Campylobacteriosis

Reporting Information

Class B

Report a case, suspected case, and/or positive laboratory result to the local public health department in which the patient resides by the close of the next business day. If patient residence is unknown, report to the local public health department in which the reporting healthcare provider or laboratory is located.

Reporting Form(s) and/or Mechanism

The Ohio Disease Reporting System (ODRS) should be used to report cases and lab findings to the Ohio Department of Health (ODH). For healthcare providers without access to ODRS, the Ohio Confidential Reportable Disease Form (HEA 3334) may be used.

The Positive Laboratory Findings for Reportable Disease Form (HEA 3333) may be used for laboratories without access to ODRS or electronic laboratory reporting (ELR) to report positive results.

The Ohio Campylobacteriosis Case Investigation Form is available for use by the local public health department when following up with cases. Do not send this form to ODH; information collected from the form should be entered into ODRS where fields are available, and the form should be uploaded in the Administration section of ODRS.

Key Fields for ODRS Reporting

• Import status: whether the infection was travel-associated or Ohio-acquired.
• Date of illness onset.
• All fields in the Epidemiology module.
• Lab test: please specify if the test was a culture or antigen.

Agent

Campylobacter jejuni and, less commonly, C. coli are the usual causes of Campylobacter diarrhea in humans. Other Campylobacter organisms, including C. lari, C. fetus, and C. upsaliensis have also been associated with diarrhea in normal hosts. C. ureolyticus is also occasionally reported, usually from wounds. As of 1989, C. pylori was reclassified as Helicobacter pylori, which is not a reportable disease in Ohio.

Infectious Dose

A very small number of Campylobacter organisms (fewer than 500) can cause illness in humans.

Case Definition

Background

Campylobacteriosis is a bacterial illness that generally causes a self-limited clinical illness typically characterized by diarrhea (frequently with bloody stools), abdominal cramps, malaise, fever, nausea, and vomiting; asymptomatic infection also occurs frequently. Severe symptoms and invasive infections can also occur, and persons with Campylobacter infections are at increased risk for three post-infectious complications: Guillain-Barré syndrome (GBS), reactive arthritis, and irritable bowel syndrome.

Clinical Criteria

An illness of variable severity commonly manifested by diarrhea, abdominal pain, nausea, and sometimes vomiting. The organism may also rarely cause extra-intestinal infections such as bacteremia, meningitis, or other focal infections.

Laboratory Criteria for Diagnosis

Probable

Detection of Campylobacter spp. in a clinical specimen using a culture-independent diagnostic test (CIDT). The antigen test is a culture-independent diagnostic test.

Confirmed

Isolation of Campylobacter spp. from a clinical specimen.

Epidemiologic Linkage

A clinically compatible case that is epidemiologically linked to a case that meets the probable or confirmed laboratory criteria for diagnosis.

Case Classification

Probable

A case that meets the probable laboratory criteria for diagnosis or a clinically compatible case that is epidemiologically linked to a probable or confirmed case of campylobacteriosis.

Confirmed

A case that meets the confirmed laboratory criteria for diagnosis.

Not a Case

This status will not generally be used when reporting a case, but may be used to reclassify a report if an investigation revealed that it was not a case.

Criteria to Distinguish a New Case from an Existing Case

A case should not be counted as a new case if laboratory results were reported within 30 days of a previously reported infection in the same individual.

Comments

Campylobacteriosis was made a nationally notifiable disease in 2015.

The use of CIDTs as stand-alone tests for the direct detection of Campylobacter in stool is increasing. Data regarding their performance indicate variability in the sensitivity, specificity, and positive predictive value of these assays depending on the manufacturer (CDC unpublished data). It is therefore useful to collect information on the laboratory conducting the testing using the laboratory’s unique Clinical Laboratory Improvement Amendments (CLIA) number and, when possible, type and manufacturer of the CIDT used to diagnose each case. Culture confirmation of CIDT-positive specimens is ideal, but not practical to achieve in most jurisdictions. Examples of CIDT are: antigen testing, DNA (PCR) testing.

Signs and Symptoms

Symptoms can be mild to severe. Fever, headache, myalgia, and malaise can occur 12-24 hours before onset of intestinal symptoms, which include diarrhea (stool might contain blood or mucus), abdominal pain, vomiting, and nausea. Symptoms last from one day to one week or longer.

Diagnosis

Campylobacteriosis is diagnosed by means of stool culture or CIDT; see case definition above. Most hospital laboratories have the ability to identify Campylobacter.

ODH Laboratory performs testing for campylobacteriosis. In some circumstances testing can be done at the ODH Laboratory without charge. To arrange for testing at ODH Lab, contact the ODH Bureau of Infectious Diseases (BID) at (614) 995-5599. If specimens or isolates are being sent to ODH Laboratory for further testing, the Ohio Department of Health (ODH) Laboratory Microbiology Specimen Submission Form (HEA 2530) needs to be submitted with the specimens.

Epidemiology

Source

Campylobacter is commonly found in healthy wild and domestic animals. The most important sources to humans are poultry, cattle, puppies, kittens, swine, sheep, rodents, and birds. The majority of human cases probably result from consumption of contaminated food (especially chicken) and water. Campylobacter can survive for months in surface water at 4°C (40°F).

