title: Persistence of livestock associated MRSA CC398 in humans is dependent on intensity of animal contact.
abstract: BACKGROUND
  The presence of Livestock Associated MRSA (LA-MRSA) in humans is associated with intensity of animal contact. It is unknown whether the presence of LA-MRSA is a result of carriage or retention of MRSA-contaminated dust. We conducted a longitudinal study among 155 veal farmers in which repeated nasal and throat swabs were taken for MRSA detection. Periods with and without animal exposure were covered.
  
  
  METHODS
  Randomly, 51 veal calf farms were visited from June-December 2008. Participants were asked to fill in questionnaires (n = 155) to identify potential risk factors for MRSA colonisation. Nasal and throat swabs were repeatedly taken from each participant for approximately 2 months. Swabs were analysed for MRSA and MSSA by selective bacteriological culturing. Spa-types of the isolates were identified and a ST398 specific PCR was performed. Data were analyzed using generalized estimation equations (GEE) to allow for correlated observations within individuals.
  
  
  RESULTS
  Mean MRSA prevalence was 38% in farmers and 16% in family members. Presence of MRSA in farmers was strongly related to duration of animal contact and was strongly reduced in periods with absence of animal contact (-58%). Family members, especially children, were more often carriers when the farmer was a carrier (OR = 2, P<0.05). Only 7% (n = 11) of the participants appeared to be persistent carriers. A large heterogeneity in spa-types was detected, however 92.7% belonged to LA-MRSA CC398. A surprisingly high fraction of the spa-types (7.3%) did not belong to CC398.
  
  
  CONCLUSIONS
  The presence of LA-MRSA in farmers is strongly animal-exposure related. The rapidly decreasing MRSA prevalence during absence of animal contact suggests that LA-MRSA is a poor persistent colonizer in most humans. These results are of relevance for MRSA control strategies.
authors.affiliation: Division Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands. h.graveland@uu.nl
authors.forename: Haitske
authors.initials: H
authors.lastname: Graveland
authors.forename: Jaap A
authors.initials: JA
authors.lastname: Wagenaar
authors.forename: Kelly
authors.initials: K
authors.lastname: Bergs
authors.forename: Hans
authors.initials: H
authors.lastname: Heesterbeek
authors.forename: Dick
authors.initials: D
authors.lastname: Heederik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002353:Carrier State / Q000382:microbiology; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure / Q000032:analysis*; D005260:Female; D006801:Humans; D007223:Infant; D058751:Livestock / Q000382:microbiology*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification* / Q000502:physiology; D008875:Middle Aged; D011795:Surveys and Questionnaires; D055815:Young Adult