SLIDE 1:

Campylobacter
Results from national and state specific surveillance and case-control studies

SLIDE 2:

Campylobacter

• Most commonly diagnosed bacterial cause of foodborne illness in the United States (FoodNet)
• Causes an estimated 2.4 million infections annually (P. Mead, EID 1999)
  • 150,000 Physician visits annually
  • 13,174 Hospitalized annually
  • 124 Deaths annually
• Campylobacter jejuni represents an estimated 99% of all human Campylobacter infections (C. Friedman, Campylobacter, 2000)

SLIDE 3:

Campylobacter infections

• Most people who become ill with Campylobacter get diarrhea, cramping, abdominal pain, and fever.
• In infants, elderly, and persons with compromised immune systems, Campylobacter occasionally spreads to the bloodstream and causes a serious life-threatening infection
  • Estimated 600 such infections each year
• Guillan-Barre syndrome is the most common cause of acute paralysis in adults in the United States

SLIDE 4:

Foodborne Diseases Active Surveillance Network (FoodNet)

An Image

SLIDE 5

FoodNet helps fill in the surveillance pyramid

An Image

SLIDE 6:

FoodNet helps fill in the surveillance pyramid

An Image

SLIDE 7:

FoodNet Campylobacter rates 1996-2000*

A Graphical Image

SLIDE 8

Antibiotic use

• The majority of patients who seek care for their Campylobacter infections receive an antibiotic
• Fluoroquinolones (i.e. ciprofloxacin) are the drug of choice to treat Campylobacter infections in adults
  • approved for human use in 1986
  • other treatment options are limited
• Antibiotics may shorten the duration of illness if given early in the course of illness (J. Sobel et al, 1996)
• Antibiotics essential and may be life-saving for persons with invasive Campylobacter infections
  • Estimated at 100 persons/year

SLIDE 9

Fluoroquinolone resistance in the United States and Minnesota, 1990 – 2000*

A Graphical Image

SLIDE 10:

Cases of fluoroquinolone-resistant C. jejuni Infection in Minnesota Residents, 1996-1999

A Graphical Image

SLIDE 11:

Percentage of all Campylobacter jejuni cases among persons who did not travel which were fluoroquinolone-resistant, Minnesota, 1996-2000

SLIDE 12:

NARMS Surveillance

A Graphical Image

SLIDE 13:

Campylobacter

• Poultry is a dominant source of human Campylobacter infection
  • Between 40%-80% of chickens purchased in US grocery stores are contaminated with Campylobacter
• Other sources of infection may include raw milk, water, and exposure to pets

SLIDE 14:

Percentage of Retail Chicken Products Positive for Campylobacter, Minnesota, 1999-2000

SLIDE 15:

FoodNet case-control study

• 12 months in 1998-1999
• 7 sites
  • All patients with culture-confirmed Campylobacter infections were eligible to participate in this study
• Cases were patients with symptomatic culture-confirmed Campylobacter infections. Controls were age group and telephone exchange matched

SLIDE 16:

Results: FoodNet Case-Control StudyDistribution of Cases by FoodNet site, N=1316

SLIDE 17:

Results: FoodNet Case-Control StudySeasonality of Campylobacter infections, FoodNet case-control study, 1998, N=1316

A Graphical Image

SLIDE 18:

Results: FoodNet Case-Control StudyIllness severity among 1316 patients

SLIDE 19:

Results: FoodNet Case-Control StudyDemographics

SLIDE 20:

Results: FoodNet Case-Control Study

• 12% of case patients reported travel outside the US in the 7 days prior to illness onset
  • Persons who reported international travel were 6.2 times more likely to have a Campylobacter infection (mOR = 6.2, (3.2, 12.0))
• 47% of cases reported eating chicken in a restaurant in the 7 days prior to illness onset
  • Persons who ate chicken in a restaurant or commercial establishment were 2.6 times more likely to have a Campylobacter infection (mOR = 2.6, (1.9, 3.5))

SLIDE 21:

Isolates tested for antimicrobial susceptibility

• 646/ 1316 (49%) isolates were tested for antimicrobial susceptibility and were interviewed
  • 64 (10%) were fluoroquinolone-resistant

SLIDE 22:

Fluoroquinolone resistance

• 12% (78/646) of cases reported travel outside the US in the 7 days before illness onset
  • Persons with fluoroquinolone-resistant infections were 7.6 times more likely to report international travel (OR= 7.6, (4.3-13.4))
• 88% (568/646) of cases did not report travel outside the US in the 7 days prior to illness onset
  • Persons with fluoroquinolone-resistant infections were 10 times more likely to report eating chicken or turkey in a commercial food establishment (mOR = 10.0, (1.3-78))
  • Therefore, 90% of fluoroquinolone-resistant Campylobacter infections among people who did not travel can be attributed to eating chicken

SLIDE 23:

Conclusion

• Campylobacter is the leading cause of foodborne diseases
• Antibiotics are important for the treatment of Campylobacter infections
  • Fluoroquinolones

SLIDE 24:

Conclusion

• Fluoroquinolone resistance was absent in 1991, has increased particularly since 1995, and is now common
  • Acquired internationally and domestically
• Poultry is the dominant source of fluoroquinolone-resistant Campylobacter in the United States