Social,and Economic Dimensions of Campylobacter jejuni Infections in the UK

Question 1

The Campylobacter jejuni causes bacterial diarrheal illness most commonly in children and immunocompromised people. The symptoms include headache, fever, myalgia that could be severe and last more than day. The symptoms after 1-5 days changes that include bloody diarrhoea, dysentery, abdominal pain, stomach cramps and fever near to 40℃ (Kim et al., 2017). The complications caused by the infection include dehydration, toxic megacolon and sepsis which occurs mainly among children who are below 1 year of age and individuals who are immunocompromised. The chronic condition of the disease sometimes leads individuals to develop Guillain–Barré syndrome as complication in which nervous ending that are responsible in joining the brain and spinal cord with the rest of the body are damaged (Ramos et al., 2019). The self-limiting actions that can be taken are intake of pasteurised milk and properly cooked food, washing of hands and maintaining hygiene (Szczepanska et al., 2017). The social impact of the disease is that it pollutes the environment and infects more people by transmitting through untreated water and uncooked foods (Szczepanska et al., 2017). The economic impact of Campylobacter jejuni in UK is that it is regarded as the third costly food-borne illness and estimates £583 million to have been spent in 2008 for its management (bbsrc.ukri.org, 2016).

Question 2

The Campylobacter jejuni is prevalently found in food animals like the pigs, cattle, sheet, poultry, ostrich along with pet dogs and cats (He et al., 2019). According to report, in 2013, the poultry meat in 25 cases, red meat in 18 cases, shellfish in 13 case, milk and dairy in 1 case was responsible in causing outbreak of food brone illness in the UK (assets.publishing.service.gov.uk, 2013). In 2016, the Public Health England identified outbreak of Campylobacter jejuni in the North West of England where 69 cases are reported. The outbreak was mainly reported to have caused due to drinking of raw milk extracted from cattle in the nearby farm (Kenyon et al., 2020). In 2017, another outbreak of Campylobacter jejuni is reported in a hotel located in North Yorshire where six cases wrere immediately reported following a Christmas dinner. In this case, the food which was considered to be responsible in outbreak of the disease is chicken liver pâté (Wensley et al., 2020). In 2016, within the UK, nearly 58,938 cases of Campylobacter jejuni is reported which was 63,201 cases in 2015. The rate of reporting of the health issue was found to have increased in the UK from 89.8 per 100,000 population in 2016 to 96.8 per 100,000 in 2017 (Whitworth, 2019).

Question 3

On January 2017 in North Yorkshire, UK, the local Environmental Health (EH) team was contacted by local health member of the team responsible in reporting gastroenteritis after a Christmas part been held at a hotel on 17 December 2016. The team analysed the situation and reported 7 confirmed cases of Campylobacter jejuni (campylobacteriosis) with rest 12 cases mentioned probably to have occurred due to infection by Campylobacter jejuni (Wensley et al., 2020). The EH team on being contacted initially to investigate the cause of the outbreak, contacted the local staff at the hotel to take the names of the people who attended the party. Moreover, they took the step of case finding by personally contacting all the confirmed cases of campylobacteriosis in the area after 28 December 2016 to determine if they are anyhow linked with the venue (Wensley et al., 2020). This is an effective approach to understand if the people affected by campylobacteriosis are inter-related with the venue or party in any way.

The next sept taken by the EH staff is that they identify the cases that mentioned to have presence of Campylobacter spp. in the faecal specimen submitted to the laboratory and tested by following protocol mentioned at the local National Health Service microbiology laboratory (Wensley et al., 2020). This is because the authorities wished to review and analyse the patient who are affected by the disease. The authorities responsible in investigating the campylobacteriosis outbreak distributed survey questionnaire to the affected groups who have attend the venue or anyhow linked with it and expressed symptoms of the food poisoning. The questionnaire included informing about the symptoms, consumed food and drinks and additional potential risk factor to be responsible in sporadic outbreak of campylobacteriosis (drinking water from private source, milk consumed, close contact with animal faeces, etc) (Wensley et al., 2020). This is an effective step taken by the authorities as it led to epidemiological investigation which is essential in understanding the time and location of the illness and where and when it may have started and what food is responsible for its occurrence.

The EH staff avoid interviewing the hotel staff and no outbreak among them was reported (Wensley et al., 2020). The EH staff further investigated the premises of the hotel on 4 January and gathered food samples along with environmental swabs on 5 January from the premises. The collected specimens were sent by the EH staff for evaluation of Listeria spp., coliform bacteria and Campylobacter spp., and to assess their aerobic counts to the PHE Food Water and Environment (FWE) laboratory (Wensley et al., 2020). This was an effective step as it helped to identify the way the environmental and cooking preparations were responsible in outbreak of the disease.

