Validation of questions designed for investigation of gastroenteritis

Background: Health departments routinely investigate cases of gastroenteritis through interviews to determine the source of infection. However, validation studies of dietary questionnaires typically focus on quantities consumed and don't assess questions designed to identify sources of foodborne illness. We aimed to assess the accuracy and reliability of information collected by surveys of food history recall for gastroenteritis investigations. Methods: A questionnaire was developed to investigate the sources of foodborne gastroenteritis in Australia, with questions on food exposures selected for validation. Fifty-five participants photographed all foods consumed and food receipts obtained during a seven-day observation period. These photographs were uploaded to an online survey or emailed to the researcher. Participants were contacted 14 days later for a telephone interview about foods consumed in the seven-day period. Questionnaire responses were compared to uploaded photographs. Kappa statistics (κ) and 95% confidence intervals were calculated. Sixty-two questions were assessed, including those targeting foods considered high-risk for foodborne gastroenteritis. Potential risk factors covered by these questions included: meats (poultry, beef, pork, and deli meats), the state of poultry purchased (raw versus precooked), and the number of meals eaten outside of the home. Results: Several questions targeting high-risk foods were found to have substantial-to-almost perfect agreement (κ ≥ 0.610) between what was eaten and what was reported by participants, with most questions showing at least a moderate level of agreement (κ = 0.410–0.600). Questions regarding exposure to different types of meat showed a high level of consistency. The only question with poor participant recall (κ < 0.000) was that relating to consumption of undercooked beef or veal. Conclusion: Several questions designed for investigation of gastroenteritis were found to provide at least a moderate level of accurate and reliable recall, even after a delay until interview. These questions are suitable for investigating sources of foodborne gastroenteritis

A meta‐analysis of case‐control studies examining sporadic campylobacteriosis in Australia and New Zealand from 1990 to 2016

We conducted a meta-analysis of case-control studies to identify locally relevant risk factors for sporadic campylobacteriosis in Australia and New Zealand.We searched Medline, Web of Science, ProQuest and Google Scholar using PRISMA guidelines. Reference lists and grey literature were hand-searched. Meta-analyses were conducted in the R package 'metafor' using published odds ratios and 95% confidence intervals.We identified 325 articles, from which we included 10 that described case-control studies. Four risk factors were statistically significant in the meta-analysis: eating undercooked poultry (OR=4.28, 95%CI 3.09-5.93); eating poultry cooked outside the home (OR=2.13, 95%CI 1.66-2.72); having pet chickens (OR=3.29, 95%CI 2.12-5.10); and overseas travel (OR=5.55, 95%CI 3.20-9.63). Among children, having pet dogs showed elevated but not significant risk (OR=1.57, 95%CI 0.99-2.49).We identified consumption of chicken meat and contact with domestic chickens as important risk factors for campylobacteriosis in Australia and New Zealand. Implications for public health: While consumption of chicken meat is a well-known risk factor for campylobacteriosis, zoonotic transmission is often overlooked. This research indicates a greater need for public health awareness surrounding zoonotic campylobacteriosis, especially for young children

Status of antimicrobial resistance in clinical isolates of Campylobacter jejuni and Campylobacter coli in Australia

The aim of this study was to investigate the prevalence of resistance to six antimicrobials in Campylobacter jejuni and Campylobacter coli isolates from gastroenteritis cases using phenotypic antimicrobial susceptibility testing (AST) and whole genome sequencing (WGS). Resistance rates in Australia were compared to European Food Safety Authority data (EFSA) and the United States Centers for Disease Control and Prevention’s (CDC) National Antimicrobial Resistance Monitoring System. A total of 164 Campylobacter isolates (137 C. jejuni and 27 C. coli) were collected from patients with campylobacteriosis from eight Australian states and territories from October 2018 to February 2019 and tested for susceptibility to six antimicrobials using ETEST® strips. Genomic DNA was sequenced using the Illumina NextSeq platform and resistance genes identified from assembled WGS sequences using the Nullarbor pipeline and ResFinder. Phenotypically, 14.0%, 20.1%, 1.8% and 14.6% of isolates were resistant to ampicillin, ciprofloxacin, erythromycin and tetracycline, respectively. All isolates tested were susceptible to amoxicillin-clavulanic acid and gentamicin with no resistance detected. We identified twelve resistance genes, namely aad9, aadE, aph(3’)Illa, blaOXA-61, blaOXA-184, blaOXA-185, blaOXA-449, blaOXA-625, catA, erm(B), sat4, tet(O), and mutations in the gyrA and 23S rRNA genes. For each antimicrobial tested, concordance between resistance phenotype and genotype ranged from 33.3 to 100.0%. Compared to the United States and countries in Europe, Australia has low rates of ciprofloxacin and tetracycline resistance. Although one in five isolates were resistant to ciprofloxacin, most (98.2%) were susceptible to erythromycin, the drug of choice for treating Campylobacter infection

Risk factors for campylobacteriosis in Australia: outcomes of a 2018–2019 case–control study

Background: We aimed to identify risk factors for sporadic campylobacteriosis in Australia, and to compare these for Campylobacter jejuni and Campylobacter coli infections. Methods: In a multi-jurisdictional case–control study, we recruited culture-confirmed cases of campylobacteriosis reported to state and territory health departments from February 2018 through October 2019. We recruited controls from notified influenza cases in the previous 12 months that were frequency matched to cases by age group, sex, and location. Campylobacter isolates were confirmed to species level by public health laboratories using molecular methods. We conducted backward stepwise multivariable logistic regression to identify significant risk factors. Results: We recruited 571 cases of campylobacteriosis (422 C. jejuni and 84 C. coli) and 586 controls. Important risk factors for campylobacteriosis included eating undercooked chicken (adjusted odds ratio [aOR] 70, 95% CI 13–1296) or cooked chicken (aOR 1.7, 95% CI 1.1–2.8), owning a pet dog aged < 6 months (aOR 6.4, 95% CI 3.4–12), and the regular use of proton-pump inhibitors in the 4 weeks prior to illness (aOR 2.8, 95% CI 1.9–4.3). Risk factors remained similar when analysed specifically for C. jejuni infection. Unique risks for C. coli infection included eating chicken pâté (aOR 6.1, 95% CI 1.5–25) and delicatessen meats (aOR 1.8, 95% CI 1.0–3.3). Eating any chicken carried a high population attributable fraction for campylobacteriosis of 42% (95% CI 13–68), while the attributable fraction for proton-pump inhibitors was 13% (95% CI 8.3–18) and owning a pet dog aged < 6 months was 9.6% (95% CI 6.5–13). The population attributable fractions for these variables were similar when analysed by campylobacter species. Eating delicatessen meats was attributed to 31% (95% CI 0.0–54) of cases for C. coli and eating chicken pâté was attributed to 6.0% (95% CI 0.0–11). Conclusions: The main risk factor for campylobacteriosis in Australia is consumption of chicken meat. However, contact with young pet dogs may also be an important source of infection. Proton-pump inhibitors are likely to increase vulnerability to infection.</p