Population distribution and burden of acute gastrointestinal illness in British Columbia, Canada

BACKGROUND: In developed countries, gastrointestinal illness (GI) is typically mild and self-limiting, however, it has considerable economic impact due to high morbidity. METHODS: The magnitude and distribution of acute GI in British Columbia (BC), Canada was evaluated via a cross-sectional telephone survey of 4,612 randomly selected residents, conducted from June 2002 to June 2003. Respondents were asked if they had experienced vomiting or diarrhoea in the 28 days prior to the interview. RESULTS: A response rate of 44.3% was achieved. A monthly prevalence of 9.2% (95%CI 8.4 – 10.0), an incidence rate of 1.3 (95% CI 1.1–1.4) episodes of acute GI per person-year, and an average probability that an individual developed illness in the year of 71.6% (95% CI 68.0–74.8), weighted by population size were observed. The average duration of illness was 3.7 days, translating into 19.2 million days annually of acute GI in BC. CONCLUSION: The results corroborate those from previous Canadian and international studies, highlighting the substantial burden of acute GI

[A trial among laboratories participating in a RIVM/NIVEL sentinel study of incidence and cause of gastro-enteritis.]

Abstract niet beschikbaarIn 1992, in collaboration with the Dutch Institute for Investigation of Primary Health Care (NIVEL) and the National Institute of Public Health and Environmental Protection (RIVM), a national sentinel study of incidence and cause of gastro-enteritis was started. Patients with complaints of gastro-enteritis, consulting participating practitioners, were asked to complete a questionnaire and send a faecal sample to the nearest laboratory for examination. 24 laboratories took part in the study. Samples were investigated for the presence of Salmonella, Shigella and Campylobacter. For adequate interpretation of the results, an investigation of quality assurance in the different laboratories was carried out. The RIVM distributed artificially contaminated, simulated faecal samples. The laboratories were asked to examine these samples, according to their usual methods, for the presence of Salmonella, Shigella and Campylobacter. One laboratory didn't investigate the received samples. The other laboratories were able to demonstrate the presence of Salmonella, Shigella and Campylobacter in samples contaminated with these bacteria. None of the laboratories isolated bacteria from the control sample. Escherichia coli, added to a sample as interfering strain, was suppressed or discriminated by the selective or distinguishing characteristics of the methods used.GHI HIGB VHI VV

Qualitative and quantitative research for Clostridium perfringens enterotoxin in faecal samples of patients with acute gastro-enteritis with an enzyme-linked immunosorbent assay

Abstract niet beschikbaarOver a period of five years (1987-1991) practitioners in Amsterdam and Helmond have registered patients with complaints of acute gastro-enteritis. These patients completed a questionnaire and sent faecal samples to the Public Health Laboratory of Amsterdam or Eindhoven. The samples were examined for the presence of Salmonella, Shigella and Campylobacter species and sometimes for other enteropathogens. When available an aliquot of the sample was sent on to the National Institute of Public Health and Environmental Protection (RIVM) where it was examined for the presence of Clostridium perfringens enterotoxine (CPE). An enzym-linked immunosorbent assay (ELISA) was used to investigate the presence of CPE. Faecal samples were also screened for the presence of CPE neutralizing factors. In total 1261 faecal samples were investigated, 29 had CPE neutralizing factors. In 1195 (97%) of the remaining 1232 samples, no CPE was detected and in 37 (3%) samples, CPE was detected in concentrations varying from 1 to > 1000 ng per gram faeces. Lower concentrations CPE were mainly found in faeces from children younger than 5 years of age. In one third of the samples containing CPE, also another micro-organism, capable of causing complaints of gastro-enteritis, was found. This was especially the case with CPE concentrations lower than 1000 ng per gram faeces.GHI RIV

