UIMINEN LUONNONVESISSÄ SUOLISTOINFEKTIORISKI - Campylobacter?
Campylobacter and Salmonella infections in Finland 1981-2011 4/24/2013 EYHL,HY
Vuodenaikaisvaihtelukampylobakteerioosi 1000 900 800 700 600 500 400 300 200 Tam Hel Maa Huh Tou Kes Hei Elo Syy Lok Mar Jou 100 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Kampylobakteeritapaukset kuukausittain (THL) MITKÄ OVAT TARTUNTALÄHTEET? Kampylobakteeritapaukset kuukausi-ilmoitukset Kotimaiset tapaukset /THL) 800 M ä ä rä 700 600 500 400 1995 1996 1997 1998 1999 2006 300 200 100 4/24/2013 EYHL,HY 0 January February March April May June July August September October November December Kuukausi
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 48/10 0 70/89 3/124 22/137 40/134 79/124 12.00 3.19 2.27 2.90 1.54-93.77 1.58-6.45 1.24-4.16 1.21-6.95 0.0052 b 0.0017 0.0089 0.0287 No INCREASED risk associated with DRINKING WATER from treated water
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 10.79 1.31-89.09 0.0272 Drinking water from a dug well 3.36 1.37-8.24 0.0082 Swimming in natural sources water 2.80 1.23-6.39 0.0145
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) 0.030 Swimming in natural bodies of water 18/46 New and unassigned STs (4/4) 0.019 Eating pork chops 15/36 ST-45 complex (0/6) 0.030 Pvalue(s) Eating minced pork meat 19/36 ST-45 complex (5/16) 0.042 Eating or tasting raw minced meat 2/38 ST-48 complex (2/3) 0.004 Eating boiled or otherwise cooked fish 21/42 ST-45 complex (1/8) 0.045 Eating soft cheese 15/40 ST-137 (3/3) 0.046 Drinking from a dug well 12/45 ST-677 complex (0/11) 0.023 Drinking nonchlorinated water from a small water plant 6/45 ST-677 complex (4/11) 0.025 Drinking water from natural sources 7/45 ST-677 complex (4/11) 0.050 Contact with a dog 23/44 ST-677 complex (2/10), ST-45 complex (7/8) 0.031, 0.0 48 Contact with a cat 14/38 ST-45 complex (10/18) 0.042
Major ST CCs among Campylobacter jejuni isolates from humans between 1996 and 2006 (de Haan et al. 2012) 50 45 Proportion of isolates (%) 40 35 30 25 20 15 10 5 0 1996 1999 2002 2003 2006
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
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 = 0.02536) human and natural water (= Fst 0.04727) C. jejuni isolates had similarity to each other. least-similar populations were bovine and chicken C. jejuni i ( = Fst 0.25016) and the bovine and natural water C. jejuni isolates. ( Fst =0.23976)
Vesinäytteet 2001-2009 Tutkittiin 286 luonnonvesi- ja uimarantavesinäytettä 20% posit. C. jejuni: 7.9% 2000 2001 (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)
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
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)
CC ST_45, CC ST-283 Pulut, hanhet LINTUJEN MLST TYYPPIEN ASSOSIAATIO- LINTULAJI (Griekspoor et al. 2013)
Mitä tietoa muualta uimisen liittymisestä sairastumiseen suolistoinfektioon?
Risk Factors - campylobacter in NLbased study
Distribution og Campylobacter outbreaks in USA 1997-2008
Campylobacter outbreaks USA
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): e42599. doi:10.1371/journal.pone.0042599 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0042599
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)
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
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
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