDLINE, Scopus, Web of science, CINAHL and JSTOR were searched for UK qualitative studies engaging with the risk, diagnosis, management or consequences of gastrointestinal infections from 1980 to July 2019. Five reviewers were involved in applying inclusion and exclusion criteria, extracting and synthesising data (PROSPERO CRD 42017055157).

RESULTS

Searches identified 4080 studies, 18 met the inclusion criteria. The majority (n = 16) contained data relating to the risk of gastrointestinal infection and these made up the main synthesis. The tenets of meta-ethnography were used to glean new understandings of the role of social and environmental contexts in shaping the risk of gastrointestinal infection, specifically with respect to foodborne GI illness. Three main explanations concerning risk emerged from the data: explanations of risk in the community were underpinned by understandings of 'bugs', dirt and where food comes from; risks were negotiated in households alongside diverse processes of decision making around food; and resources available to households shaped food practices.

CONCLUSION

This systematic review highlights the scarcity of UK qualitative evidence examining gastrointestinal infections. Apart from risk, questions around diagnosis, management and consequences of illness were largely untouched. No studies investigated patterning by socio-economic status. Nevertheless, the meta-ethnography yielded wider contextual theories and explanations as to why people might not follow food hygiene guidance, giving pointers to the types of qualitative enquiry needed to develop more effective interventions.

Socioeconomic status and infectious intestinal disease in the community: a longitudinal study (IID2 study)

Background

Infectious intestinal diseases (IID) are common, affecting around 25% of people in UK each year at an estimated annual cost to the economy, individuals and the NHS of £1.5 billion. While there is evidence of higher IID hospital admissions in more disadvantaged groups, the association between socioeconomic status (SES) and risk of IID remains unclear. This study aims to investigate the relationship between SES and IID in a large community cohort.

Methods

Longitudinal analysis of a prospective community cohort in the UK following 6836 participants of all ages was undertaken. Hazard ratios for IID by SES were estimated using Cox proportional hazard, adjusting for follow-up time and potential confounding factors.

Results

In the fully adjusted analysis, hazard ratio of IID was significantly lower among routine/manual occupations compared with managerial/professional occupations (HR 0.74, 95% CI 0.61-0.90).

Conclusion

In this large community cohort, lower SES was associated with lower IID risk. This may be partially explained by the low response rate which varied by SES. However, it may be related to differences in exposure or recognition of IID symptoms by SES. Higher hospital admissions associated with lower SES observed in some studies could relate to more severe consequences, rather than increased infection risk.

Estimating the burden of acute gastrointestinal illness in the community in Gansu Province, northwest China, 2012-2013

Background

Acute gastrointestinal illness (AGI) imposes considerable social and economic burden on low and middle-income countries. This study aimed to estimate the occurrence, distribution, and burden of self-reported AGI in Gansu Province of northwest China, where economic growth rates have lagged far behind those of other regions in China and systematic studies to investigate the burden of AGI are still lacking.

Methods

Twelve-month, retrospective face-to-face surveys were conducted in three sentinel sites between June 2012 and May 2013. Respondents were asked if they had experienced diarrhoea or vomiting in the 28 days prior to the interview.

Results

In total, 2094 interviews were completed. The adjusted monthly prevalence was 8.5% with an incidence rate of 1.16 episodes of AGI per person-year. Healthcare was sought by 73.8% of those reporting illness. Of the cases who visited a doctor, 50.5% submitted a stool sample. The use of antibiotics was reported by 65.6% of the cases and 53.3% took antidiarrhoeals. In the multivariable model, age, household income and sentinel site were significant risk factors of being a case of AGI.

Conclusions

The burden of AGI was considerable in Gansu Province of northwest China. Ongoing research to identify the main causes of AGI is needed for more accurate estimate of the burden of AGI in this region.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2458-14-787) contains supplementary material, which is available to authorized users.

Burden of self-reported acute gastrointestinal illness in China: a population-based survey

Background

Acute gastrointestinal illness (AGI) is an important public-health problem worldwide. Previous national studies of the incidence of AGI in China were performed decades ago, and detailed information was not available. This study therefore sought to determine the magnitude, distribution, and burden of self-reported AGI in China.

Methods

Twelve-month, retrospective face-to-face surveys were conducted in 20 sentinel sites from six provinces between July 2010 and July 2011.

Results

In total, 39686 interviews were completed. The overall adjusted monthly prevalence of AGI was 4.2% (95% confidence interval, 4.0–4.4), corresponding to 0.56 episodes of AGI per person-year. Rates of AGI were highest in children aged < 5 years. Healthcare was sought by 56.1% of those reporting illness. Of the cases who visited a doctor, 32.7% submitted a stool sample. The use of antibiotics was reported by 49.7% of the cases who sought medical care and 54.0% took antidiarrhoeals. In the multivariable model, gender, age, education, household type, residence, season, province and travel were significant risk factors of being a case of AGI.

Conclusions

This first population-based study in China indicated that AGI represents a substantial burden of health. Further research into the specific pathogens is needed to better estimate the burden of AGI and foodborne disease in China.

Laboratory-based surveillance of Campylobacter and Salmonella infection and the importance of denominator data

Laboratory data are the cornerstone in surveillance of infectious disease. We investigated whether changes in reported incidence of Campylobacter and Salmonella infection might be explained by changes in stool sampling rates. Data were extracted from a national database on 585 843 patient stool samples tested by microbiology laboratories in Wales between 1998 and 2008. Salmonella incidence fell from 43 to 19 episodes/100 000 population but Campylobacter incidence after declining from 111/100 000 in 1998 to 84/100 000 in 2003 rose to 119/100 000 in 2008. The proportion of the population sampled rose from 2·0% in 1998 to 2·8% in 2008, mostly due to increases in samples from hospital patients and older adults. The proportion of positive samples declined for both Salmonella and Campylobacter from 3·1% to 1·1% and from 8·9% to 7·5%, respectively. The decline in Salmonella incidence is so substantial that it is not masked even by increased stool sampling, but the recent rise in Campylobacter incidence may be a surveillance artefact largely due to the increase in stool sampling in older people.