Foodborne infections and - intoxications in the Netherlands, 1979-1990

Abstract niet beschikbaarThe total number of reported foodborne illnesses showed an apparent decrease in the period 1979-1990 from ca. 250 outbreaks (1700 patients) to ca. 160 outbreaks (1000 patients) per year. In the same period, the percentage of outbreaks with unknown etiology increased slightly from ca. 70 to ca. 80%. It is not known whether these changes reflect a genuine change in the pattern of foodborne disease or a decrease in efficiency of the passive surveillance system. Both Bacillus sereus and Salmonella were important pathogens in reported outbreaks of foodborne diseases. The incidence of Staphylococcus aureus and Clostridium perfringens seem to decrease. Remarkable is the continuing role of Shigella in contaminated food. Most frequently reported sources of foodborne diseases were Chinese foods, followed by meat and meat products. Also (shell) fish is reported frequently. Some increase of dairy products as a source of infection seems to be noticeable. The most frequently reported location where the suspected food was prepared is the restaurant. An increase in complaints from cafeteria's and private houses is noted.HIG

Incidence of acute gastro-enteritis in sentinels in the Netherlands, 1992-1993

In the Netherlands gastroenteritis belongs to the ten diseases with the highest incidence rates. A sentinel study on the incidence of gastrointestinal complaints and the occurrence of the investigated pathogens (Campylobacter, Salmonella and Shigella) was carried out in about 40 general practices in 1992 and 1993. The sentinel stations were as representative as possible of the Dutch population. The study was undertaken by the National Institute of Public Health and Environmental Protection (RIVM) and the Netherlands Institute of Primary Health Care (NIVEL) in cooperation with the general practitioners who participated in the Dutch Sentinel Practice Network and 24 laboratories. Age and sex of patients who met the case definition were reported to the NIVEL. These patients were asked by their GP to provide a stool sample and to complete a questionnaire. The number of patients that were either reported to the NIVEL or have been given a questionnaire by their GP was estimated at about 2370. A completed questionnaire was received from 58.9% (1400/2370) of these patients. Eighty percent (1400/1744) of the cases completed the questionnaire they received. Results of microbiological analysis were obtained for 89.1% (1248/1400) of patients who completed the questionnaire. The crude incidence rate of acute gastrointestinal complaints was 55.3 per 10,000 person years, after correction for non response it was 89.9 per 10,000 person years. The incidence was lower in 1993 than in 1992. Between men and women no differences have been found. The highest incidences have been found in the agegroups under five. The incidence rate for Campylobacter was 6.9 per 10,000 person years (182 samples positive), for Salmonella 2.2 (55 samples positive) and for Shigella 0.4 per 10,000 person years (10 samples positive). After correction for non response these incidences were 11.7 and 3.5 and 0.6 per 10,000 person years. The Salmonella incidence rate was higher in 1993 than in 1992 and higher in men than in women. The highest incidence rates for Campylobacter and Salmonella were found in the agegroups under five. The (late) summer months as expected, showed the highest incidence rates. Incidence rates for gastroenteritis as well as for microorganisms were lower than incidences found in other sentinels. To follow trends in incidence rates and microorganisms it is necessary to undertake sentinels repeatedly with the same methodology and population. However results cannot be generalised to the general population and consequently it remains necessary to carry out a population cohort study every 5 to 10 years.Gastro-enteritis behoort in Nederland tot de tien ziekten met de hoogste incidentie. In 1992 en 1993 vond een huisartsenpeilstationonderzoek plaats naar de incidentie en de microbiologie van dit ziektebeeld. Het onderzoek werd uitgevoerd door het Rijksinstituut voor Volksgezondheid en Milieuhygiene (RIVM) en het Nederlands Instituut voor Onderzoek van de Gezondheidszorg (NIVEL), in samenwerking met de huisartsen die meewerkten aan de Continue Morbiditeits Registratie (CMR) van het NIVEL en 24 microbiologische laboratoria. Door de huisartsen werden patienten die voldeden aan de gehanteerde case-definitie gemeld aan het NIVEL. Verder verzochten de huisartsen de patienten om een vragenlijst in te vullen en een faecesmonster in te sturen. De exacte respons van de huisartsen kon niet worden berekend omdat er geen gegevens waren over het aantal personen dat in de onderzoeksperiode een peilstationarts consulteerden maar ondanks dat ze aan de case-definitie voldeden niet in het onderzoek werden opgenomen. Er werden 1400 ingevulde vragenlijsten ontvangen. Het aantal personen dat werd gemeld en/of waaraan door de huisartsen een onderzoekspakket werd uitgedeeld, werd berekend op circa 2370 uitgaande van de aanname dat de respons onder patienten die wel en patienten die niet werden gemeld gelijk was. Van 59% (1400/2370) van deze patienten werd een vragenlijst ontvangen. De respons van de patienten ten aanzien van het insturen van vragenlijsten was 80,3% (1400/1744). Van 89,1% (1248/1400) van de personen waarvan een vragenlijst werd ontvangen was de uitslag van het microbiologisch onderzoek bekend. De incidentie van huisartsconsulten voor gastro-enteritis was 55,3 per 10.000 persoonsjaren, na correctie voor geschatte non-respons was dat 89,9 per 10.000 persoonsjaren. De incidentie was in 1993 significant lager dan in 1992. Tussen mannen en vrouwen werd geen verschil in incidentie gevonden. De incidentie was het hoogst bij de 0-jarigen en ook bij de 1 tot en met 4-jarigen was deze duidelijk hoger dan in de andere leeftijdsgroepen. De incidentie van Campylobacter was 6,9 per 10.000 persoonsjaren (182 monsters positief), van Salmonella 2,2 (55 monsters positief) en van Shigella 0,4 per 10.000 persoonsjaren (10 monsters positief). Na correctie voor geschatte non-respons waren deze incidenties respectievelijk 11,7 en 3,5 en 0,6 per 10.000 persoonsjaren. De incidentie van Salmonella was in 1993 hoger dan in 1992 en onder mannen hoger dan onder vrouwen. Voor Campylobacter en Salmonella waren de incidentiecijfers het hoogst in de leeftijdsgroepen onder 5 jaar. Zoals verwacht waren de incidentiecijfers het hoogst in de (late) zomermaanden. De incidentiecijfers van zowel het ziektebeeld als de afzonderlijke micro-organismen waren, ook na correctie voor de geschatte non-respons, duidelijk lager dan in andere peilstationonderzoeken. Waarschijnlijk zijn verschillen in methodologie, gehanteerde case-definities en onderzoekspopulaties hierop van invloed geweest. Om trends in de incidentie van gastro-enteritis en van de onderzochte en andere mogelijke verwekkers te kunnen volgen is het van belang dat huisartsenpeilstationonderzoek bij herhaling wordt uitgevoerd met een gelijkblijvende methodologie en onderzoekspopulatie. Het blijft evenwel van belang om de bevindingen eens in de 5 tot 10 jaar te ijken aan een populatiestudie

