1. Foodborne Campylobacteriosis in New Zealand Evidence rather than prejudice Donald Campbell Principal Advisor (Public Health) Science Group

2. Statistics are the triumph of the quantitative method, and the quantitative method is the victory of sterility and death. Hillaire Belloc 1870 -1953

3. The burden of acute gastro- intestinal disease pyramid

4. Human disease surveillance in New Zealand Ministry of Health Environmental Services and Research Ltd Public Health Units New Zealand Food Safety Authority

5. Disease Investigations Enteric Purpose Disease Control Attribution Monitoring Methods Outbreaks Sporadic Foodborne Detecting, controlling and preventing outbreaks Priorities / setting policy for control (risk assessment) Estimating burden of disease Identifying emerging issues Data source Evaluation and monitoring

6. Campylobacteriosis 2006 Cases 15,873 383.5/100,000 Hospitalisations 677 (969) 7.3% Mortality 1

7. Campylobacteriosis Jan 03 - May 07

8. Notification Rates

9. Campylobacter 2005

10. Disease Notifications

11. Monthly Campylobacteriosis 2004 - 2007

12. Enteric Outbreaks 2006 No of outbreaks % of outbreaks No of cases % of cases Norovirus15631.5394562.6 Campylobacteriosis479.52233.5 Giardia326.5981.6 Cryptosporidium255.11161.8 Salmonella224.4741.2 C perfringens122.4621.0 Others346.62173.4 Unidentified15330.9141522.5

13. Case-case Analysis 2006 (%) Food premise Untreated drinking water Recreational water Farm Animal Overseas Travel Campylobacteriosis52.416.410.728.66.0 Cryptosporidiosis26.034.729.853.28.2 Giardiasis27.036.427.827.626.6 Salmonellosis46.020.216.725.219.3 Shigellosis48.913.322.24.460.5 Yersiniosis34.620.111.621.66.7

14. Case-control studies MAGIC 1997 PAR chicken 50%+ Home protective Christchurch 1994 Poultry outside home Auckland 1996 Barbecued, undercooked chicken

15. Published campylobacteriosis investigation reports Likely CauseNo. of Outbreak Reports Likely foodborne2 Limited for foodborne2 Likely waterborne5 Limited for waterborne1 Possibly food or water2 Unclear1 Total13

16. Overall evidence for causality in New Zealand Foodborne transmission Evidence of association Strength of association Biologic gradient Consistency Biological plausibility Coherence Temporality Food dominant cause

17. The government is very keen on amassing statistics. They collect them, add them, raise them to the nth power, take the cube root and prepare wonderful diagrams. But you must remember that every one of these figures comes in the first instance from the Chowty Dar who just puts down what he damn well pleases. Sir Josiah Stamp 1929

18. Good surveillance does not necessarily ensure the making of right decisions but it reduces the chances of making wrong ones. Alexander Langmuir 1963