Sporadic Reportable Bacterial Enteric Infection in Children. Part 1

In particular, water used for recreational swimming or playing contributed a leading proportion of all REI‐Bs. Although recreational water exposure has been implicated in many REI‐B outbreaks and beach water (without known contamination) has been identified as a risk for nonspecific diarrheal illnesses, this is the first study to identify this association with sporadic microbiologically confirmed REI‐Bs in the United States and the apparent magnitude of this association was surprisingly large. Most other studies of sporadic REI‐Bs have not examined recreational water exposure, and those that did have not identified such associations. Swimming in beach water has been identified as a risk factor for enterohemorrhagic E. coli infection (including, but not specifically limited to, infection with E. coli O157) and Campylobacter infection in Germany and Finland, respectively. Recreational water exposure is a plausible and potentially important risk factor for infection and merits further investigation.

We identified other non‐food associations, some of which corroborate other studies and others that are novel associations in the context of sporadic infection. For example, the risk observed here of sporadic Campylobacter infection as a result of drinking untreated surface water is in agreement with other reports, but the use of private well water and the use of septic systems have not been previously reported to be associated with sporadic infection. Our data also refine previously reported associations. For example, animal exposure as a risk for Campylobacter infection in our study was limited to children who had animals at their residence. Attention has focused on pathogen transmission in public petting zoos, and recommendations to mitigate risk in these settings have been disseminated. However, a different focus might be necessary for people living with such animals.

Some food‐related exposures warrant comment. Sprouts and cilantro, recognized transmission vehicles in outbreaks, were demonstrated to be associated with sporadic Salmonella and Campylobacter infection, respectively, but only cilantro contributed to disease burden. Suboptimal kitchen hygiene practices (i.e., not using bleach or dishwashers) after preparation of raw meat and poultry contributed an important proportion of Campylobacter infections, similar to recent findings from France. Handling practices for raw poultry and the consumption of meat or poultry prepared from raw states at home also contributed to the incidence of Campylobacter infection.

Eating foods from fast‐food and table‐service restaurants contributed especially to the incidence of Campylobacter and E. coli O157 infection, respectively, as has been previously reported. Interestingly, the risk of Campylobacter and E. coli O157 infection associated with domestic travel did not appear to be related to eating food from commercial venues, as the risk was not modified by adjusting for any of the restaurant type exposures. Perhaps this risk relates to hygiene lapses during family travel.

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