Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, 4200 Valley Drive, College Park, MD, 20742, USA.
Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, 4200 Valley Drive, College Park, MD, USA.
Environ Res. 2020 Sep;188:109773. doi: 10.1016/j.envres.2020.109773. Epub 2020 Jun 8.
Campylobacter is a leading cause of bacterial foodborne illness in the United States. Campylobacter infections have most often been associated with food-related risk factors, such as the consumption of poultry and raw milk. Socioeconomic, agricultural and environmental factors, including drinking water source, can also influence the risk of campylobacteriosis. Approximately 19% of Maryland residents rely on private wells as their sole source of water. Given that the federal Safe Drinking Water Act does not regulate the water quality of private wells, these could be important non-foodborne transmission pathways for Campylobacter. To address this issue, data on the number of culture-confirmed cases of Campylobacter infection in Maryland between 2007 and 2016 were obtained from the Foodborne Diseases Active Surveillance Network. Cases were linked by zip code with data from the Maryland well permits registry, the 2010 U.S. Census, the 2016 American Community Survey, and the USDA Agricultural Census. Campylobacteriosis incidence rates and well prevalence were calculated by zip code. Negative binomial regression models were then constructed to evaluate the association between the prevalence of private wells, presence/absence of animal feeding operations and the incidence of campylobacteriosis across the physiographic provinces in Maryland. From 2007 to 2016, a total of 5746 cases of campylobacteriosis were reported in Maryland, and annual incidence rates ranged from 6.65 to 11.59 per 100,000 people. In our statewide analysis, a significant positive association was observed between well prevalence and increased campylobacteriosis incidence at the zip code level (Incidence Rate Ratio (IRR) = 1.35, 95% Confidence Interval (CI) = 1.11, 1.63). A significant positive association was also observed between well prevalence and increased campylobacteriosis incidence in the Appalachian and Coastal provinces of Maryland (IRR = 2.94, 95% CI = 1.11, 7.76 and IRR = 1.70, 95% CI = 1.25, 2.31, respectively). The presence of broiler chicken operations, increasing median age and percentage of residents living in poverty were also significantly associated with campylobacteriosis incidence at the zip code level in some physiographic provinces in Maryland. To our knowledge, these are the first US data to demonstrate an association between prevalence of private wells and campylobacteriosis incidence at the zip code level.
空肠弯曲菌是美国食源性细菌病的主要原因。弯曲菌感染最常与食物相关的危险因素有关，例如食用家禽和生奶。社会经济、农业和环境因素，包括饮用水源，也会影响弯曲菌病的风险。马里兰州约有 19%的居民依赖私人水井作为唯一的水源。由于联邦《安全饮用水法》不规范私人水井的水质，这些可能是弯曲菌的重要非食源性传播途径。为了解决这个问题，我们从食源性疾病主动监测网络获得了马里兰州 2007 年至 2016 年期间经培养确认的弯曲菌感染病例数的数据。通过邮政编码将病例与马里兰州水井许可证登记处、2010 年美国人口普查、2016 年美国社区调查和美国农业部农业普查的数据联系起来。根据邮政编码计算了弯曲菌病的发病率和水井的流行率。然后构建了负二项回归模型，以评估马里兰州各地理区域私人水井的流行率、动物饲养场的存在/不存在与弯曲菌病发病率之间的关系。2007 年至 2016 年期间，马里兰州共报告了 5746 例弯曲菌病病例，年发病率范围为每 100000 人 6.65 至 11.59 例。在我们的全州分析中，在邮政编码一级观察到水井流行率与弯曲菌病发病率增加之间存在显著正相关（发病率比（IRR）= 1.35，95%置信区间（CI）= 1.11，1.63）。还观察到水井流行率与马里兰州阿巴拉契亚和沿海省份弯曲菌病发病率增加之间存在显著正相关（IRR = 2.94，95%CI = 1.11，7.76 和 IRR = 1.70，95%CI = 1.25，2.31）。在马里兰州的一些地理区域，肉鸡养殖场的存在、中位年龄的增加和生活在贫困中的居民比例的增加也与邮政编码一级的弯曲菌病发病率显著相关。据我们所知，这些是美国首例证明私人水井的流行率与邮政编码一级的弯曲菌病发病率之间存在关联的数据。