Question 4

The pathogen Campylobacter jejuni is mainly transmitted from the meat and products of the farm animals when they are consumed in undercooked manner. However, they may be transferred from the environment through infected cutting boards, hand and plates on which the affected food is prepared and handled (Negretti et al., 2017). The Campylobacter jejuni infection is normally caused due to consumption of undercooked or uncooked foods. This is because Campylobacter jejuni is found to be present within the gastrointestinal tract of the cattle in harmless manner but during the extraction of meat in their presence, the uncooked meat develops to be a key agent in causing the infection (Wieczorek et al., 2018). The raw milk can also be considered as a major source of infection for Campylobacter jejuni. This is because the bacteria is found to be present in healthy cattle as well as is transferred by files in the farm (Jaakkonen et al., 2020). The Campylobacter jejuni is also able to be transferred from the healthy gut of the chicken when consumed in undercooked or improperly cooked manner (Jaakkonen et al., 2020). This is because Campylobacter jejuni is seen to survive at low temperature such as 4℃ as well as survive effectively within 30-45℃ with doubling its growth at 32℃ but they are unable to grow in room temperature such as 20-25℃. However, chicken and meat products are usually stored in the freezer where the favourable temperature is present for Campylobacter jejuni in growing leading to cause food poisoning (foodstandards.gov.au, 2013).

The Campylobacter jejuni usually cause infection through the release of distending cytolethal toxin (CDT) in the large intestine of the human which leads to damage the normal cells as the toxin result to create DNase activity which stimulated production of chromosomal DNA damage resulting to alter the normal structure of the cell (Andrzejewska et al., 2019). The Campylobacter jejuni is mentioned to be becoming increasingly resistant towrads many clinically significant antibiotics which is creating major concern for the medicine to be used for its treatment in public. The resistance of the bacteria to tetracycline and fluoroquinolone are found to be increasingly prevalent in many countries (Maćkiw et al., 2012). The study by Elhadid et al. (2020) determined the antimicrobial resistance expressed by Campylobacter jejuni to certain agents., It was revealed that it expressed 56.3% resistance to nalidixic acid, 55.8% resistance to ciprofloxacin and 49.7% to tetracycline followed by 4.5% resistance to streptomycin and 2% resistance to erythromycin. The other pathogen like Campylobacter jejuni which shares similar pattern of infection are Salmonella, Helicobacter, Cyclospora, Listeria and others (Elhadid et al., 2020).

Question 5

The food hygiene standards to be followed in preventing or reducing spread of Campylobacter jejuni includes:

All foods are to be cooked in thoroughly manner and it is to be ensure that meat is cooked in such a way so that no pink juices are released from it at the end of the cooking. This is because such juice indicates that the meat is undercooked and need more heat for thorough cooking to avoid any bacteria from it to enter the body during consumption (WHO, 2020).

All the poultry products are required to be cooked until they reach the temperature of 74℃ (WHO, 2020)

During cooking of meat from which the bacteria is mainly transferred, it is to be ensured no part of the meat remains pink that is even the deepest part is to be cooked thoroughly to avoid contamination (WHO, 2020).

The consumption of untreated or unpasteurised milk or surface water is to be avoided

The milk to be used for consumption is to be cooked above 7℃ for minimum 2 minutes to ensure the bacteria (if present) dies (WHO, 2020)

The additional precautions to be taken to avoid incidence of Campylobacter jejuni is as follows:

• Hands are to be washed thoroughly with the help of disinfectant or soap before initiating to prepare meal (WHO, 2020)
• Hands are to be washed before and after the handling and touching of raw food of any animal origin or elsewhere (WHO, 2020)
• In order to prevent cross-contamination, the kitchen utensils used for cutting and managing the raw meat such as cutting boards, knife, cutlery and other are to be thoroughly washed with soap and disinfectant (WHO, 2020)
• The table-tops on which the raw meat or meat products are placed are to be disinfected and washed with soap (WHO, 2020)
• The people affected by diarrhoea, mainly the children, are to be made to thoroughly wash their hands with soap and disinfectants to reduce the risk of the spread of the infection (WHO, 2020)
• The hands are also to be washed with soap after coming in contact with pets like dogs and cats before touching ant food products for consumption or cooking (WHO, 2020)

Question 6

The pathogen Campylobacter jejuni is frequently related with wide range of food poisoning occurring in the UK. This is evident as in 2016, 90.2 cases were confirmed for the pathogen by 100,000 of population in the UK. Moreover, a total of 58,987 cases of Campylobacter jejuni confirmed in the laboratories of the UK. The mentioned statistics is reported to be far below the actual outbreak of the pathogen due to underreporting of the disease (Kenyon et al., 2020). In regard to assumed measures, it is mentioned that Campylobacter jejuni is responsible for causing sickness to nearly 300,000 people every year. It is one of the hindered foodborne illness as nearly 15,000 people are required to be admitted to hospital due to the infection as reported in the UK. Moreover, it is mentioned that the Campylobacter jejuni leads to cause minimum of 80 deaths each year in the UK (bbsrc.ukri.org, 2016). This indicates that the bacterial disease is widely spread in the UK and creates harmful consequences for the people on being affected by it. There are control measure which can be taken but due to lack of awareness regarding the disease along with underreporting, effective management regarding it is unable to be reached within the UK.

