Campylobacter infection

Notification requirements for Campylobacter infection

Campylobacter infection is a ‘routine’ notifiable condition and must be notified by pathology services in writing within 5 days of diagnosis. Medical practitioners are not required to notify cases of Campylobacter infection.

This is a Victorian statutory requirement.

Primary school and children’s services centre exclusion for Campylobacter infection

Exclude cases from primary school and children’s services until there has not been a loose bowel motion for 24 hours.

Laboratories are required to notify Campylobacter jejuni, C. coli or C. lari isolated from water supplies or C. jejuni detected in food.

Infectious agent of Campylobacter infection

The most common Campylobacter species that cause infection are C. jejuni, C. coli, C. fetus, C. lari and C. upsaliensis.

Identification of Campylobacter infection

Clinical features

Campylobacter infection may be subclinical or cause disease of variable severity. C. jejuni infection typically results in abdominal pain, malaise, nausea and /or vomiting and diarrhoea (which is frequently bloody). In 50 per cent of people, the diarrhoea is preceded by a febrile period. Symptoms usually occur 2–5 days after exposure and may persist for 1–2 weeks.

Campylobacter infection has been associated with rare sequelae, including reactive arthritis, urticaria, erythema nodosum, febrile convulsions and Guillain-Barré syndrome. Less common forms include a typhoid-like syndrome, or a meningeal syndrome. Human infection with C. fetus may cause localised abscesses or generalised sepsis, particularly in immunosuppressed people.

People who are immunocompromised have an increased risk of infection and re-occurrence, have more severe symptoms and are more likely to become chronic carriers.

Campylobacter is also an important cause of traveller’s diarrhoea.

Diagnosis

Infection is diagnosed by culture of Campylobacter spp. from faeces, blood or other clinical specimens. Antibody-based and polymerase chain reaction detection methods have also been developed.

Incubation period of Campylobacter

The incubation period is usually 2–5 days, with a range of 1–10 days, depending on the dose ingested.

Public health significance and occurrence of Campylobacter infection

Campylobacter infections are now the most commonly notified of the enteric pathogen infections in Victoria. All age groups are affected. Those most commonly affected are children under 5 years of age and young adults. Most cases in Australia appear to be sporadic, but foodborne and waterborne outbreaks occur, and it is likely that many outbreaks are not detected.

Reservoir of Campylobacter

Many animals may be sources of human infection. Those most often implicated are poultry, other birds, cattle, puppies, kittens, other pets, swine, sheep and rodents.

Mode of transmission of Campylobacter

Infection occurs most commonly by the ingestion of the organism via contaminated food or water, particularly raw or undercooked meats (especially poultry) or raw milk, and from contact with pets (especially puppies and kittens), farm animals and infected infants. The infective dose is often low (typically fewer than 500 organisms). Person-to-person transmission is uncommon, but spread may occur via the faecal–oral route.

Period of communicability of Campylobacter infection

Cases are infectious throughout their illness, for several days to several weeks. Excretion of organisms may continue for some weeks after symptoms resolve.

Susceptibility and resistance to Campylobacter infection

All non-immune people are susceptible to infection. Immunity to serologically related strains may follow infection and may be more common in high-incidence regions.

Control measures for Campylobacter infection

Preventive measures

Prevention is dependent on good personal and food hygiene. Raw meats, especially poultry, should be cooked thoroughly and refrigerated if stored after cooking. Wash utensils used to prepare raw meats and poultry in hot, soapy water before using them to prepare non-cooked food such as salads. Unpasteurised milk and dairy products should not be consumed. Recognise pets as sources of infection and encourage handwashing after animals are handled.

Control of case

Treatment, including fluid and electrolyte replacement, is largely symptomatic. Antibiotics may be indicated, however, for severe illness or where prompt termination of faecal excretion is desired. Antibiotics are not indicated for diarrhoeal disease in which the causative pathogen is not known, except in some very severe illnesses when empirical treatment may be considered. Rising rates of antibiotic resistance, particularly in overseas strains, complicate the choice of antibiotics.

To prevent further transmission, the importance of handwashing and personal hygiene should be stressed, particularly with respect to food preparation. Healthcare workers, childcare workers and food handlers should be excluded from work until diarrhoea has ceased. Children in childcare or primary school should be excluded until there has not been a loose bowel motion for 24 hours. As asymptomatic excretion may persist, diligent personal hygiene is required.

For hospitalised patients, apply standard precautions. Apply contact precautions for diapered or incontinent people for the duration of illness.

Control of contacts

The diagnosis should be considered in symptomatic contacts. Investigate related cases to identify a common source.

Outbreak measures for Campylobacter infection

Two or more cases suspected to be food- or waterborne should be reported immediately, particularly in institutions. Obtain food histories and investigate other recognised vehicles of infection, such as pets or farm animals, to identify a common source.