[Research to improve the method for isolating Yersinia spp. from stools of patients with complaints of gastro-enteritis.]

Abstract niet beschikbaarThis report describes a collaborative study carried out by the Regional Laboratory of Amsterdam and the National Institute of Public Health and Environmental Protection (RIVM), to improve the method for isolating Yersinia spp, from stools of patients with complaints of gastro-enteritis. During a period of one year, the Regional Laboratory of Amsterdam examined 1007 faecal samples for the presence of Yersinia spp, using 6 different methods. Best results were obtained with enrichment in physiological saline with phosphate buffer 0.01 M, pH 7.2 (PBS) during 7 days at 4 degrees C followed by inoculation on and incubation of cefsulodin irgasan novobiocine agar (CIN) during 24 and 48 hours at 37 degrees C. This met gave an isolation percentage of 1.4%. However drawback of this method is the long incubation period. This makes the method unpractical for primary diagnostical use. Therefore improvement of the enrichment was investigated. Tests were carried out at the RIVM, to examine the possibility of increasing the growth rate of Yersinia spp. and decreasing the incubation time by adding glucose and peptone to PBS. Increase of the glucose concentration in PBS+peptone seemed to have little effect on the groth rate of Yersinia. Buffered peptonwater (BPW) was used as an alternative medium. Comparison of BPW with glucose and PBS with glucose showed that BPW was superior. Evaluation took place by examining 1014 faecal samples from patients with complaints of gastroenteritis by the Regional Laboratory of Amsterdam using 4 isolation methods including enrichment in PBS and BPW. Of these methods, enrichment in Rappaport according to Wauters (RVW) and enrichment in PBS gave the best results. The difference with former results using RVW by the Regional Laboratory of Amsterdam is caused by quality improvement due to introduction of a quality assurance system for the media. Apparently the exact composition and preparation of Rappaport-broth according to Wauters is very critical. It is recommended that direct inoculation on CIN should take place and when clinical advantage is expected, enrichment in RVW could take place. When the low isolation frequency and long incubation periods are regarded, it doesn't seem sensible to perform "cold" enrichment methods for routine investigation of faeces for the presence of Yersinia spp.GH

