title: Risk factors for campylobacteriosis of chicken, ruminant, and environmental origin: a combined case-control and source attribution analysis.
abstract: BACKGROUND
  Campylobacteriosis contributes strongly to the disease burden of food-borne pathogens. Case-control studies are limited in attributing human infections to the different reservoirs because they can only trace back to the points of exposure, which may not point to the original reservoirs because of cross-contamination. Human Campylobacter infections can be attributed to specific reservoirs by estimating the extent of subtype sharing between strains from humans and reservoirs using multilocus sequence typing (MLST).
  
  
  RESULTS
  We investigated risk factors for human campylobacteriosis caused by Campylobacter strains attributed to different reservoirs. Sequence types (STs) were determined for 696 C. jejuni and 41 C. coli strains from endemic human cases included in a case-control study. The asymmetric island model, a population genetics approach for modeling Campylobacter evolution and transmission, attributed these cases to four putative animal reservoirs (chicken, cattle, sheep, pig) and to the environment (water, sand, wild birds) considered as a proxy for other unidentified reservoirs. Most cases were attributed to chicken (66%) and cattle (21%), identified as the main reservoirs in The Netherlands. Consuming chicken was a risk factor for campylobacteriosis caused by chicken-associated STs, whereas consuming beef and pork were protective. Risk factors for campylobacteriosis caused by ruminant-associated STs were contact with animals, barbecuing in non-urban areas, consumption of tripe, and never/seldom chicken consumption. Consuming game and swimming in a domestic swimming pool during springtime were risk factors for campylobacteriosis caused by environment-associated STs. Infections with chicken- and ruminant-associated STs were only partially explained by food-borne transmission; direct contact and environmental pathways were also important.
  
  
  CONCLUSIONS
  This is the first case-control study in which risk factors for campylobacteriosis are investigated in relation to the attributed reservoirs based on MLST profiles. Combining epidemiological and source attribution data improved campylobacteriosis risk factor identification and characterization, generated hypotheses, and showed that genotype-based source attribution is epidemiologically sensible.
authors.affiliation: Istituto Superiore di Sanità, Department of Veterinary Public Health and Food Safety, Rome, Italy. lapo.mughinigras2@unibo.it
authors.forename: Lapo
authors.initials: L
authors.lastname: Mughini Gras
authors.forename: Joost H
authors.initials: JH
authors.lastname: Smid
authors.forename: Jaap A
authors.initials: JA
authors.lastname: Wagenaar
authors.forename: Albert G
authors.initials: AG
authors.lastname: de Boer
authors.forename: Arie H
authors.initials: AH
authors.lastname: Havelaar
authors.forename: Ingrid H M
authors.initials: IH
authors.lastname: Friesema
authors.forename: Nigel P
authors.initials: NP
authors.lastname: French
authors.forename: Luca
authors.initials: L
authors.lastname: Busani
authors.forename: Wilfrid
authors.initials: W
authors.lastname: van Pelt
mesh_terms: D000818:Animals; D002167:Campylobacter / Q000145:classification; D002169:Campylobacter Infections / Q000453:epidemiology* / Q000382:microbiology*; D016022:Case-Control Studies; D002417:Cattle; D002645:Chickens / Q000382:microbiology*; D016001:Confidence Intervals; D004197:Disease Reservoirs / Q000382:microbiology*; D004783:Environmental Microbiology; D006801:Humans; D058885:Multilocus Sequence Typing; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D012307:Risk Factors; D012418:Ruminants / Q000382:microbiology*