1. No category

13.4.2015
Understanding
Campylobacter infections
Mirko Rossi DVM, PhD
Ass. Professor in Environmental Hygiene, Faculty of Veterinary Medicine
www.helsinki.fi/yliopisto
13.4.2015
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Ulla-Maija Kärkkäinen ISLAB, Kuopio
Tamara Tuuminen ISLAB, Mikkeli
Jaakko Uksila CFHC, Jyväskylä
Hilpi Rautelin Uppsala University
Human studies
Hakkinen Marjaana EVIRA
Chicken study
Jukka Corander UH
Sam Sheppard University Swansea
Ann-Katrin Llarena
Chicken study
Professor Marja-Liisa Hänninen
Conceived and designed the studies
Dr. Ji Zhang
developing GeP
Dr. Rauni Kivistö
Sara Kovanen
Human studies
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Campylobacter
• The most commonly reported
gastrointestinal bacterial pathogen in
humans in the European Union (EU) –
estimated 9 mil/year infections
•
C. jejuni/ C. coli – 95% infections
(~90% of C. jejuni)
• The cost (public health systems and to
lost productivity) in the EU is estimated
to be around EUR 2.4 billion/year
• Acute self-limiting enteritis and severe
post-infections sequelae
www.helsinki.fi/yliopisto
13.4.2015
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13.4.2015
Campylobacteriosis in Finland
and EU – incidence
Reported cases
over 100 000 pop.
140
120
~ 80
100
80
Uusima
FI (Aver - SD w/o Uusimaa)
60
Finland
40
~ 60
20
0
2009
2010
2011
2012
2013
Source THL - 2015
2014
www.helsinki.fi/yliopisto
13.4.2015
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Campylobacteriosis in Finland
and EU – incidence
Reported cases
over 100 000 pop.
140
120
100
80
Uusima
FI (Aver - w/o Uusimaa)
Finland
60
EU
40
20
0
2009
2010
2011
2012
2013
Source THL, EFSA - 2015
2014
www.helsinki.fi/yliopisto
13.4.2015
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Summer peak – risk factors
(Schönberg-Norio et al. 2004)
No of cases
Finland Total
(Source THL)
1000
June-Sept July
800
600
400
200
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Tasting or eating raw or
undercooked meat
Drinking water from a dug
well
Swimming in lakes and rivers
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2
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Diversity of C. jejuni in Finland
(De Hann et al., 2012)
898 isolates (1996-2010)
1
2
3
4
P < 0.05
1 = Chicken and Human
2 = Bovine, wild birds, Helsinki zoo
3 = Bovine
4 = Natural water
www.helsinki.fi/yliopisto
13.4.2015
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Defining the source of infection
Wild birds
Natural water
1
2
3
4
1
2
3
4
Poultry
Bovine
www.helsinki.fi/yliopisto
(De Hann et al., 2012)
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Defining the source of infection
Similar results in UK
PIG
ENVIRONMENT
WILD BIRD
Wilson et al., 2008 PLoS Genetics
CATTLE
CHICKEN
SHEEP
Eläinlääketieteellinen tiedekunta / Henkilön nimi /
Esityksen nimi
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13.4.2015
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3
13.4.2015
EFSA-BIOHAZ estimation
¯Campylobacter spp.
positive flocks = most costeffective measure in
controlling human
infections
↑ broiler production/consumption
↑ campylobacteriosis
50–80% of all campylobacteriosis
cases are associated with the chicken
reservoir as a whole
www.helsinki.fi/yliopisto
13.4.2015
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Does this strategy have the same
impact in all the EU countries?
Prevalence in Broiler
Human notification rate
• UK
80 %
• UK
• Denmark
13 %
• Denmark
67.3
• Finland
74.9
• Finland
5 %*
104.0
* (Jun-Sept)
Values notificated for 2013
(EFSA, 2015)
Eläinlääketieteellinen tiedekunta / Henkilön nimi /
Esityksen nimi
13.4.2015
www.helsinki.fi/yliopisto
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Overlapped dominant sequence
types of human and avian C. jejuni
Human 1996 - 2012
Broiler 2004 - 2012
De Hann et al., 2010; AEM
Kovanen et al., 2014; JCM
Llarena et al, 2015; PLoSONE
ST-45
27 %
ST-45
33 %
Others (<2%)
34 %
others (< 4%)
39 %
ST-677
11 %
ST-50
11 %
ST-137
4%
ST-677
9%
ST-267
ST-230 2 %
6%
ST-11
4 % ST-50
3 % ST-451
ST-230
5%
6%
ST-267
6%
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Seasonality of prevalence of the
dominant sequence types in poultry
Llarena et al, 2015; PLoSONE
Broiler 2004 - 2012
ST-45
33 %
Others (<2%)
34 %
ST-677
9%
ST-11
4 % ST-50
3 % ST-451
ST-230
5%
6%
ST-267
6%
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13.4.2015
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”Cryptic outbreaks”: common source in
sporadic cases?
Kovanen et al, 2014; JCM
Whole genome analysis using ~70% of total loci
(~1200 vs 7 loci of MLST)
Human domestic cases 2012 from three hospital districts
1 to 8 allele differences
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13.4.2015
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No overlapping between avian
and human genotypes Kovanen et al., submitted
www.helsinki.fi/yliopisto
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13.4.2015
Temporary shift in the summer peak
in poultry vs human at ST level
Kovanen et al., submitted
www.helsinki.fi/yliopisto
Decreased impact of chichen
meat
Kovanen et al., submitted
www.helsinki.fi/yliopisto
Calibrating genetic diversity: more
complex than expected
Rossi & Zhang, unpublished
www.helsinki.fi/yliopisto
13.4.2015
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13.4.2015
Spatial-temporal evolution of ST-45cc:
introgression or clonal expansion?
Rossi & Zhang, unpublished
www.helsinki.fi/yliopisto
13.4.2015
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Spatial-temporal evolution of ST-45cc:
introgression or clonal expansion?
Rossi & Zhang, unpublished
www.helsinki.fi/yliopisto
13.4.2015
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Conclusion
• The use of genomics in our recent studies has
revealed more complex epidemiological
scenarios and ecological dynamics than
previously believed
• It is still unclear how and through which routes
different populations and sub-populations of C. jejuni
circulating in animals might impact the incidence of
Finnish campylobacteriosis
• Will a ¯Campylobacter spp. positive flocks in Finland
significantly affect the incidence of
campylobacteriosis?
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