PhD thesis - University of Hertfordshire Research Archive

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Campylobacter infections would have occurred in England and Wales in 2006, with 190,000 general practice consultations. The same study estimated that each case of Campylobacter infection cost the nation £315, based on 1995 prices. Bringing these figures up to date (Anon., 2007), the cost of campylobacteriosis in England & Wales in 2006 would have been approximately £220,039,652. Campylobacter enteritis is usually self-limiting, with symptoms resolving gradually after the acute phase and lasting on average seven to ten days (Skirrow & Blaser, 2000). A spectrum of illness exists, however, and almost ten percent of cases require hospital admission as a result of their illness. Infections can manifest extra-intestinally, most commonly as bacteraemia (Skirrow et al., 1993) and rarely as cholecystitis, pancreatitis, cystitis, meningitis and endocarditis (Peterson, 1994). Irritable Bowel Syndrome and Reactive Arthritis are the most common sequelae associated with infection, occurring in 25% and 1-7% of cases respectively (Spiller et al., 2000; Hannu et al., 2002). Less common but more serious, approximately one in 5000 cases develop Guillain-Barré Syndrome – an acute demyelinating neuropathy, requiring months of intensive therapy (Tam et al., 2006b). Campylobacter-associated mortality is considered to be rare, but is relatively poorly described in the literature. Scandinavian registry studies have demonstrated excess one year mortality following Campylobacter infection, suggesting that the long term impact of campylobacteriosis is underestimated. The same studies estimate case-fatality rates of 0.23% and 0.19% respectively (Helms et al., 2003; Ternhag et al., 2005). To examine Campylobacter-associated mortality in England and Wales, mortality data from the Office for National Statistics were obtained and analysed (Appendix 2). Campylobacter infection was recorded as the underlying cause of death in 45 instances between 1993 and 2006, representing a case fatality rate of 0.007%. However, when all causes of death were considered, campylobacters were implicated in 153 deaths (case fatality rate 0.02%), suggesting that the role of campylobacters in UK national mortality statistics is underestimated by a factor greater than three. Most patients who died 21
were elderly or had a pre-existing underlying condition. Over a quarter fulfilling both criteria. Deaths were age and season-dependent, with mortality increasing in patients over 60 years and in the winter months. Campylobacter-associated mortality was most likely to be underestimated when the patient was very old (≥80 years) or had an underlying condition. 22
Page 1 and 2: Population-Based Sentinel Surveilla
Page 3 and 4: The research carried out by the can
Page 5 and 6: Dedication. This thesis is dedicate
Page 7 and 8: 7. Results (the published work). ..
Page 9 and 10: Statement identifying the degree fo
Page 11 and 12: Paper Reference Page 6 Gillespie IA
Page 13 and 14: Statement of the candidate’s cont
Page 15 and 16: Declaration form. I, Iain Andrew Gi
Page 17 and 18: 2. History. In contrast to other co
Page 19 and 20: The application of veterinary techn
Page 21: The incidence of laboratory-confirm
Page 25 and 26: they would for other bacterial gast
Page 27 and 28: papers (Pearson et al., 1977; Bruce
Page 29 and 30: Studies were most frequently conduc
Page 31 and 32: The content of peer-reviewed public
Page 33 and 34: infection. An approximation of the
Page 35 and 36: hypotheses a „blank canvas‟ app
Page 37 and 38: 6. Materials and methods. Regional
Page 39 and 40: presentation and severity, foreign
Page 41 and 42: together, etc). The results of the
Page 43 and 44: and improve response during the stu
Page 45 and 46: The published work. 7.1 Epidemiolog
Page 47 and 48: community illness was more common a
Page 49 and 50: north west England and in Yorkshire
Page 51 and 52: community was no different from oth
Page 53 and 54: provide useful insights into the ep
Page 55 and 56: Cases in case-control studies of la
Page 57 and 58: 8. Discussion. The research carried
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Page 61 and 62: fundamentally flawed. Since the app
Page 63 and 64: control studies. The potential role
Page 65 and 66: Campylobacter spp. from cattle farm
Page 67 and 68: Cameron, S., Ried, K., Worsley, A.,
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Hanel, C. M. & Atanassova, V. 2007,
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Hudson, S. J., Lightfoot, N. F., Co
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Kessel, A. S., Gillespie, I., O'Bri
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costs-of-illness, Rijksinstituut vo
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Department of Health and Human Serv
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Potter, R. C., Kaneene, J. B., & Ha
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Siemer, B. L., Harrington, C. S., N
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Sopwith, W., Birtles, A., Matthews,
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Campylobacter infection: a general
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The published work 90
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Table A1.1: Notable events in the h
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Year Human medicine Veterinary medi
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Levy, A. J. 1928, "A gastro-enterit
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Appendix 2. An assessment of the ro
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compare the period after 2000 with
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condition was significantly associa
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Deaths/100,000 cases 600 500 400 30
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Table A2.1: Factors affecting the u
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Appendix 3. An analytical review of
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to indigenously acquired infection
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susceptibility to Campylobacter inf
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year demonstrated that only the num
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Table A3.1 Reported epidemiological
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Table A3.3 Selected reported risk f
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Table A3.5. The effect of various r
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Deming, M. S., Tauxe, R. V., Blake,
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Harris, N. V., Weiss, N. S., & Nola
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Kist, M. & Rossner, R. 1985a, in Ca
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Oosterom, J., den Uyl, C. H., Banff
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Severin, W. P. J. 1982, "Epidemiolo
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Appendix 4. The Campylobacter Senti
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