Wat is de bron (transmissieroutes, risicofactoren) van campylobacteriosis bij de mens

Wat is de bron van campylobacteriosis bij de mens

(transmissieroutes, risicofactoren)

Wilfrid van Pelt Met dank aan: Lapo Mughini-Gras, Joost Smid, Arie Havelaar, Jaap Wagenaar, Ingrid Friesema, Martijn Bouwknegt en vele, vele anderen 1

Bronnen, Transmissieroutes, Risicofactoren CaSa 2002-2003

C. coli 2

Symposium Campylobacter bij pluimvee, Lelystad, 14 juni 2013, Wilfrid van Pelt

C. jejuni

Campylobacter incidentie EU landen en Australie 140

# per 100.000 inhabitants

120

100

80

Denmark England & Wales Norway Sweden Australia Netherlands

Kentering toename 2001 Opnieuw toename, EU, vanaf 2006/7/8

60

40

20

0 1980

3

1984

1988

1992

1996

2000

2004

2008

2012


Risk based interventions: they work!

Emerging Infectious Diseases 2011; 17 (6): 1007-15.

4


Succes interventie in pluimvee industrie New Zeeland geplaatst in EU perspectief 450 400

# per 100.000 inhabitants

350 300 250

Denmark England & Wales Norway Sweden New Zealand Australia Netherlands

200 150 100 50 0 1980 5

1984

1988

1992

1996

2000

2004

2008

2012


Epidemiological IID studies in NL Campylobacter

† Patient-controle Onderzoek, Br, Tr, Rf

Register study:

Hospital

+/46 / yr

GEOPS 2008/9 CaSa 2002/3: +/- 650 / yr CaSa 2002/3:

6500 / yr

Laboratories NIVEL 1996/9: +/- 23.000 / yr

General Practices Is 70-90.000 cases/jr Veel??

Sensor 1999: 1x / 160 pyr

Symptomatic Infected General population

Infected (sero-respons):

Infected (1996/2007): 1x / 10 mnths (lab x3000)

symptomatic+a-symptomatic

Blootstelling (Eric Evers): 1x / 1-2 weken 6


Bronnen attributie met collecties isolaten van bronnen en mens Salmonellosis and Campylobacteriosis met (moleculaire) typering. 7


8


Probabilistic assignment of human disease (o.a. Island model) Wilson et al. (2008). PLoS Genet 26, e1000203

Clinical isolate genotype probably came from chicken.

1

2

● Multiple potential sources. ● Different hosts have different Campylobacter types, so disease can be attributed to host sources. 9


Campylobacter source attribution by MLST typing (New Zealand)

Mullner P, French N, et 2009). A Infect Genet Evol. 138

Left: Middle: Right:

Dutch model Adapted Hald model Island model

Zelfde beeld: Schotland

Sheppard, et al. (2009). Clin Infect Dis 48, 1072-1078.

Dutch model Adapted Hald model Island model

UK

10

Wilson et al. (2008). PLoS Genet 26, e1000203.


Campylobacter source attribution by MLST typing Netherlands

Copy uit staat van de zoonoses, 2012

11


Campylobacter MLST typing, Nederland Ranking Sequence Types (ST’s) mens-kip, loopt parallel

ST ranking mens-kip loopt parallel: •Sterke gelijkenis mens-kip in 2002/3 zowel als 2010/11 •Groot verschil 2002/3 met 2010/11 in zowel mens als kip NEPLUVI--Streeklaboratoria

12


Campylobacter MLST typing, Nederland ST types uit pluimvee van verschillende EU landen

ST types van NL kip ver uit het belangrijkste

13


Reservoir-specifieke ST risico factoren Risk factor

Chicken

OR* Chicken1

OR* Ruminants2

OR* Environment3

1,9 (1,2–2,9)

Beef

0,6 (0,4–0,9)

Prok

0,7 (0,5–0,9)

Tripe

4,0 (1,1–14,2)

Game meat

3,3 (1,4–7,8)

Yogurt

0,4 (0,3–0,7)

Chocolate

0,5 (0,4–0,7)

Seafood

0,6 (0,4–0,9)

0,5 (0,3–0,9)

Barbecue – rural

7,1 (3,2–15,6)

Barbecue - urban

4,1 (1,3–14,2)

Meat in paste

0,3 (0,1–0,8)

0,5 (0,2–0,8)

Cooked vegetables

0,3 (0,1–0,9)

Salad

0,4 (0,2–0,9)

Fruit

0,5 (0,3–0,9)

Consuming chicken ≤ once/mese

1,7 (1,0–2,9)

Owning ≥1 adult dog

3,5 (1,0–12,0)

Proton-punp inhibitors

4,7 (2,4–9,1)

Contact with GE case

1,8 (1,1–3,0)

5,7 (2,2–16,3) 3,4 (1,3–8,7)

Attending private swimming pool Chronic GI diseases Occupational exposure to animals

14

16,8 (2,6–107,6) 1,8 (1,1–3,1)

5,0 (2,1–12,1) 3,2 (1,2–9,0)


