title: Campylobacter infection associated with consumption of duck liver pâté: a retrospective cohort study in the setting of near universal exposure.
abstract: A retrospective cohort study was performed following several reported cases of gastrointestinal illness after a catered event. The attack rate was 45/77 (58·4%) by clinical case definition, with four individuals confirmed to have Campylobacter. There was near universal exposure to most foodstuffs served; consumption of duck liver pâté [relative risk (RR) 2·53, 95% confidence interval (CI) 1·05-6·10], mixed leaf salad (RR 2·91, 95% CI 1·22-6·92) and table water (RR undefined, P < 0·01) were associated with illness in univariate analysis, with only the latter associated in the final multivariable model (P < 0·001). Samples of cooked duck liver pâté subsequently prepared using identical methods at the venue were contaminated with Campylobacter jejuni and C. coli; water sampling was negative. Making inferences about causation in the presence of near universal exposures in this study required consideration of the limitations of statistical analysis, with the most compelling evidence of the causal role of inadequately prepared duck liver pâté provided by environmental investigation.
authors: Public Health England, South of England Region, UK.
authors: N J
authors: NJ
authors: Young
authors: North Somerset Council Food and Safety Team, Weston-Super-Mare, UK.
authors: J
authors: J
authors: Day
authors: Avon, Gloucestershire and Wiltshire Public Health England Centre, Bristol, UK.
authors: F
authors: F
authors: Montsho-Hammond
authors: Public Health England Statistics Unit, London, UK.
authors: N Q
authors: NQ
authors: Verlander
authors: Avon, Gloucestershire and Wiltshire Public Health England Centre, Bristol, UK.
authors: C
authors: C
authors: Irish
authors: Avon, Gloucestershire and Wiltshire Public Health England Centre, Bristol, UK.
authors: B
authors: B
authors: Pankhania
authors: Field Epidemiology, Public Health England, UK.
authors: I
authors: I
authors: Oliver
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002167:Campylobacter / Q000145:classification / Q000302:isolation & purification*; D002169:Campylobacter Infections / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003296:Cooking; D004196:Disease Outbreaks; D004372:Ducks; D005260:Female; D005516:Food Microbiology; D006801:Humans; D007223:Infant; D008099:Liver / Q000382:microbiology*; D008297:Male; D008461:Meat Products / Q000382:microbiology*; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
references: J Clin Pathol. 1999 Nov;52(11):812-4
references: 10690169
references: Epidemiol Infect. 1999 Aug;123(1):47-55
references: 10487641
references: Emerg Infect Dis. 2003 Oct;9(10):1219-25
references: 14609455
references: J Appl Microbiol. 1998 Jul;85(1):187-91
references: 9721669
references: Lett Appl Microbiol. 2006 Dec;43(6):591-5
references: 17083702
references: J Clin Microbiol. 1998 Feb;36(2):335-9
references: 9466737
references: J Appl Microbiol. 2008 Dec;105(6):1729-43
references: 18397258
references: Euro Surveill. 2006;11(5):137-9
references: 16757851
references: Euro Surveill. 2010 Nov 04;15(44):
references: 21087588
references: J Food Prot. 1999 Apr;62(4):325-8
references: 10419203
references: Emerg Infect Dis. 2012 Nov;18(11):1717-22
references: 23092616
references: J Food Prot. 2003 Sep;66(9):1581-6
references: 14503709
references: J Clin Microbiol. 2001 Jan;39(1):14-23
references: 11136741
references: Appl Environ Microbiol. 1986 Feb;51(2):307-11
references: 3954344
references: Foodborne Pathog Dis. 2012 Jun;9(6):498-505
references: 22571641
references: Commun Dis Intell Q Rep. 2011 Dec;35(4):299-300
references: 22624491
references: Lett Appl Microbiol. 2001 Dec;33(6):434-9
references: 11737627
references: Epidemiol Infect. 2009 Mar;137(3):383-8
references: 18647437
references: Environ Microbiol Rep. 2011 Oct;3(5):574-580
references: 22164198
references: Foodborne Pathog Dis. 2009 Dec;6(10):1241-50
references: 19895264
references: Am J Epidemiol. 1992 Jan 1;135(1):96-104
references: 1736665
references: J Food Prot. 2003 Mar;66(3):403-9
references: 12636292
references: Epidemiol Infect. 2010 Dec;138(12):1691-4
references: 20727250