Risk factors for salmonella gastroenteritis in children less than five years of age in Taiwan.

BACKGROUND

Nontyphoid Salmonella spp. have been among the most common pathogens of acute gastroenteritis in children in Taiwan. However, the principal sources of transmission remain poorly defined.

METHODS

A matched case-control study was conducted from January 2009 to October 2010. Cases were children aged 2-60 months who were hospitalized at 3 medical centers in Taiwan because of diarrhea and found to have culture-proven nontyphoidal Salmonella infection. Controls were healthy children or children with acute diseases other than gastroenteritis and matched to cases by age, gender, study site and enrollment date.

RESULTS

A total of 396 cases and 930 matched controls were included for analysis. Multivariate analysis using conditional logistic regression identified contact with household members having diarrhea (matched odds ratio [mOR], 17.9; 95% confidence interval [CI]: 8.82-36.34; P < 0.0001), consumption of instant powdered milk (mOR, 2.04; 95% CI: 1.05-3.94; P = 0.0344), visits to health-care facilities (mOR, 1.66; 95% CI: 1.12-2.48; P = 0.0126) and consumption of purchased groundwater (mOR, 1.50; 95% CI: 1.06-2.11; P = 0.0214) within 1 week preceding enrollment as independent factors associated with increased risk of salmonellosis. Hand washing before meals (P = 0.0311), breastfeeding (P = 0.0370), consumption of chicken (P = 0.0019) and consumption of food prepared by caregivers (P = 0.0011) were protective against Salmonella infection.

CONCLUSIONS

The principal transmission routes of Salmonella infection in Taiwanese children are person-to-person, waterborne and environmental contacts. The possibility of powdered milk and groundwater contamination of Salmonella cannot be excluded and requires further investigation.