Incidence of acute gastro-enteritis in sentinels in the Netherlands, 1992-1993

Gastro-enteritis behoort in Nederland tot de tien ziekten met de hoogste incidentie. In 1992 en 1993 vond een huisartsenpeilstationonderzoek plaats naar de incidentie en de microbiologie van dit ziektebeeld. Het onderzoek werd uitgevoerd door het Rijksinstituut voor Volksgezondheid en Milieuhygiene (RIVM) en het Nederlands Instituut voor Onderzoek van de Gezondheidszorg (NIVEL), in samenwerking met de huisartsen die meewerkten aan de Continue Morbiditeits Registratie (CMR) van het NIVEL en 24 microbiologische laboratoria. Door de huisartsen werden patienten die voldeden aan de gehanteerde case-definitie gemeld aan het NIVEL. Verder verzochten de huisartsen de patienten om een vragenlijst in te vullen en een faecesmonster in te sturen. De exacte respons van de huisartsen kon niet worden berekend omdat er geen gegevens waren over het aantal personen dat in de onderzoeksperiode een peilstationarts consulteerden maar ondanks dat ze aan de case-definitie voldeden niet in het onderzoek werden opgenomen. Er werden 1400 ingevulde vragenlijsten ontvangen. Het aantal personen dat werd gemeld en/of waaraan door de huisartsen een onderzoekspakket werd uitgedeeld, werd berekend op circa 2370 uitgaande van de aanname dat de respons onder patienten die wel en patienten die niet werden gemeld gelijk was. Van 59% (1400/2370) van deze patienten werd een vragenlijst ontvangen. De respons van de patienten ten aanzien van het insturen van vragenlijsten was 80,3% (1400/1744). Van 89,1% (1248/1400) van de personen waarvan een vragenlijst werd ontvangen was de uitslag van het microbiologisch onderzoek bekend. De incidentie van huisartsconsulten voor gastro-enteritis was 55,3 per 10.000 persoonsjaren, na correctie voor geschatte non-respons was dat 89,9 per 10.000 persoonsjaren. De incidentie was in 1993 significant lager dan in 1992. Tussen mannen en vrouwen werd geen verschil in incidentie gevonden. De incidentie was het hoogst bij de 0-jarigen en ook bij de 1 tot en met 4-jarigen was deze duidelijk hoger dan in de andere leeftijdsgroepen. De incidentie van Campylobacter was 6,9 per 10.000 persoonsjaren (182 monsters positief), van Salmonella 2,2 (55 monsters positief) en van Shigella 0,4 per 10.000 persoonsjaren (10 monsters positief). Na correctie voor geschatte non-respons waren deze incidenties respectievelijk 11,7 en 3,5 en 0,6 per 10.000 persoonsjaren. De incidentie van Salmonella was in 1993 hoger dan in 1992 en onder mannen hoger dan onder vrouwen. Voor Campylobacter en Salmonella waren de incidentiecijfers het hoogst in de leeftijdsgroepen onder 5 jaar. Zoals verwacht waren de incidentiecijfers het hoogst in de (late) zomermaanden. De incidentiecijfers van zowel het ziektebeeld als de afzonderlijke micro-organismen waren, ook na correctie voor de geschatte non-respons, duidelijk lager dan in andere peilstationonderzoeken. Waarschijnlijk zijn verschillen in methodologie, gehanteerde case-definities en onderzoekspopulaties hierop van invloed geweest. Om trends in de incidentie van gastro-enteritis en van de onderzochte en andere mogelijke verwekkers te kunnen volgen is het van belang dat huisartsenpeilstationonderzoek bij herhaling wordt uitgevoerd met een gelijkblijvende methodologie en onderzoekspopulatie. Het blijft evenwel van belang om de bevindingen eens in de 5 tot 10 jaar te ijken aan een populatiestudie.In the Netherlands gastroenteritis belongs to the ten diseases with the highest incidence rates. A sentinel study on the incidence of gastrointestinal complaints and the occurrence of the investigated pathogens (Campylobacter, Salmonella and Shigella) was carried out in about 40 general practices in 1992 and 1993. The sentinel stations were as representative as possible of the Dutch population. The study was undertaken by the National Institute of Public Health and Environmental Protection (RIVM) and the Netherlands Institute of Primary Health Care (NIVEL) in cooperation with the general practitioners who participated in the Dutch Sentinel Practice Network and 24 laboratories. Age and sex of patients who met the case definition were reported to the NIVEL. These patients were asked by their GP to provide a stool sample and to complete a questionnaire. The number of patients that were either reported to the NIVEL or have been given a questionnaire by their GP was estimated at about 2370. A completed questionnaire was received from 58.9% (1400/2370) of these patients. Eighty percent (1400/1744) of the cases completed the questionnaire they received. Results of microbiological analysis were obtained for 89.1% (1248/1400) of patients who completed the questionnaire. The crude incidence rate of acute gastrointestinal complaints was 55.3 per 10,000 person years, after correction for non response it was 89.9 per 10,000 person years. The incidence was lower in 1993 than in 1992. Between men and women no differences have been found. The highest incidences have been found in the agegroups under five. The incidence rate for Campylobacter was 6.9 per 10,000 person years (182 samples positive), for Salmonella 2.2 (55 samples positive) and for Shigella 0.4 per 10,000 person years (10 samples positive). After correction for non response these incidences were 11.7 and 3.5 and 0.6 per 10,000 person years. The Salmonella incidence rate was higher in 1993 than in 1992 and higher in men than in women. The highest incidence rates for Campylobacter and Salmonella were found in the agegroups under five. The (late) summer months as expected, showed the highest incidence rates. Incidence rates for gastroenteritis as well as for microorganisms were lower than incidences found in other sentinels. To follow trends in incidence rates and microorganisms it is necessary to undertake sentinels repeatedly with the same methodology and population. However results cannot be generalised to the general population and consequently it remains necessary to carry out a population cohort study every 5 to 10 years.IGZ VH

