title: Tri-county comprehensive assessment of risk factors for sporadic reportable bacterial enteric infection in children.
abstract: 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.
authors.affiliation: Department of Pediatrics and Global Health, University of Washington, Public Health-Seattle and King County, Seattle, Washington, USA.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Denno
authors.forename: William E
authors.initials: WE
authors.lastname: Keene
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Hutter
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Koepsell
authors.forename: Marianne
authors.initials: M
authors.lastname: Patnode
authors.forename: Denny
authors.initials: D
authors.lastname: Flodin-Hursh
authors.forename: Laurie K
authors.initials: LK
authors.lastname: Stewart
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Duchin
authors.forename: Laurette
authors.initials: L
authors.lastname: Rasmussen
authors.forename: Robert
authors.initials: R
authors.lastname: Jones
authors.forename: Phillip I
authors.initials: PI
authors.lastname: Tarr
mesh_terms: 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