As of Dec. 13, a total of 97 people in 17 states have laboratory-confirmed infections or symptoms consistent with a Campylobacter infection and are linked to this outbreak. In Ohio, 32 cases have been linked to the outbreak between June 25 and Oct. 21; six patients have been hospitalized. Nineteen of the cases occurred in females, whereas 13 were male. Individuals range in age from less than a year to 67.
The Ohio Department of Health (ODH), Ohio Department of Agriculture Animal Disease Diagnostic Laboratory (ODA ADDL), various local health departments, Centers for Disease Control and Prevention (CDC), United States Department of Agriculture, Animal and Plant Health Inspection Service (USDA APHIS) and the Food and Drug Administration (FDA) have been involved in the outbreak investigation in Ohio.
What is campylobacteriosis?
Campylobacteriosis is a common gastrointestinal disease in humans and many domestic animals. Diarrhea is the predominant sign; however, systemic manifestations can occur. More than 2,000 human cases were reported in Ohio in 2016.
Most human cases of campylobacteriosis are associated with eating raw or undercooked poultry or from cross-contamination of other foods by these items. Campylobacter can also be acquired from drinking raw milk or having contact with contaminated water.
Companion animals are known to be a potential source of infection. Epidemiologic and laboratory evidence has identified outbreak strains of Campylobacter that link ill individuals to contact with pet store puppies. Isolates from humans and dogs in this outbreak appear to be resistant to commonly recommended first-line antibiotics. Antibiotic resistance may result in an increased risk of hospitalization, development of bloodstream infections or treatment failure in patients.
Investigators are looking for the source of infection in people and puppies so they can recommend how to stop the outbreak and prevent more illnesses. For more information about the multistate outbreak investigation and the antibiotic resistance profile, visit: CDC Campylobacter Outbreaks
Animals housed in crowded conditions such as a kennel, shelter or pet store are at a higher risk for developing symptomatic Campylobacter infections. Regardless of where it comes from, however, any puppy or dog can carry, get sick from and/or shed Campylobacter. The same is true for certain other pets, including kittens and cats, ferrets, rodents, and other small mammals.
Puppies tend to have higher shedding rates of Campylobacter when compared to adult dogs and are more likely to exhibit signs and symptoms. Supportive care is recommended for dogs diagnosed with Campylobacter; however, severe infections may require antibiotic treatment. Due to the multidrug resistance pattern of the current Campylobacter outbreak strains, culture and sensitivity should be conducted to help avoid inappropriate treatment. Routine screening of healthy pets for Campylobacter colonization is not indicated. Testing asymptomatic pets in a household with human cases may be considered in an outbreak setting.
Below are some recommendations for the prevention of illness, animal testing guidelines, and answers to commonly asked questions:
Prevention Messages for Pet Owners
To prevent illness, follow these steps:
- Wash hands thoroughly with running water and soap for at least 20 seconds every time you touch dogs, their food, or clean up after them.
- Pick up and dispose of dog feces (poop), especially in areas where children might play. Use disposable gloves and wash your hands thoroughly afterwards.
- Clean up any urine (pee), feces, or vomit in the house immediately and disinfect the area. Use disposable gloves to handle anything that has touched urine, feces or vomit, and wash your hands thoroughly afterwards.
- Don’t let pets lick family members’ mouths, faces, open wounds or areas with broken skin.
- Take your dog to the veterinarian regularly to keep it healthy and to help prevent the spread of disease.
Testing Dogs for Campylobacter
The following are testing recommendations for symptomatic animals:
- Conduct a gram-stained fecal smear in dogs under 12 months of age and all dogs adopted from crowded environments or pet stores if they are showing signs of Campylobacter infection, including bloody mucoid diarrhea, to identify Campylobacter-like organisms.
- Laboratory confirmation of Campylobacter infection can be made from a culture of a fresh fecal sample transported on ice or in Cary-Blair transport medium; or a quantitative-PCR from a fresh fecal sample, in consultation with a veterinary diagnostic lab.