A community-based survey in four regions of the Netherlands into the incidence and burden of disease of gastro-enteritis, and Campylobacter and Salmonella infections

Om te komen tot een schatting van de incidentie van gastro-enteritis, Campylobacter en Salmonella-infectie in de algemene bevolking is in 1991 een populatiestudie uitgevoerd in een aantal gemeenten verspreid over Nederland. Tevens diende deze studie een schatting te geven van het deel van de gastro-enteritis-episodes dat gedekt wordt door onderzoek binnen huisartsenpopulaties. Aan het onderzoek hebben 2206 personen deelgenomen (35% respons), die een persoontijd bijdroegen van 660 persoonjaren. De gestandaardiseerde incidentie van gastro-enteritis was 447 eerste episodes per 1000 persoonjaren. De gestandaardiseerde incidentie van Campylobacter was 86 eerste infecties per 1000 persoonjaren ; van Salmonella was dit 35 eerste infecties per 1000 persoonjaren. Uit 4,5% van de faecesmonsters van personen met gastro-enteritis werd Campylobacter geisoleerd, uit 1,6% Salmonella. 91% van de gastro-enteritis-episodes met Campylobacter was toe te schrijven aan deze infectie. Voor 22% van de eerste episodes werd een huisarts geconsulteerd. Extrapolatie naar de Nederlandse bevolking gaf een geschat aantal van 7,0 miljoen episodes van gastro-enteritis per jaar. Jaarlijks zouden in Nederland 1,5 miljoen episodes van gastro-enteritis gepaard gaan met gemiddeld 1,5 consultaties van een huisarts, 3,8 miljoen episodes zouden gepaard gaan met geneesmiddelengebruik en 12000 jaar zouden worden verzuimd van school of werk. De incidentie van gastro-enteritis-episodes waarvoor een huisarts geconsulteerd werd ligt tienmaal zo hoog als in de huisartsenpeilstation-onderzoeken. Dit leidt tot de conclusie dat resultaten van huisartsenpeilstationonderzoek niet direct naar de populatie te extrapoleren zijn, op basis van het percentage personen met gastro-enteritis dat de huisarts bezoekt. De extrapolatiefactor kan slechts worden achterhaald indien de data van een populatiestudie direct kunnen worden gekoppeld aan de data van een huisartsenpeilstationstudie.In order to estimate the incidence of gastro-enteritis, and Campylobacter and Salmonella infections in the general population, a population survey was conducted in 1991 in a number of municipalities across the Netherlands. The study was also intended to produce an estimate of the proportion of gastro-enteritis episodes that are seen by general practitioners. 2206 persons took part in the study (35% response) and contributed 660 person-years of observation. The standardised incidence of gastro-enteritis was 447 first episodes per 1000 person-years. The standardised incidence of Campylobacter was 86 first infections per 1000 person-years and of Salmonella, 35 first infections per 1000 person-years. From 4.5% of the samples of persons with gastro-enteritis Campylobacter was isolated ; from 1.6%, Salmonella was isolated. 91% of the gastro-enteritis episodes with Campylobacter was attributable to this infection. In 22% of the first episodes a general practitioner was consulted. Extrapolation to the Dutch population gives an estimated number of 7.0 million episodes of gastro-enteritis a year. On a yearly basis 1.5 million episodes would have led to consultation of a general practitioner, 3.8 million episodes would have led to the use of medicine and 12,000 years would have been missed from school or work. The number of consultations of a general practitioner in this study was 10 times as high as in the studies done among the populations treated by general practices. It is concluded that the results of a study in general practices cannot be directly extrapolated to the general population, based on the percentage of persons with gastro-enteritis that consult a general practitioner. This extrapolation factor can only be clarified if the data of a population study can be linked to the data of a study in general practices.IGZVHIHIG

