A Campylobacter jejuni outbreak investigation in Crete, Greece: indications for waterborne spread

Abstract number: P1164

Karagiannis I., Sideroglou T., Gkolfinopoulou K., Velonakis E.N., Scoulica E., Panagiotopoulos T., Mellou K., Bonovas S.

Objectives: To present the results of the investigation of a C. jejuni outbreak, which took place around Chania, a town in Crete, Greece, in late May to early June 2009.

Methods: Two analytical studies were conducted in parallel: a case–control and a case-crossover study. Fifty cases were included in the two studies and 124 controls, with respiratory track symptoms, frequency matched for age, were recruited in the case–control study. The case definition was the same for both studies. The questionnaires were completed via telephone interviews with the children's parents in July 2009. STATA v11.0 was used for data analysis. Stool cultures, PFGE and MLST sub-typing in human samples and PFGE in chicken samples were conducted. Water quality tests were run in the outbreak area.

Results: Thirty-seven cases and 79 controls responded. The median age of cases and controls was 2 years. Sex distribution did not differ between cases and controls. The most commonly reported symptoms were diarrhoea (100%), fever (58.3%) and bloody stool (58.3%). In the univariate analysis consumption of tap water from the town's supply system was protective against Campylobacteriosis (OR: 0.23, 95% C.I: 0.06–0.77). In the stratified analysis by tap water supplier, consumption of tap water at home could be computed for rural areas only (ORMH=3.26, 95% C.I: 0.98–10.82). For these areas statistically significant factors were: consumption of bottled water (OR: 0.15, 95% C.I: 0.04–0.54), use of a tap water filter (OR: 0.00, 95% C.I: 0.00–0.53), use of dishwashers for children's utensils (OR: 0.16, 95% C.I: 0.03–0.75), consumption of concentrated milk (OR: 2.68, 95% C.I: 0.98–7.37) and consumption of milk types that need to be diluted with water (OR: 3.05, 95% C.I: 0.99–10.49). In the multivariable analysis, the town water supplier (OR: 0.17, 95% C.I.: 0.05–0.57) and drinking tap water (OR: 4.39, 95% C.I: 1.30–14.8) were statistically significant. Case-crossover design revealed no risk factors. The strains from patients' samples were identical but different from that of the chicken sample. No Campylobacter was found in any water sample.

Conclusions: Although there are indications that tap water quality was poor during and exactly before the outbreak, no Campylobacter was found in any of the environmental samples. However, there is strong epidemiological proof that tap water was the vehicle of the outbreak.

Session Details

Date: 10/04/2010
Time: 00:00-00:00
Session name: Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases
Location: Vienna, Austria, 10 - 13 April 2010
Presentation type:
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