Occurrence

Campylobacteriosis occurs worldwide. In developed countries, the incidence is at least as high as that of Salmonella. In 2018, over 2,000 cases were reported in Ohio, for the second year in a row. The majority of cases occur from July through October. Most recognized cases occur in children <5 years of age, adults 20-39 years of age, and adults >60 years of age. All ages are at risk.

Mode of Transmission

Campylobacteriosis is acquired via the fecal-oral route from undercooked meat (especially poultry), contaminated food or water, or raw milk as well as from direct contact with infected pets, livestock, or infected infants. Foods can become cross-contaminated from poultry via raw meat juice or misuse of cutting boards. Person-to-person transmission is uncommon.

Period of Communicability

Throughout the acute phase (several days to several weeks), the organism is present in the stool and is communicable. In the absence of antimicrobial therapy, the organism can be excreted for two to seven weeks post-infection. Convalescent excretion does not usually extend beyond three months post-infection. The chronic carrier state in humans is rare.

Incubation Period

1-10 days, usually 2-5 days.

Public Health Management

Case

Investigation

All cases reported to the local health department should initially be followed up with a telephone call to obtain demographic and epidemiologic data. If the case worked at or recently obtained a puppy from any of the following: pet store, humane society, animal shelter, or rescue operation, secure the human case isolate or positive specimen for further testing at ODH Lab and notify ODH BID at (614) 995-5599.

No further work-up is recommended if neither the case nor any household member is employed in a sensitive occupation (direct food handling, direct patient care, employee in a child care center who handles food or directly cares for children) or attends a child care center, unless there is evidence that the case is part of an outbreak.

Treatment

Antimicrobial treatment for Campylobacter infection is usually not indicated. Campylobacter organisms are susceptible in vitro to the following: erythromycin, tetracyclines, and quinolones. Antimicrobial agents can reduce the duration of symptoms if given early in the illness and are indicated in invasive cases. Antimicrobial resistance is an emerging problem with Campylobacter.

Isolation and Follow-Up Specimens

Ohio Administrative Code (OAC) 3701-3-13 (B) states:

"Campylobacteriosis: a person with campylobacteriosis who attends a child care center or works in a sensitive occupation shall be excluded from the child care center or work in the sensitive occupation and may return when the following conditions are met:

1. A child may return to a child care center after his or her diarrhea has ceased.
2. A person may return to work in a sensitive occupation after diarrhea has ceased, provided the person's duties do not include food handling.
3. A food handler may return to work only after diarrhea has ceased and one of the following conditions are met:
   • Forty-eight hours of effective antimicrobial therapy; or
   • Two consecutive follow-up stool specimens are negative for Campylobacter."

Obtain the first stool specimen no sooner than 48 hours after cessation of diarrhea or, if being treated, at least 48 hours after completion of antibiotic therapy. Obtain the remaining specimen(s) at least 24 hours apart.

Contacts

If a household contact (of a confirmed case) is employed in a sensitive occupation or is a child care center attendee, all household members with diarrhea should be tested for Campylobacter and treated if positive.

Prevention and Control

Meat, especially poultry, should be thoroughly cooked. Avoid cross contamination of other foods, especially fruits and vegetables, with raw meat juices. Avoid unpasteurized milk and untreated water. Hand washing after contact with animals can also help prevent campylobacteriosis.

Thorough hand washing should be emphasized, especially after bowel movements, changing diapers, and before eating or preparing food.

Food Handlers

Symptomatic persons should be excluded from work. As detailed in Isolation above, food handlers may only return to work after diarrhea has ceased, and either 48 hours of effective antimicrobial therapy or 2 consecutive follow-up stool specimens are negative for Campylobacter.

Food Service Operation rules also pertain to this situation. Campylobacteriosis is a disease which can be transmitted through food. Persons infected with a disease that is communicable by food are not permitted to work as food handlers. For additional information, refer to Ohio Administrative Code (OAC) 3717-1-02.1 Ohio Uniform Food Safety Code Management and Personnel: Employee Health.

Healthcare Workers, Child Care Workers, and Children Who Attend Child Care Centers

Symptomatic persons should be excluded from work. As detailed in Isolation above, persons in these sensitive occupations and children who attend child care centers may return when diarrhea has ceased, provided their duties do not include food handling.

Child Care Center Outbreak Control

Whenever a case of campylobacteriosis has been identified in a child care center attendee or worker, staff and children who are symptomatic and in the same classroom as the case should be cultured for Campylobacter. Arrangements to have this testing performed at ODH Laboratory can be made by contacting ODH BID at (614) 995-5599.

Special Information

Persons with diarrhea of infectious or unknown cause (e.g., confirmed or suspect cases of campylobacteriosis) are not permitted to work in sensitive occupations, according to Ohio Administrative Code (OAC) 3701-3-13 (H) which states: "Diarrhea, infectious or of unknown cause: a person with diarrhea, of infectious or unknown cause, who attends a child care center or works in a sensitive occupation shall be excluded from the child care center or work in the sensitive occupation and may return only after diarrhea has ceased. A person with infectious diarrhea of known cause shall be isolated in accordance with the provisions of the rule set forth for the specified disease."

" 'Sensitive occupation' means direct food handling, direct patient care, the handling of food or provision of direct care to children in a child care center, or any other occupation which provides significant opportunity for an infected individual to transmit infectious disease agents" per Ohio Administrative Code (OAC) 3701-3-01 (X).