An outbreak of food poisoning among British tourists visiting Amsterdam, June 1992

Abstract niet beschikbaarAn outbreak of food poisoning with Clostridium perfringens occurred among 48 British tourists visiting Amsterdam, june 1992. Thirty-nine cases of illness (nausea, abdominal pain and diarrhoea occurred among 41 tourists who attended a meal on June 6, at an Amsterdam Chinese restaurant. No symptoms of illness were reported from 7 tourists that did not eat at the Chinese restaurant. An epidemiologic investigation was conducted by the Communicable Disease Surveillance Centre (CDSC), Colindale, London. CDSC reported this outbreak to the Foodborne Disease Coordinating Centre at the National Insitute of Public Health and Environmental Protection (RIVM), Bilthoven, the Netherlands. A full inspection of the restaurant had been carried out at once by the Amsterdam Inspectorate of Health Protection (KVW) and the staff was interviewed. It was necessary to take enforcement action by way of an Improvement Notice. Samples of the environment and various foods/ ingredients were taken for bacteriological examination. The Public Prosecutor will consider the advice of the KVW to undertake preventive measures. Clostridium perfringens-enterotoxin was detected in 6 out of 7 faecal samples taken from the British tourists. No such evidence was found in the food and environmental samples, taken 6 days after the meal at the restaurant. It was agreed that RIVM would translate the CDSC- questionnaire in order to extend the epidemiologic investigation if possible to a group of Dutch quests that visited the Chinese restaurant on June 6th. Although a tour-operator was initially willing to contact a group of 30 customers, they finally decided to deny all cooperation to the investigation. After a discussion with the Department of the Chief Medical Officer of Health (Division of Infectious Diseases), it was decided that there were no further means of action for the RIVM to identify the group of Dutch restaurant-quests.HIGB GH

[Epidemiological and microbiological research of the occurrence of acute gastro-intestinal illnesses in sentinel populations in Amsterdam and Helmond, 1987-1991.]

Abstract niet beschikbaarFrom 1987 to 1991 a pilot study was carried out in sentinels in Amsterdam and Helmond to determine the feasibility of a study on the incidence of acute gastro-intestinal complaints and (the causing) micro-organisms in general practice. Therefore questionnaires were filled in by patients consulting their G.P. and meeting the case definition ; faeses samples were examined according to standard laboratory procedures. The incidence of gastro-intestinal infections was 15/1000 in Amsterdam as well as in Helmond. Examination of faecal samples gave positive results for Campylobacter in 14%, for Salmonella in 5% and for Shigella in 2%. In 1990 the faecal samples were tested on a more extensive spectrum of micro-organisms than in the other years. Based on these data the percentage of positive faecal samples is estimated on 42%. This percentage should be interpreted with caution. An active and continuous surveillance of acute gastro-enteritis is feasible and provides relevant epidemiological information.GH