UIMINEN LUONNONVESISSÄ SUOLISTOINFEKTIORISKI - Campylobacter?

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Väinö Ranta
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1 UIMINEN LUONNONVESISSÄ SUOLISTOINFEKTIORISKI - Campylobacter?

2 Campylobacter and Salmonella infections in Finland /24/2013 EYHL,HY

3 Vuodenaikaisvaihtelukampylobakteerioosi Tam Hel Maa Huh Tou Kes Hei Elo Syy Lok Mar Jou

4 Kampylobakteeritapaukset kuukausittain (THL) MITKÄ OVAT TARTUNTALÄHTEET? Kampylobakteeritapaukset kuukausi-ilmoitukset Kotimaiset tapaukset /THL) 800 M ä ä rä /24/2013 EYHL,HY 0 January February March April May June July August September October November December Kuukausi

5 CASE_CONTROL STUDY 2002 in Finland -RISK FACTORS (Schönberg- Norio et al. 2005) univariate analysis Risk factor Cases n = 100 Control s n = 137 Adjuste d OR 95% CI 2-tailed p Increased risk Tasting/eating undercooked or raw meat a Drinking water from a dug well Swimming in natural waters Eating strawberries 14/88 31/96 48/ /89 3/124 22/137 40/134 79/ b No INCREASED risk associated with DRINKING WATER from treated water

6 Table 3. Matched multivariate analysis of significant risk factors for domestically acquired sporadic Campylobacter infection from July through September 2002, in Finland (Schönberg-Norio et al. 2005) Risk factor Adjusted OR 95% CI 2-tailed p Tasting or eating raw or undercooked meat Drinking water from a dug well Swimming in natural sources water

7 TABLE 2. Significant associations between ST or ST complex and epidemiological variablesa (Kärenlampi et al. 2007) Variable No. of positive cases/total no. of cases b Association (no. of positive cases/total no. of cases) b Hospitalization 26/46 New and unassigned STs (0/4) Swimming in natural bodies of water 18/46 New and unassigned STs (4/4) Eating pork chops 15/36 ST-45 complex (0/6) Pvalue(s) Eating minced pork meat 19/36 ST-45 complex (5/16) Eating or tasting raw minced meat 2/38 ST-48 complex (2/3) Eating boiled or otherwise cooked fish 21/42 ST-45 complex (1/8) Eating soft cheese 15/40 ST-137 (3/3) Drinking from a dug well 12/45 ST-677 complex (0/11) Drinking nonchlorinated water from a small water plant 6/45 ST-677 complex (4/11) Drinking water from natural sources 7/45 ST-677 complex (4/11) Contact with a dog 23/44 ST-677 complex (2/10), ST-45 complex (7/8) 0.031, Contact with a cat 14/38 ST-45 complex (10/18) 0.042

8 Major ST CCs among Campylobacter jejuni isolates from humans between 1996 and 2006 (de Haan et al. 2012) Proportion of isolates (%)

9 Fig. 1 Overview of the distribution of overlapping ST complexes between human (H) (n=454) and chicken (C) (n=208) isolates from 1996 to 2007 (in percentages).(de Haan e tal. 2010) Common overlap between STs of human and chicken isolates reduced from 76% at the beginning to 58% at the end of the study period

10 Fig 1 Rarefaction curves of the ST diversity among C. jejuni isolates from bovine (n=120), poultry (n=208), domestically acquired human infections (n=454), natural waters (n=57), wild birds (n=37) and Helsinki Zoo animals (n=19) (de Haan et al. 2013) Fst values: human and chicken (Fst = ) human and natural water (= Fst ) C. jejuni isolates had similarity to each other. least-similar populations were bovine and chicken C. jejuni i ( = Fst ) and the bovine and natural water C. jejuni isolates. ( Fst = )

11 Vesinäytteet Tutkittiin 286 luonnonvesi- ja uimarantavesinäytettä 20% posit. C. jejuni: 7.9% (Hörman et al., 2004) to 81.6% (2009) MLST tyypit joita löydettiin olivat suurimmaksi osaksi harvinaisia: 60.8% ei kuulunut mihinkään klonaaliseen kompleksiin (CC) (41.6% kaikista kannoista) ST-45 CC oli kuitenkin yleinen: 1/3 kannoista (ST- 11, ST-45 and ST-137)

12 Vesinäytteet 2012 Uimavesinäytteet neljä paikkakuntaa (mm. Helsinki). Samoilta paikkakunnilta myös potilasnäytteet (kotimaiset tartunnat, kesäaika) Uimavesi: kannat ST-45 (n. 30%); loput harvinaisia tyyppejä/uusia tyyppejä Tutkimus jatkuu

13 Yhteenveto MLST tyyppien perusteella ST-45 CC liittyy ihmisten kantoihin Ihmisistä eristetään myös harvinaisia tyyppejä Case-control tutkimuksessa potilailla, joiden sairastuminen assosioitui uimaveteen oli harvinaisia ST tyyppejä(kärenlampi et al. 2007)

14 CC ST_45, CC ST-283 Pulut, hanhet LINTUJEN MLST TYYPPIEN ASSOSIAATIO- LINTULAJI (Griekspoor et al. 2013)

15 Mitä tietoa muualta uimisen liittymisestä sairastumiseen suolistoinfektioon?

16 Risk Factors - campylobacter in NLbased study

17 Distribution og Campylobacter outbreaks in USA

18 Campylobacter outbreaks USA

19 Figure 4. Overall mean probability (%) and 95% confidence interval for human C. jejuni (n = 696) and C. coli (n = 41) infections to originate from chicken, cattle, pig, sheep, and the environment (NL) Mughini Gras L, Smid JH, Wagenaar JA, de Boer AG, et al. (2012) Risk Factors for Campylobacteriosis of Chicken, Ruminant, and Environmental Origin: A Combined Case-Control and Source Attribution Analysis. PLoS ONE 7(8): e doi: /journal.pone

20 Attributed probability (%) for the five most represented sequence types and clonal complexes of Campylobacter jejuni to originate from chicken, cattle, sheep, and the environment (NL)

21 Age-specific risk factors for sporadic Campylobacter infection in regional Australia. Unicomb LE, Dalton CB, Gilbert GL, Becker NG, Patel MS. (UK) Hunter region of New South Wales, Australia, 354 cases and 593 controls consumption of restaurant chicken or beef, eating two or more "fast" food meals in a week, and overseas travel. Comparing exposures for the 0- to 4-year and 5-year and older age groups allowed detection of additional risk factors: - Eating restaurant-prepared red meat and swimming were significantly associated with Campylobacter illness in the older group only

22 Reported waterborne outbreaks of gastrointestinal disease in Australia are predominantly associated with recreational exposure. Dale K, Kirk M, Sinclair M, Hall R, Leder K. METHOD: Examination of data reported to OzFoodNet between 2001 and 2007 (6,515 gastroenteritis outbreaks ) Fifty-four (0.83%) outbreaks were classified as either 'waterborne' or 'suspected waterborne; of which 78% (42/54) were attributed to recreational water and 19% (10/54) to drinking water

23 Yhteenveto Eri puolilla maailmaa tehtyjen tutkimusten perusteella uiminen luonnonvedessä on kampylobakteeri-infektion riskitekijä Riskin suuruus on tuntematon ja luultavasti vaihtelee sekä ajallisesti (vuosivaihtelu) että alueellisesti

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