Page content: Victorian statutory requirement | Infectious agent | Identification | Incubation period | Public health significance & occurrence | Reservoir | Mode of transmission | Period of communicability | Susceptibility & resistance | Control measures | Outbreak measures

Victorian statutory requirement

Campylobacter infection (Group B disease) must be notified in writing within five days of diagnosis.

School exclusion: exclude cases from child care and school until after diarrhoea has ceased.

Laboratories are required to notify Campylobacter spp isolated from water supplies or detected in food.

Infectious agent

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

Identification

Clinical features
Campylobacter infection may be subclinical or cause disease of variable severity. C. jejuni infection typically results in abdominal pain, fever and diarrhoea which may be mucopurulent or bloody. Symptoms usually last two to five days.

Campylobacter infection has been associated with rare sequelae including reactive arthritis and Guillain-Barré syndrome (polyneuritis). Human infection with C. fetus may cause localised abscesses or generalised sepsis particularly in immunosuppressed persons.

Method of diagnosis
Infection is diagnosed by culture of Campylobacter spp. from faeces, blood or other clinical specimens.

Incubation period

The incubation period is usually two to five days, with a range of one to ten days.

Public health significance & occurrence

Campylobacter infections are now the most commonly notified of the enteric pathogens in Victoria and over 14 900 cases were reported Australia-wide in 2003 (Communicable Diseases Network Australia – National Notifiable Diseases Surveillance System). The incidence of infection appears to be increasing, a trend observed internationally. All age groups are affected. The most commonly affected are children less than five years of age and young adults. Most cases in Australia appear sporadic but food and water-borne outbreaks occur and it is likely that many outbreaks are not detected.

Reservoir

Many animals, especially birds, are carriers of Campylobacter spp. Domestic animals are another possible source of infection.

Mode of transmission

Infection occurs most commonly by ingestion of the organism via contaminated foods, particularly raw or undercooked meats (especially poultry). Person to person transmission via the faecal-oral route is common. Infection may also occur through contact with infected animals.

Period of communicability

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

Susceptibility & resistance

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

Preventive measures
Prevention is dependent on good personal and food hygiene. Raw meats should be cooked thoroughly and refrigerated after cooking, especially poultry. 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 hand washing after handling animals.

Control of case
Treatment is largely symptomatic. However, antibiotics may be indicated 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.

To prevent further transmission the importance of hand washing and personal hygiene should be stressed, particularly with respect to food preparation. Health care workers, child care workers, food handlers and children in school and child care centres should be excluded from work or school until diarrhoea has ceased. As asymptomatic excretion may persist, diligent personal hygiene is required.

Isolation is not required for hospitalised patients and standard precautions apply.

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

Control of environment
Isolation is not required for hospitalised patients and standard precautions apply.

Outbreak measures

Two or more related cases 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.