title: Risk factors for salmonella gastroenteritis in children less than five years of age in Taiwan.
abstract: BACKGROUND
  Nontyphoid Salmonella spp. have been among the most common pathogens of acute gastroenteritis in children in Taiwan. However, the principal sources of transmission remain poorly defined.
  
  
  METHODS
  A matched case-control study was conducted from January 2009 to October 2010. Cases were children aged 2-60 months who were hospitalized at 3 medical centers in Taiwan because of diarrhea and found to have culture-proven nontyphoidal Salmonella infection. Controls were healthy children or children with acute diseases other than gastroenteritis and matched to cases by age, gender, study site and enrollment date.
  
  
  RESULTS
  A total of 396 cases and 930 matched controls were included for analysis. Multivariate analysis using conditional logistic regression identified contact with household members having diarrhea (matched odds ratio [mOR], 17.9; 95% confidence interval [CI]: 8.82-36.34; P < 0.0001), consumption of instant powdered milk (mOR, 2.04; 95% CI: 1.05-3.94; P = 0.0344), visits to health-care facilities (mOR, 1.66; 95% CI: 1.12-2.48; P = 0.0126) and consumption of purchased groundwater (mOR, 1.50; 95% CI: 1.06-2.11; P = 0.0214) within 1 week preceding enrollment as independent factors associated with increased risk of salmonellosis. Hand washing before meals (P = 0.0311), breastfeeding (P = 0.0370), consumption of chicken (P = 0.0019) and consumption of food prepared by caregivers (P = 0.0011) were protective against Salmonella infection.
  
  
  CONCLUSIONS
  The principal transmission routes of Salmonella infection in Taiwanese children are person-to-person, waterborne and environmental contacts. The possibility of powdered milk and groundwater contamination of Salmonella cannot be excluded and requires further investigation.
authors.affiliation: Division of Pediatric Infectious Diseases, Chang Gung Memorial Hospital, No. 5, Fu-Shin Street, Kweishan, Taoyuan, Taiwan.
authors.forename: Chih-Jung
authors.initials: CJ
authors.lastname: Chen
authors.forename: Fang-Tzy
authors.initials: FT
authors.lastname: Wu
authors.forename: Chao A
authors.initials: CA
authors.lastname: Hsiung
authors.forename: Wan-Chi
authors.initials: WC
authors.lastname: Chang
authors.forename: Ho-Sheng
authors.initials: HS
authors.lastname: Wu
authors.forename: Ching-Yi
authors.initials: CY
authors.lastname: Wu
authors.forename: Jen-Shiou
authors.initials: JS
authors.lastname: Lin
authors.forename: Fu-Chen
authors.initials: FC
authors.lastname: Huang
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
mesh_terms: D016022:Case-Control Studies; D002675:Child, Preschool; D004783:Environmental Microbiology; D005260:Female; D005516:Food Microbiology; D005759:Gastroenteritis / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007223:Infant; D008297:Male; D012307:Risk Factors; D012480:Salmonella Infections / Q000453:epidemiology* / Q000635:transmission; D013624:Taiwan / Q000453:epidemiology; D014871:Water Microbiology