Sources and transmission routes of campylobacteriosis : A combined analysis of genome and exposure data

Mughini-Gras, Lapo; Pijnacker, Roan; Coipan, Claudia; Mulder, Annemieke C.; Fernandes Veludo, Adriana; de Rijk, Sharona; van Hoek, Angela H.A.M.; Buij, Ralph; Muskens, Gerard; Koene, Miriam; Veldman, Kees; Duim, Birgitta; van der Graaf-van Bloois, Linda; van der Weijden, Coen; Kuiling, Sjoerd; Verbruggen, Anjo; van der Giessen, Joke; Opsteegh, Marieke; van der Voort, Menno; Castelijn, Greetje A.A.; Schets, Franciska M.; Blaak, Hetty; Wagenaar, Jaap A.; Zomer, Aldert L.; Franz, Eelco


Objectives: To determine the contributions of several animal and environmental sources of human campylobacteriosis and identify source-specific risk factors. Methods: 1417 Campylobacter jejuni/coli isolates from the Netherlands in 2017–2019 were whole-genome sequenced, including isolates from human cases (n = 280), chickens/turkeys (n = 238), laying hens (n = 56), cattle (n = 158), veal calves (n = 49), sheep/goats (n = 111), pigs (n = 110), dogs/cats (n = 100), wild birds (n = 62), and surface water (n = 253). Questionnaire-based exposure data was collected. Source attribution was performed using core-genome multilocus sequence typing. Risk factors were determined on the attribution estimates. Results: Cases were mostly attributed to chickens/turkeys (48.2%), dogs/cats (18.0%), cattle (12.1%), and surface water (8.5%). Of the associations identified, never consuming chicken, as well as frequent chicken consumption, and rarely washing hands after touching raw meat, were risk factors for chicken/turkey-attributable infections. Consuming unpasteurized milk or barbecued beef increased the risk for cattle-attributable infections. Risk factors for infections attributable to environmental sources were open water swimming, contact with dog faeces, and consuming non-chicken/turkey avian meat like game birds. Conclusions: Poultry and cattle are the main livestock sources of campylobacteriosis, while pets and surface water are important non-livestock sources. Foodborne transmission is only partially consistent with the attributions, as frequency and alternative pathways of exposure are significant.