1. Two outbreaks, a dog and a nursing home ...
Cameron Moffatt1, Ranil Appuhamy2, Sandy Wynn3, Will Andrews4, Jan Roberts5, Karina Kennedy6
1OzFoodNet Epidemiologist, ACT Health Protection Service, 2Public Health Physician, Office of Chief Health Officer, ACT Health Directorate, 3Infection Prevention and Control, ACT Health Protection Service, 4Chief Veterinary Officer, Territory and Municipal Services, 5Infection Prevention and Control, Community-based Services, ACT Health Directorate, 6Staff Specialist Infectious Diseases and Microbiology, Canberra Hospital and Health Services
Background
Campylobacter gastroenteritis is common but outbreaks are not frequently reported.(1)
Most infections are viewed as food-related but animal contact, especially with puppies, is a risk factor.(2,3)
Between April and June 2012, two outbreaks of Campylobacter gastroenteritis, affecting 15 persons, occurred in an aged-care facility (ACF).
A 4 month old puppy was identified as the suspected cause and excluded from the facility.
Testing of the puppy showed it to be Campylobacter positive but a molecular link with human cases could not be established.
Panel findings
Campylobacter extensively shed by young dogs.(4-6)
Low infectious dose needed to cause human illness.(7)
Antibiotic treatment for puppy not recommended and may promote resistance.(8,9)
Infection control and animal policies did not consider restrictions based on species, age and behaviour.(10)
Campylobacter infections in the elderly carry increased risk of hospitalisation and death.(11,12)
High risk to elderly resident’s health identified.
Recommendations
The panel recommended the puppy remain excluded from the facility and not be permitted to return until:
The puppy is at least one year of age.
The puppy is assessed as being behaviourally and temperamentally suited for an ACF environment.
The infection control and animal policies at the ACF have been revised.
Methods
An expert panel was convened to undertake a risk assessment with the aim of:
- Determining risk of transmission of Campylobacter from the puppy to residents and staff
- Determining what public health actions should be taken to reduce any identified risks
A likelihood and consequence matrix was used to determine a level of risk.
Conclusions
Puppies should not be considered as ACF companion animals due to:
High rates of Campylobacter carriage and shedding.
Their social immaturity.
Susceptibility of elderly residents to infection and poor outcomes.
References
OzFoodNet Working Group, Monitoring the incidence and causes of diseases potentially transmitted by food in Australia: Annual Report of the OzFoodNet network, Communicable Diseases Intelligence, (4):p
Stafford RJ, et al., A multicentre prospective case control study of Campylobacter infection in persons aged 5 years and older in Australia. Epidemiology and Infection, :p978-88
Tenkate TD and Stafford RJ, Risk factors for Campylobacter infection in infants and young children: a matched case control study. Epidemiology and Infection, (3):p
Engvall EO et al., Isolation and Identification of Thermophilic Campylobacter Species in Faecal Samples from Swedish dogs. Scandinavian Journal of Infectious Diseases, :p713-18
Hald B, et al., Longitudinal Study of the Excretion Patterns of Thermophilic Campylobacter spp. in Young Pet Dogs in Denmark. Journal of Clinical Microbiology, (5): p
Torre E and Tello M, Factors influencing fecal shedding of Campylobacter jejuni in dogs without diarrhea. American Journal of Veterinary Research, (2): p260-62
Kothary MH and Babu US, Infective Dose of Foodborne Pathogens in Volunteers: A Review. Journal of Food Safety, ): p49-68
Weese JS, Bacterial Enteritis in Dogs and Cats: Diagnosis, Therapy and Zoonotic Potential. Veterinary Clinics of North America: Small Animal Practice, (2) p
Sehulster LM et al., Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). 2004, American Society for Healthcare Engineering / American Hospital Association: Chicago
Lefebvre SL, et al., Guidelines for animal-assisted interventions in health care facilities. American Journal of Infection Control, March; 36(2): p78-85
Crossley KB and Peterson PK, Infections in the Elderly, in Principles and Practice of Infectious Diseases, Mandell GL, Bennett JE, and Dolin R (Editors) Churchill Livingstone Elsevier: Philadelphia. p
Gradel KO et al., Morbidity and mortality of elderly patients with zoonotic Salmonella and Campylobacter: A population-based study. Journal of Infection, :p214-22