Infecties met huisdier gerelateerde STs ?... ->verhoogd risico bezit/contact huisdier

Risk factor

OR* dog/cat1

Yogurt

0,3 (0,2–0,7)

Contacts with pets owned by other people

0,4 (0,2–1,0)

Owning a puppy

3,7 (1,4–10,0)

Owning >1 dog, at least one puppy

9,2 (2,7–32,0)

Proton-pump inhibitors

11,1 (5,4–22,9)

In 2 instances out of 68 (3% vs 0,13 expected by chance), a dog and its respective owner were infected with an identical ST of C. jejuni/coli

15

15


Campylobacteriosis in Returning Travelers and Potential Secondary Transmission of Exoticallyintroduced Strains. Lapo Mughini Gras, Joost H. Smid, Jaap A. Wagenaar, Albert de Boer, Arie H. Havelaar, Ingrid H.M. Friesema, Nigel P. French, Caterina Graziani, Luca Busani, Wilfrid van Pelt

Reis gerelaterde campylobacters…(STs) Verhoogd risico person-person infecties Risk factor Contact with GE case Not washing hands after toilet visit (January-April)

OR exotic strains1 2,2 (1,9–4,6) 20,8 (1,9–233,4)

Being a school going child (April-June)

3,4 (1,0–11,4)

Being a school going child (October-December)

4,0 (1,4-11,3)

Attending a public swimming pool (October-December)

3,7 (1,3‒11,0)

Proton-pump inhibitors

9,5 (4,4‒20,6)

Yogurt

0,3 (0,2‒0,6)

16


Role chicken(-environment), human?? Day of year (period 1998-2006) 7 14 21 28 35 42 49 56 63 70 77 84 91 98 105 112 119 126 133 140 147 154 161 168 175 182 189 196 203 210 217 224 231 238 245 252 259 266 273 280 287 294 301 308 315 322 329 336 343 350 357 364

C. jejuni human without travel

95

Contaminated caeca at slaughter (%)

90

FQ-resistance (human)

85 80

Back from holiday: Introduction nw types

63% 58% 53%

New introduction from waking environment??

48%

75 70

43%

65 38%

60 Holidays - Mixing young old - Different eating

55 50

33% 28%

45 40

23%

35 30

18% Januari

Februari

Maart

April

Mei

Juni

Juli

Augustus Septembe Oktober Novembe December

Month (period 1998-2006)

17


Campylobacter contaminated caeca at slaughter FQ-resistance (human)

Endemic lab. confirmed Campylobacter (cov. 50%)

100

35

Regional staggering of holiday periods

→role spreading by humans

30

25

20

15

10

early

middle

late

5

0 22

24

26

28

30

32

34

36

38

week (average 2002-2006) 18


40

Natuurlijk “experiment” wijst op grote rol pluimveevlees

In June 1999, the dioxin crisis, caused by dioxincontaminated feed components in Belgium, resulting in withdrawal of chicken and eggs from the market. A decrease in Campylobacter infections (-40%) during June 1999 was noticed.

19


Regional culling of layers during avian influenza outbreak, 2003

Courtesy, CVI, Lelystad 20


Reduction differed between laboratories

% of expected (1995-2008)

observed%expected

140 130 120 110 100 90 80 70 60 50 40 30 20 10 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

21


Den Haag (91%) Leeuwarden (84%) Nijmegen (84%) Alkmaar (83%) Arnhem (81%) Deventer (80%) Enschede (78%) Heerlen (78%) Rotterdam (75%) Groningen (74%) Veldhoven (73%) Goes (68%) Tilburg (65%) Amsterdam (63%) Haarlem (60%) Nieuwegein (56%) Apeldoorn (30%)

May-June 2003 Regional 40-70% Reduction!!

22


Why regional reduction?? ● Regional less chicken consumption, or less supply, more expensive?? – It involved culling of layers, not broilers!!! ● Above expectation strong, immediately, longterm and regional ● Ecologic / environmental effect?? →How??

Consequences role environment ● Control focussed on end-product is not enough ● Control necessary (as well) in primary production! 23


Conclusie Campylobacter bronnen ●

Dominante rol pluimvee(+/-70%), direct (voedsel) en indirect (uitstoot omgeving, kruiscontaminatie…) epidemiologisch en microbiologisch overtuigend aangetoond. NL kip (microbiologisch) dominant.

●

Rol uitstoot(..) leghenbedrijven microbiologisch (nog) onbewezen.

●

Nieuw in NL geïntroduceerde ST-typen (reizen, risico en mens-mens infecties te geven.

●

Huisdieren zijn infectierisico voor de eigenaar. Zijn daarbij vooral doorgeefluik van Campylobacter uit de omgeving en uit hun voedsel.

vogels,…)

lijken hoger infectie

● Hypothese:

Continue introductie van nieuwe antigene types gekoppeld aan nieuwe ST types in een bevattelijke populatie verhoogd risico op ziekte totdat er net als tegen langer circulerende antigenen partiele immuniteit heeft kunnen ontwikkelen.

24


Wat is de bron (transmissieroutes, risicofactoren) van campylobacteriosis bij de mens

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