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Surveillance and Reporting Guidelines for
Campylobacteriosis
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back to
Campylobacteriosis index page |
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Disease
Reporting |
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In Washington |
DOH receives
approximately 900 to 1150 reports of campylobacteriosis per
year, for an average rate of 18.1/100,000 persons. On average, 1
death is reported to be associated with Campylobacter
infection each year.
Frequently named sources of
infection in Washington include poultry, animals, infected
individuals, and contaminated food or water. |
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Purpose of Reporting and
Surveillance |
- To identify sources of
transmission (e.g., a commercial product or public water
supply) and to prevent further transmission from such sources.
- When the source is a risk
for only a few individuals (e.g., an animal with diarrhea or
private water supply), to inform those individuals how they
can reduce their risk of exposure.
- To identify cases that may be a source of infection for
others (e.g., a food handler) and to prevent further disease
transmission.
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Reporting Requirements |
- Health care providers: notifiable to Local Health
Jurisdiction within 3 work days
- Hospitals: notifiable to Local Health Jurisdiction within
3 work days
- Laboratories: no requirements for reporting
- Local health jurisdictions: notifiable to DOH
Communicable Disease Epidemiology within 7 days of case
investigation completion or summary information required
within 21 days
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Case Definition for Surveillance |
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Clinical Criteria for Diagnosis |
An infection
that may result in diarrheal illness of variable severity. |
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Laboratory Criteria for Diagnosis |
- Isolation of Campylobacter from any clinical
specimen.
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Case Definition |
- Probable: a clinically compatible case that is
epidemiologically linked to a confirmed case.
- Confirmed: a case that is laboratory confirmed.
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A. Description |
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1. Identification |
An acute
zoonotic bacterial enteric disease of variable severity
characterized by diarrhea, abdominal pain, malaise, fever,
nausea and vomiting. The illness is frequently over within 2-5
days and usually lasts no more than 10 days. Prolonged illness
may occur in adults; relapses can occur. Gross or occult blood
in association with mucus and WBCs is often present in liquid
stools. A typhoid-like syndrome or reactive arthritis may occur,
and rarely, febrile convulsions, Guillan-Barre syndrome or
meningitis. Some cases mimic acute appendicitis. Many infections
are asymptomatic.
Diagnosis is based on isolation
of the organisms from stool using selective media, reduced
oxygen tension and an incubation temperature of 43ºC (109.4ºF).
Visualization of motile and curved, spiral or S-shaped rods
similar to those of Vibrio cholerae by phase contrast or
darkfield microscopy of stool can provide rapid presumptive
evidence for Campylobacter enteritis. |
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2. Infectious Agent |
Campylobacter jejuni
and, less commonly, C. coli are the usual causes of
Campylobacter diarrhea in humans. A variety of 20 or more
biotypes and serotypes occur; their identification may be
helpful for epidemiologic purposes. Other Campylobacter
organisms, including C. laridis and C. fetus ssp.
fetus, have also been associated with diarrhea in normal
hosts. |
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3. Worldwide Occurrence |
These organisms are an important
cause of diarrheal illness in all parts of the world and all age
groups, causing 5%-14% of diarrhea worldwide. They are an
important cause of travelers' diarrhea. In developed countries;
children (less than 5 years) and young adults have the highest
incidence of illness. In developing countries, illness is
confined largely to children under 2 years of age, especially
among infants. Common source outbreaks have occurred, most often
associated with foods, especially undercooked chicken,
unpasteurized milk and nonchlorinated water; these occur in
spring and fall. The largest number of sporadic cases in
temperate areas occur in the warmer months. |
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4. Reservoir |
Animals, most frequently poultry
and cattle. Puppies, kittens, other pets, swine, sheep, rodents
and birds may also be sources of human infection. Most raw
poultry meat is contaminated with C. jejuni. |
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5. Modes of Transmission |
By ingestion of the organisms in
undercooked chicken and pork, contaminated food and water, or
raw milk; from contact with infected pets (especially puppies
and kittens), farm animals or infected infants. Contamination of
milk most frequently occurs from fecal carrier cattle; people
and food can be contaminated from poultry, especially from
common cutting boards. Person to person transmission appears to
be uncommon with C. jejuni. |
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6. Incubation Period |
Usually 2 to 5 days, with a
range of 1-10 days, depending on dose ingested. |
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7. Period of Communicability |
Throughout the course of
infection; usually from several days to several weeks.
Individuals not treated with antibiotics may excrete organisms
for as long as 2-7 weeks. The temporary carrier state is
probably of little epidemiologic importance, except in infants
and others who are incontinent of stool. Chronic infection of
poultry and other animals constitutes the primary source of
infection. |
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8. Susceptibility and Resistance |
Immune mechanisms are not well
understood, but lasting immunity to serologically related
strains follows infection. In developing countries, most people
develop immunity in the first 2 years of life. |
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B. Methods of Control |
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1. Preventive Measures |
- Use irradiated foods or cook thoroughly all foodstuffs
derived from animal sources, particularly poultry. Avoid
recontamination from uncooked foods within the kitchen after
cooking is completed.
- Pasteurize all milk and chlorinate or boil water
supplies.
- Implement comprehensive control programs and hygienic
measures (change of boots and clothes; thorough cleaning and
disinfection) to prevent spread of organisms in poultry and
animal farms.
- Recognize, prevent and control Campylobacter
infections among domestic animals and pets. Puppies and
kittens with diarrhea are possible sources of infection;
erythromycin may be used to treat their infections, reducing
risk of transmission to children. Stress handwashing after
animal contact.
- Minimize contact with poultry and its feces; wash hands
when this cannot be avoided.
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2. Control of Patient, Contacts
and the Immediate Environment |
- Report to local health authority.
- Isolation: Enteric precautions for hospitalized patients.
Exclude symptomatic individuals from food handling or care of
people in hospitals, custodial institutions and day care
centers; exclusion of asymptomatic convalescent stool positive
individuals is indicated only for those with questionable
handwashing habits. Stress proper handwashing.
- Concurrent disinfection: Of feces and articles soiled
therewith. In communities with a modern and adequate sewage
disposal system, feces can be discharged directly into sewers
without preliminary disinfection. Terminal cleaning.
- Quarantine: None.
- Immunization of contacts: None is available.
- Investigation of contacts and source of infection: Useful
only to detect outbreaks; investigate outbreaks to identify
the implicated food, water or raw milk to which others may
have been exposed.
- Specific treatment: None generally indicated except
rehydration and electrolyte replacement. C. jejuni or
C. coli organisms are susceptible in vitro to a number
of antimicrobial agents, including erythromycin, tetracyclines
and quinolones, but these agents are of value only early in
the illness and when the identity of the infecting organism is
known, or to eliminate the carrier state.
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3. Epidemic Measures |
Groups of cases, such as in a
classroom, should be reported immediately to the local health
authority, with search for vehicle and mode of spread. |
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4. International Measures |
WHO Collaborating Centres. |
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