Search

Katrin Gaardbo Kuhn,1 Eva Møller Nielsen,2 Kåre Mølbak,1,3 Steen Ethelberg1 1Infectious Disease Epidemiology & Prevention, Statens Serum Institut, Copenhagen, Denmark; 2Bacteria, Parasites & Fungi, Statens Serum Institut, Copenhagen, Denmark; 3Institute of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark Background: Each year more than 4,000 cases of campylobacteriosis are reported in Denmark, making it the most common bacterial gastrointestinal infection. Here we describe a case-control study to identify sources of infection with a focus on environmental factors.Methods: From January to December 2016, we conducted a prospective case-control study among Danish persons aged 1–30 years. Participants were invited by letter to complete an online questionnaire. Crude and adjusted ORs were calculated and final parsimonious multivariate models developed using logistic regression.Results: The study recruited 1366 cases and 4,418 controls, of whom 65% and 66%, respectively, completed the questionnaire. A multivariate model for domestically acquired cases showed, among others, increased risk of infection with bathing in fresh water (OR=5.1), contact to beach sand (OR=1.8), owning a pet dog with diarrhea (OR=4.6), and eating minced beef (OR=2.6) or chicken (OR=2.5). The model for children highlighted similar risk factors but also included bathing in a paddling pool (OR=13.6) and eating fresh strawberries (OR=5.3). A separate analysis for persons reporting foreign travel showed increased infection risk when traveling to Asia, Africa, or Turkey and that eating from street kitchens and having contact to water during traveling were also risk factors.Conclusion: Environmental factors and animal contact account for a sizeable proportion of domestic Campylobacter infections in the age group studied. The study also re-confirmed handling/consumption of chicken as an important risk factor while highlighting minced beef as a potential new risk factor. Overall, these results contribute to a better understanding of the transmission dynamics of Campylobacter and will be used to improve national guidelines for prevention of infection. Keywords: Campylobacter, determinants, case-control, environment, food

Wastewater-based epidemiology (WBE) expanded rapidly in response to the COVID-19 pandemic. As the public health emergency has ended, researchers and practitioners are looking to shift the focus of existing wastewater surveillance programs to other targets, including bacteria. Bacterial targets may pose some unique challenges for WBE applications. To explore the current state of the field, the National Science Foundation-funded Research Coordination Network (RCN) on Wastewater Based Epidemiology for SARS-CoV-2 and Emerging Public Health Threats held a workshop in April 2023 to discuss the challenges and needs for wastewater bacterial surveillance. The targets and methods used in existing programs were diverse, with twelve different targets and nine different methods listed. Discussions during the workshop highlighted the challenges in adapting existing programs and identified research gaps in four key areas: choosing new targets, relating bacterial wastewater data to human disease incidence and prevalence, developing methods, and normalizing results. To help with these challenges and research gaps, the authors identified steps the larger community can take to improve bacteria wastewater surveillance. This includes developing data reporting standards and method optimization and validation for bacterial programs. Additionally, more work is needed to understand shedding patterns for potential bacterial targets to better relate wastewater data to human infections. Wastewater surveillance for bacteria can help provide insight into the underlying prevalence in communities, but much work is needed to establish these methods.IMPORTANCEWastewater surveillance was a useful tool to elucidate the burden and spread of SARS-CoV-2 during the pandemic. Public health officials and researchers are interested in expanding these surveillance programs to include bacterial targets, but many questions remain. The NSF-funded Research Coordination Network for Wastewater Surveillance of SARS-CoV-2 and Emerging Public Health Threats held a workshop to identify barriers and research gaps to implementing bacterial wastewater surveillance programs., Competing Interests: RUH is managing member of AquaVitas, LLC and founder of the ASU non-profit project OneWaterOneHealth operating in the same intellectual space. LPS is employed by Ceres Nanosciences.

From 2001 to 2010, the consumption of antibiotics in Denmark increased by 32%. The objective of this study was to investigate the potential demographic factors associated with this increase. Defined daily doses (DDD) per 1000 inhabitant-days for the leading antibiotic groups and substances in primary health care in 2001 and 2010 were adjusted for population size and compared between and within age groups and genders. An increased antibiotic consumption was observed for all age groups between 2001 and 2010. Particular age-specific increases in the consumption of tetracyclines, extended-spectrum penicillins, and amoxicillin/clavulanic acid were observed. The generally increased consumption of antibacterial agents in the Danish population during the past decade was driven by people older than 65 y and, to a lesser extent, those aged 20-39 y. Evidence suggests that this increase may reflect general practitioners prescribing more antibiotics per visit and in larger doses.