- Puppies and dogs with Campylobacter infection should be isolated to prevent the spread of infection. Campylobacter infections are often self-limiting and supportive care is frequently the only treatment needed.
- If a Campylobacter infection is confirmed with laboratory testing, the animal has hemorrhagic diarrhea or a fever, and antibiotic treatment is warranted: The choice of antibiotic should be guided by culture and sensitivity results to avoid inappropriate use of antibiotics. The antibiotic resistance profile for this outbreak includes the commonly used antibiotics (e.g. fluoroquinolones, macrolides). Because Campylobacter jejuni has inherent antibiotic resistance to other commonly prescribed oral antibiotics (e.g. penicillins, cephalosporins, trimethoprim-sulfamethoxazole), infections with the outbreak strains may be difficult to treat with oral antibiotics.
What do I tell a client that wants to know if their pet is colonized with or shedding Campylobacter?
- Although the true prevalence of Campylobacter in dogs is unknown, we do know that healthy, asymptomatic dogs may shed the bacteria intermittently in their stool.
- Educate your clients about the importance of prevention, which includes proper hand hygiene when cleaning up after their pets and maintaining their pets’ wellness visits to keep them healthy. If an individual is immunocompromised, that person should consult their healthcare provider.
- Asymptomatic animals are not routinely cultured for Campylobacter or other enteric pathogens. If, however, there is an infected household member—human or pet—then testing may be warranted.
Where can I submit dog stool samples for Campylobacter testing?
- The ODA ADDL has the capability to perform both culture and PCR for Campylobacter.
- Other tools used to characterize Campylobacter are whole genome sequencing (also offered at ODA ADDL) and antimicrobial susceptibility testing. For information regarding testing, please contact the ODA ADDL.
- If an illness is associated with a human case, the testing may be covered by the FDA’s Veterinary Investigation Response Network (Vet-LIRN). For more information, please contact Dr. Jennifer Jones or Dr. Olgica Ceric.
What test should I request?
- Direct fecal smears can be offered in a veterinary clinic as a screening tool for detecting Campylobacter-like organisms.
- For samples submitted to laboratories, both culture and PCR are currently being used as an aid for diagnosis.
Is campylobacteriosis a reportable disease?
In Ohio, campylobacteriosis is a reportable disease in humans but not animals. Human healthcare providers should report campylobacteriosis cases to the local health department in the jurisdiction where the case resides.
For more information
Ohio Department of Health
Bureau of Infectious Diseases
Ohio Department of Agriculture
Animal Disease Diagnostic Laboratory
Centers for Disease Control and Prevention
- Multistate Outbreak Details https://www.cdc.gov/campylobacter/outbreaks/puppies-9-17/index.html
- General Information about Campylobacter https://www.cdc.gov/campylobacter/index.html
- Healthy Pets Healthy People https://www.cdc.gov/healthypets/index.html
- National Antimicrobial Resistance Monitoring System for Enteric Bacteria https://www.cdc.gov/narms/index.html
- When and How to Wash Your Hands https://www.cdc.gov/handwashing/when-how-handwashing.html
- Pet Food Safety https://www.cdc.gov/features/pet-food-safety/index.html
Animal Disease Diagnostic Laboratory, Ohio Department of Agriculture
- Animal Disease Diagnostic Lab Home Page http://www.agri.ohio.gov/addl
- Bacteriology Submission and Shipping Guidelines http://www.agri.ohio.gov/divs/ai/addl/forms/bacti/Submissions%20Bacteriology%20Specimen.pdf
- ADDL Tests and Fees http://www.agri.ohio.gov/divs/ai/addl/addltests.aspx
- ADDL Sample Submission Form http://www.agri.ohio.gov/divs/ai/addl/forms/anim-addlsample.pdf
Food and Drug Administration
- Veterinary Laboratory Investigation and Response Network https://www.fda.gov/AnimalVeterinary/ScienceResearch/ucm247334.htm
—Submitted by Ohio Department of Health