PhD thesis - University of Hertfordshire Research Archive

control studies. The potential role of drinking water (both bottled and
municipal) in campylobacteriosis was highlighted in a number of the
published works, and therefore research is required to improve the methods
for the isolation of campylobacters from water, leading to a detailed
assessment of the prevalence of, and hence the potential risk from,
campylobacters in drinking waters. Outbreaks of campylobacteriosis appear
to be underascertained and therefore a system should be developed which
routinely detects and reports clusters of infection to local investigators. This
would require not only the agreement of a minimum dataset (onset date,
postcode and foreign travel status (for exclusion purposes) should suffice) to
define clusters in time and space, but also a change to current
public/environmental health practice, as the data collected would need to be
entered into a single database for analysis. Finally, work should continue into
the development of typing methods which are sufficiently robust so as to form
epidemiologically-meaningful organism groups, whilst not being overly
cumbersome or prohibitively expensive and hence are applicable to all
campylobacters.
In conclusion, campylobacters are a common cause of gastrointestinal
disease in developed countries worldwide. The disease is not trivial and a
number of sequelae add to the substantial disease burden.
Campylobacteriosis-associated death, whilst rare, appears to be
underestimated. An improved understanding of the complex epidemiology of
Campylobacter infection is therefore an essential first step in informing on
prevention strategies. This study has demonstrated that the systematic
collection of standardised epidemiological information on all cases of
Campylobacter infection, reported from large, well defined populations over
prolonged periods, coupled with detailed strain characterisation, can achieve
this, leading to public health gains.
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