References

Andrzejewska, M., Szczepańska, B., Śpica, D. and Klawe, J.J., 2019. Prevalence, virulence, and antimicrobial resistance of Campylobacter spp. in raw milk, beef, and pork meat in Northern Poland. Foods, 8(9), p.420.

bbsrc.ukri.org 2016, UK Research and Innovation Strategy for Campylobacter − in the food chain, Available at: https://bbsrc.ukri.org/documents/100717-campylobacter-strategy-pdf/#:~:text=Campylobacter%20accounts%20for%20a%20third,unpasteurised%20milk%20and%20untreated%20water. [Accessed on: 20 March 2020]

Elhadidy, M., Ali, M.M., El-Shibiny, A., Miller, W.G., Elkhatib, W.F., Botteldoorn, N. and Dierick, K., 2020. Antimicrobial resistance patterns and molecular resistance markers of Campylobacter jejuni isolates from human diarrheal cases. PloS one, 15(1), p.e0227833.

He, Z., Gharaibeh, R.Z., Newsome, R.C., Pope, J.L., Dougherty, M.W., Tomkovich, S., Pons, B., Mirey, G., Vignard, J., Hendrixson, D.R. and Jobin, C., 2019. Campylobacter jejuni promotes colorectal tumorigenesis through the action of cytolethal distending toxin. Gut, 68(2), pp.289-300.

Jaakkonen, A., Kivistö, R., Aarnio, M., Kalekivi, J. and Hakkinen, M., 2020. Persistent contamination of raw milk by Campylobacter jejuni ST-883. PloS one, 15(4), p.e0231810.

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Kenyon, J., Inns, T., Aird, H., Swift, C., Astbury, J., Forester, E. and Decraene, V., 2020. Campylobacter outbreak associated with raw drinking milk, North West England, 2016. Epidemiology & Infection, 148.

Kim, E., Koo, T., Park, S.W., Kim, D., Kim, K., Cho, H.Y., Song, D.W., Lee, K.J., Jung, M.H., Kim, S. and Kim, J.H., 2017. In vivo genome editing with a small Cas9 orthologue derived from Campylobacter jejuni. Nature communications, 8(1), pp.1-12.

Maćkiw, E., Korsak, D., Rzewuska, K., Tomczuk, K. and Rożynek, E., 2012. Antibiotic resistance in Campylobacter jejuni and Campylobacter coli isolated from food in Poland. Food Control, 23(2), pp.297-301.

Negretti, N.M., Gourley, C.R., Clair, G., Adkins, J.N. and Konkel, M.E., 2017. The food-borne pathogen Campylobacter jejuni responds to the bile salt deoxycholate with countermeasures to reactive oxygen species. Scientific reports, 7(1), pp.1-11.

old.food.gov.uk 2008, Management of outbreaks of foodborne illness in England and Wales, Available at: https://old.food.gov.uk/sites/default/files/multimedia/pdfs/outbreakmanagement.pdf [Accessed on: 20 March 2020]

Ramos, A.P., Leonhard, S.E., Halstead, S.K., Cuba, M.A., Castañeda, C.C., Dioses, J.A., Tipismana, M.A., Abanto, J.T., Llanos, A., Gourlay, D. and Grogl, M., 2021. Guillain-Barré syndrome outbreak in Peru 2019 associated with Campylobacter jejuni infection. Neurology-Neuroimmunology Neuroinflammation, 8(2).pp.34-67.

Szczepanska, B., Andrzejewska, M., Spica, D. and Klawe, J.J., 2017. Prevalence and antimicrobial resistance of Campylobacter jejuni and Campylobacter coli isolated from children and environmental sources in urban and suburban areas. BMC microbiology, 17(1), pp.1-9.

Wensley, A., Padfield, S. and Hughes, G.J., 2020. An outbreak of campylobacteriosis at a hotel in England: The ongoing risk due to consumption of chicken liver dishes. Epidemiology & Infection, 148.

Whitworth, J., 2019, U.K. sees rise in Campylobacter, Salmonella cases, Available at: https://www.foodsafetynews.com/2019/01/u-k-sees-rise-in-campylobacter-salmonella-cases/ [Accessed on: 20 March 2020]

WHO 2020, Campylobacter, Available at: https://www.who.int/news-room/fact-sheets/detail/campylobacter [Accessed on: 20 March 2020]

Wieczorek, K., Wołkowicz, T. and Osek, J., 2018. Antimicrobial resistance and virulence-associated traits of Campylobacter jejuni isolated from poultry food chain and humans with diarrhea. Frontiers in microbiology, 9, p.1508.

foodstandards.gov.au 2013, Campylobacter species, Available at: https://www.foodstandards.gov.au/publications/Documents/Campylobacter%20species%20-%20dec%202013.pdf [Accessed on: 20 March 2020]