Tri-county comprehensive assessment of risk factors for sporadic reportable bacterial enteric infection in children.
BACKGROUND
The aim of this study was to determine risk factors for childhood sporadic reportable enteric infection (REI) caused by bacteria, specifically Campylobacter, Salmonella, Escherichia coli O157, or Shigella (REI-B).


METHODS
Matched case-control study. Case patients aged <19 years who were reported to 3 Washington State county health departments and matched control subjects were interviewed from November 2003-November 2005. Matched odds ratios (ORs) were calculated by using conditional logistic regression. Population attributable risk percentages were calculated for exposures associated with infection.


RESULTS
Two hundred ninety-six case patients were matched to 580 control subjects. Aquatic recreation was the most important factor associated with all REI-Bs studied (beach water exposure [OR for Salmonella infection, 28.3 {CI, 7.2-112.2}; OR for Shigella infection, 14.5 {CI 1.5-141.0} or any recreational water exposure [OR for Campylobacter infection, 2.7 {CI, 1.5-4.8}; OR for Escherichia coli O157 infection, 7.4 {CI, 2.1-26.1}]). Suboptimal kitchen hygiene after preparation of raw meat or chicken (OR, 7.1 [CI, 2.1-24.1]) and consumption of food from restaurants were additional risks for Campylobacter infection. Infection with Salmonella was associated with the use of private wells as sources of drinking water (OR, 6.5 [CI, 1.4-29.7]), and the use of residential septic systems was a risk for both Salmonella (OR, 3.2 [CI, 1.3-7.8]) and E. coli (OR, 5.7 [CI, 1.2-27.2]) O157 infection.


CONCLUSIONS
Overall, non-food exposures were as important as food-related exposures with regard to their contributions to the proportion of cases. Infection prevention efforts should address kitchen hygiene practices and non-food exposures, such as recreational water exposure, in addition to food-consumption risks.
Denno
Donna M
DM
Department of Pediatrics and Global Health, University of Washington, Public Health-Seattle and King County, Seattle, Washington, USA.
Keene
William E
WE
Hutter
Carolyn M
CM
Koepsell
Jennifer K
JK
Patnode
Marianne
M
Flodin-Hursh
Denny
D
Stewart
Laurie K
LK
Duchin
Jeffrey S
JS
Rasmussen
Laurette
L
Jones
Robert
R
Tarr
Phillip I
PI
D000293:Adolescent; D000818:Animals; D000829:Animals, Domestic; D001493:Bathing Beaches; D002167:Campylobacter / Q000302:isolation & purification; D002169:Campylobacter Infections / Q000453:epidemiology* / Q000382:microbiology; D016022:Case-Control Studies; D002648:Child; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D019453:Escherichia coli O157 / Q000302:isolation & purification; D005511:Food Handling; D006801:Humans; D006920:Hygiene; D007410:Intestinal Diseases / Q000453:epidemiology* / Q000382:microbiology; D016015:Logistic Models; D015999:Multivariate Analysis; D018570:Risk Assessment; D012475:Salmonella / Q000302:isolation & purification; D012760:Shigella / Q000302:isolation & purification; D013551:Swimming Pools; D014195:Travel; D014861:Washington / Q000453:epidemiology