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Campylobacteriosis is the most commonly reported bacterial gastroenteritis in Germany. We performed a large case control study combined with source attribution analysis to identify specific risk factors and routes of transmission in Germany and to quantify the proportion of human cases attributable to certain sources. The aim of this study was to build a basis for evidence-based prioritisation of possible prevention strategies.
Case patients and randomly selected controls completed a questionnaire (study period Nov 2011-Feb 2014). Campylobacter isolates of case patients as well as from food, animals and the environment collected in temporal and geographical relation were further analysed by multilocus sequence typing. We conducted univariable and multivariable logistic regression analyses. Source attribution analysis was performed using Bayesian inference on an asymmetric island model.
We analysed questionnaires from 1,812 case patients and 3,983 control persons. Most important risk factors based on the population attributable fractions (PAF) were: consumption of chicken meat (adjusted odds ratio [aOD] 1.6; 95% confidence interval [CI] 1.2-2.0; PAF 32%) and eating out (aOD 1.6; 95% CI 1.3-2.0; PAF 30%). We also identified factors reflecting insufficient kitchen hygiene as important routes of transmission: preparation of packaged poultry meat in the household (aOD 1.4; 95% CI 1.1-1.6; PAF 13%) and of non-heated food together with raw meat (aOD 1.3; 95% CI 1.1-1.5; PAF 12). Of 230 attributable human Campylobacter isolates, 63% (n=146) were assigned to the source chicken.
Our study confirms chicken as the major source of human campylobacteriosis in Germany. Thus, efforts should be stepped up to reduce bacterial load on chicken meat and to educate consumers on handling chicken meat safely.