PhD thesis - University of Hertfordshire Research Archive

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Table 1. Trends in the design and outcome of reported case-control studies of sporadic Campylobacter infection. Factor Publication area (%) 80s (12) Decade (N) 90s (10) 00s (13) Total N America 58 0 38 34 Rest of Europe 33 20 46 34 UK 8 60 8 23 Australasia Study population 0 20 8 9 All 75 80 77 77 Adults 17 20 0 11 Infants & children 8 0 23 11 Percentage indigenous 9 40 62 38 Mean study length (months) 14 7 12 11 Mean sample size 326 456 565 452 Mean number of variables 19 32 106 55 Mean exposure period 7 10 10 9 Mean interview lag 10 10 14 11 Percentage matching 83 100 100 94 Percentage multivariate analysis Foreign travel 17 50 92 54 † % enquiry 60 83 100 76 % risk factor Poultry variables 33 33 50 39 % enquiry – any 75 80 85 80 % enquiry – ch* 58 70 77 69 Mean no. variables – any 4 9 10 8 Mean no. variables – ch* 4 6 8 6 % risk factor – any 89 63 73 75 % risk factor – ch* Other (non-poultry) meats 86 43 50 58 % enquiry 42 70 92 69 Mean no. variables 8 5 6 6 % risk factor Dairy 40 29 42 38 % enquiry 40 100 100 80 % risk factor Water 80 51 31 46 % enquiry 42 60 77 60 % risk factor Animal contact 80 33 40 48 % enquiry 42 60 77 60 % risk factor 80 33 40 48 Total risk factors identified 44 41 55 140 Mean risk factors identified 4 4 4 4 † , Excludes indigenous-only studies; *, chicken 27
Studies were most frequently conducted over twelve months on subjects from all age groups, but some were restricted to adults or infants/children. The average number of study participants increased over the surveillance period, with the number of parameters under investigation increasing commensurately. Studies increasingly focused on indigenously-acquired infections, employed matching in control selection and utilised multivariate statistical techniques in analysis. Surprisingly, the period of exposure for which information was sought did not vary greatly, averaging nine days. Based on the information reported, most studies asked participants about recent exposure to poultry (especially chicken) or dairy produce, as well as foreign travel and contact with animals and the wider environment. A disproportionately high number of questions on poultry and/or chicken consumption were included compared with other meat types, and the number of poultry-related questions posed increased over the surveillance period. The number of questions on selected epidemiological parameters, reported in each study, is provided in table A3.2 of Appendix 3. General poultry consumption was the most commonly identified risk factor, with three quarters (75%) of studies reporting this exposure where it was investigated, followed by animal contact (48%), water consumption (48%), dairy consumption (46%) and foreign travel (non-indigenous studies; 44%). Where investigated, chicken consumption was the most commonly identified specific exposure (58%), and the number of specific chicken risk factors reported (26) was exactly double the second most commonly reported specific risk factor (contact with animals other than dogs; 13; Appendix 3; table A3.3). Where Population Attributable Fractions (an estimate of the proportion of disease in the general population that is attributable to a particular risk factor) were reported (seven studies), chicken accounted for between 0 and 24% of campylobacter cases, and an average of 12% of cases. Other important specific risk factors identified included the consumption of unpasteurised milk (47%), barbecued food (44%) or raw water (44%), and contact with dogs (42%). No case-control studies identified beef or lamb as a risk factor for Campylobacter infection. 28
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 and 22: The incidence of laboratory-confirm
Page 23 and 24: were elderly or had a pre-existing
Page 25 and 26: they would for other bacterial gast
Page 27: papers (Pearson et al., 1977; Bruce
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
Page 59 and 60: The sentinel health authorities wer
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.,
Page 69 and 70: Doyle, L. P. 1948, "The etiology of
Page 71 and 72: other industrialised countries," in
Page 73 and 74: Hanel, C. M. & Atanassova, V. 2007,
Page 75 and 76: Hudson, S. J., Lightfoot, N. F., Co
Page 77 and 78: 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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