Bacterial Intestinal Infections: Was It The Chicken Salad, Private Well Water, Or The Swim?
Source of Article: http://www.sciencedaily.com/releases/2009/01/090126173831.htm
ScienceDaily (Jan. 28, 2009) — A new study finds swimming, having a private well or septic system, and other factors not involving food consumption were major risk factors for bacterial intestinal infections not occurring in outbreaks.
Outbreaks linked to food, such as the current Salmonella outbreak involving peanut butter that has sickened more than 500 people in 43 states, account for only about 10 percent of intestinal infections, which are medically termed as enteric infections. The new study, in the February 15 issue of The Journal of Infectious Diseases, now available online, suggests that methods for controlling bacterial enteric outbreaks may not be completely relevant to controlling the other 90 percent or so that occur sporadically.
In a USDA-sponsored, two-year study of children and adolescents in three Washington state counties, the investigators, led by Donna M. Denno, MD, MPH, of the University of Washington, and Phillip I. Tarr, MD, of Washington University, St. Louis, interviewed 296 patients, aged 19 years or less, who were infected at some point between 2003 and 2005 and who were matched with 580 uninfected controls. Laboratory tests identified the bacteria responsible for infection as Campylobacter in 151 cases, Salmonella in 86 cases, Escherichia coli O157 in 39 cases, and Shigella in 20 cases.
Analysis of the data suggested that non-food exposures pose risks of sporadic bacterial enteric infection that are comparable in magnitude to those of food exposures. In particular, one surprise was a strong association with swimming and other forms of recreational water exposure for all four types of infection. Another surprising finding was an association with private well water (Salmonella) and septic system (Salmonella and E. coli O157) exposures. Hand washing practices and daycare attendance, however, were not associated with an increased risk of infection, also a surprise. Finally, farm owners exposed to farm animals were at risk for Campylobacter infections.
Among food-related exposures, suboptimal cleaning practices in the kitchen
following preparation of raw meat was an important risk factor for
Campylobacter infections, and Campylobacter and E. coli infections were
strongly associated with eating foods from fast food and table service
restaurants, respectively. Conversely, consumption of vegetables in general
and organic vegetables in particular lowered the risk of Salmonella
infections, although eating lettuce or spinach from sealed retail plastic
bags increased the risk. The investigators found no increased risk of
Salmonella infection associated with chicken or egg consumption, perhaps
because of the limited prevalence of certain Salmonella serotypes in the
study area. They also found no association between E. coli O157 infections
and ground beef consumption; they speculated that this might relate to
industry and consumer precautions taken in the wake of highly publicized
outbreaks, including one in
In an accompanying editorial, state epidemiologist Timothy F. Jones, MD,
of the Tennessee Department of Health in
Most bacterial enteric infections occur in children, and up to 90 percent of cases occur sporadically rather than in outbreaks.
This study found that non-food-borne risk factors are at least as important in sporadic bacterial enteric infections as are food-borne risk factors.
Water exposures and food preparation practices appear to be important modes of transmission for bacterial enteric infections.
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