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Campylobacter epidemiology: a descriptive study reviewing 1 million cases in England and Wales between 1989 and 2011
  1. Gordon L Nichols1,2,3,
  2. Judith F Richardson1,
  3. Samuel K Sheppard4,5,
  4. Chris Lane1,
  5. Christophe Sarran6
  1. 1HPA Colindale, Health Protection Agency, London, UK
  2. 2University of Thessaly, Larissa, Greece
  3. 3University of East Anglia, Norwich, UK
  4. 4Department of Zoology, University of Oxford, Oxford, UK
  5. 5Institute of Life Science, College of Medicine, Swansea University, Swansea, UK
  6. 6Met Office, Exeter, Devon, UK
  1. Correspondence to Professor Gordon L Nichols; gordon.nichols{at}hpa.org.uk

Abstract

Objectives To review Campylobacter cases in England and Wales over 2 decades and examine the main factors/mechanisms driving the changing epidemiology.

Design A descriptive study of Campylobacter patients between 1989 and 2011. Cases over 3 years were linked anonymously to postcode, population density, deprivation indices and census data. Cases over 5 years were anonymously linked to local weather exposure estimates.

Setting Patients were from general practice, hospital and environmental health investigations through primary diagnostic laboratories across England and Wales.

Participants There were 1 109 406 cases.

Outcome measures Description of changes in Campylobacter epidemiology over 23 years and how the main drivers may influence these.

Results There was an increase in Campylobacter cases over the past 23 years, with the largest increase in people over 50 years. Changes in the underlying population have contributed to this, including the impacts of population increases after World War I, World War II and the ‘baby boom’ of the 1960s. A recent increase in risk or ascertainment within this population has caused an increase in cases in all age groups from 2004 to 2011. The seasonal increase in cases between weeks 18 (Early May) and 22 (Early June) was consistent across ages, years and regions and was most marked in children and in more rural regions. Campylobacter prevalence by week in each region correlated with temperature 2 weeks before. There were higher prevalences in areas with a low population density, low deprivation and lower percentage of people of ethnic origin. Data from sero–phage and multilocus sequence typing show a few common types and many uncommon types.

Conclusions The drivers/mechanisms influencing seasonality, age distribution, population density, socioeconomic and long-term differences are diverse and their relative contributions remain to be established. Surveillance and typing provide insights into Campylobacter epidemiology and sources of infection, providing a sound basis for targeted interventions.

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Footnotes

  • To cite: Nichols GL, Richardson JF, Sheppard SK, et al. Campylobacter epidemiology: a descriptive study reviewing 1 million cases in England and Wales between 1989 and 2011. BMJ Open 2012;2:e001179. doi:10.1136/bmjopen-2012-001179

  • Contributors GLN compiled the surveillance data and did the descriptive analysis. JFR compiled the phenotyping data. SKS compiled the genetic typing data. CL linked surveillance data to geographic markers, population density and socioeconomic variables. CS linked the location and date with recent local rainfall and temperature. All contributed to the final manuscript.

  • Funding There was no funding associated with this work. Work was conducted using the in-kind resources of the contributing organisations only.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Surveillance data only.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The descriptive data presented in the paper are available for use by others. Numbers for the figures are available as a supplementary file with this paper and on the Dryad website. The evidence base for table 2 is also available.

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