Análise de Risco aplicada aos alimentos no Brasil: perspectivas e desafios

Trata-se de um estudo de caso no qual se discutiram as ideias do Comitê do Codex Alimentarius do Brasil (CCAB), coordenado pelo Instituto Nacional de Metrologia, Normalização e Qualidade Industrial (Inmetro) sobre a norma Codex Alimentarius de Análise de Risco aplicada aos alimentos (AR). Os objetivos deste trabalho foram identificar e analisar a opinião dos membros do CCAB sobre AR e levantar as propostas para a adoção desta norma no país, destacando as limitações e as potencialidades locais apontadas. Os membros do CCAB mostraram-se favoráveis à iniciativa do Codex em instituir a norma AR para promover a segurança sanitária dos alimentos que transitam no mercado internacional. Houve concordância no sentido de que o governo brasileiro deva incorporar a AR como política oficial para melhorar o sistema de controle de alimentos do país e para fortalecer as exportações brasileiras de alimentos. Reconheceram que o Brasil dispõe de capacidade técnico-científica para aplicar essa norma, porém destacaram várias limitações político-institucionais. Os membros reconhecem a AR como uma iniciativa valiosa para enfrentar os riscos dos alimentos, devido a sua capacidade de aprimorar as ações de controle sanitário de alimentos realizadas pelo governo.

Description and burden of travel-related cases caused by enteropathogens reported in a Canadian community

BACKGROUND

Risk of infections by enteropathogens among individuals traveling outside their country of residence is considered important. Such travel-related cases (TRC) have been poorly estimated and described in Canada.

METHODS

Data from an enhanced, passive surveillance system of diseases caused by enteropathogens within a Canadian community from June 2005 to May 2009 were used to describe TRC in terms of disease (pathogen, symptoms, hospitalization, duration, and timing of sickness relative to return); demographics (age and gender); and travel (destination, length, and accommodation); and to compare them with non-TRC.

RESULTS

Among 1,773 reported cases, 446 (25%) were classified as TRC with 9% of them being new immigrants. The main TRC diseases were campylobacteriosis, salmonellosis, and giardiasis. Disease onset occurred before return in 42% of TRC. Main destinations were Latin America/Caribbean and Asia. No differences by month and year were observed for onset, departure, and return dates. In addition to new immigrants, three subgroups of TRC based on travel destination, length of travel, type of accommodation, and age were identified and some diseases were more frequently observed in these subgroups. Generally, TRC did not differ from domestic cases in terms of age, gender, symptoms, hospitalization, and disease duration. Campylobacter coli and Salmonella enteritidis were significantly more frequent among TRC.

CONCLUSIONS

TRC of diseases caused by enteropathogens that are reportable in Canada represent a significant proportion of the burden of the total diseases. Subgroups of TRC exist and are associated with certain diseases. These results help inform the assessment of the actual risk related to travel for each subgroup of travelers and quantify the attribution of traveling abroad to the overall burden of these gastrointestinal diseases.

Integrated data collection on zoonoses in the European Union, from animals to humans, and the analyses of the data

The European Community (EC) has been collecting for 15 years data on zoonoses and agents thereof that integrate the information from human cases and their occurrence in food and animals. The current data collection covers 11 zoonotic agents: Salmonella, Campylobacter, Listeria, verotoxigenic E. coli (VTEC), Yersinia spp., Brucella, Mycobacterium bovis, Trichinella and Echinoccoccus, as well as rabies and food-borne outbreaks. The European Food Safety Authority (EFSA) is assigned the tasks of examining the data collected and publishing the Community Summary Report. This Report is prepared in close collaboration with the European Centre for Disease Prevention and Control (ECDC) responsible for the surveillance of the communicable diseases in humans, and with EFSA's Zoonoses Collaboration Centre (ZCC, in the Technical University of Denmark). Member States report the data on animals, feed, food and food-borne outbreaks to EFSA's web-based reporting system and the data on the human cases are reported to ECDC's web-application for The European Surveillance System (TESSy). The flow and analysis of data are described as well as an outline of the future plans to improve the comparability of the data.

Sentinel surveillance for travellers' diarrhoea in primary care

Background

Travellers' diarrhoea is the most common health problem among international travellers and much of the burden falls on general practitioners. We assessed whether sentinel surveillance based in primary care could be used to monitor changes in the epidemiology of travellers' diarrhoea.

Methods

A sentinel surveillance scheme of 30 volunteer general practices distributed throughout Wales provides weekly reports of consultations for eight infectious diseases to the national Communicable Disease Surveillance Centre. Travellers' diarrhoea was introduced as a new reportable infection in July 2002.

Results

Between 1 July 2002 and 31 March 2005 there were 90 reports of travellers' diarrhoea. The mean annual consultation rate was 15.2 per 100,000 population (95% confidence interval: 12.2–18.7), with the highest rates in summer, in people aged 15–24 years, and in travellers to Southern Europe. A higher proportion of travellers than expected had visited destinations outside Europe and North America when compared to the proportion of all United Kingdom travellers visiting these destinations (38% vs. 11%; Chi² = 53.3, p < 0.0001).

Conclusion

Sentinel surveillance has the potential to monitor secular trends in travellers' diarrhoea and to help characterise population groups or travel destinations associated with higher risk.