Development of a Bacteriophage Product to Control Campylobacter Contamination in Kenya

Campylobacter is the leading bacterial cause of gastroenteritis worldwide, and recent data demonstrate that it is particularly detrimental for children under age two in developing countries. Globally, Kenya has the highest case fatality rate of campylobacteriosis, with 8.8% of infected people dying, mostly children - as compared with <0.1% in most industrialized countries. Given that antibiotic resistance rates for Campylobacter are increasing, alternative sustainable options are urgently needed. To address this public health issue, we have undertaken to develop bacteriophage (phage) products to decrease Campylobacter levels, specifically targeted for applications in Kenya. Phages are naturally occurring viruses that target and kill specific bacteria, and are active against both antibiotic-resistant and antibiotic-sensitive bacteria. They are easy to isolate from contaminated environments, and relatively inexpensive to produce, and form the basis of several commercial products targeting foodborne pathogens in North America.

Kenya has the highest case fatality rate of campylobacteriosis, with 8.8% of infected people dying, mostly children. As in many other countries, poultry sources are the primary source of Campylobacter infection in Kenya, with studies demonstrating contamination in up to 77% of retail poultry samples in the capital city of Nairobi. The bacteria frequently reside in the intestinal tracts of chickens then spread to the surface of meat products during slaughter. Campylobacter-specific bacteriophage will be isolated in Kenya and characterised in preparation for their application against Campylobacter contaminating chicken meat in Kenya. While phages in North America are currently sold in liquid formats, a liquid phage product would be disadvantageous in Kenya due to the requirement for refrigeration and the bulk shipping and storing of liquid products is costly. A spray dried product will be developed that can incorporate a cocktail of phages for rehydration at the site of use. These studies will be undertaken in parallel with stakeholder engagement research.

Health and Well-Being Impacts
In contrast to Western countries where Campylobacter typically only affects adults, in developing countries Campylobacter infection is primarily a disease of childhood. This is presumably due to the fact that good hygiene practices are less common in the food chain in developing countries, so children there are more readily exposed to Campylobacter bacteria and also develop natural immunity against the bacteria by the time they become adults. Given that Campylobacter is the leading bacterial causes of diarrhoea in children in developing countries, and Kenya has the highest Campylobacter-associated death rate worldwide, a future phage product has the potential to save many lives, as well as to significantly improve overall health. And while having fewer diarrheal episodes has obvious short-term benefits, the long-term impacts are typically more profound. Studies have shown that frequent diarrhoea episodes early in life correlate with decreased physical growth, impaired cognitive development, and diminished performance in school years. Campylobacter infection of immuno-compromised members of the population can lead to increased debilitation and the need for medical intervention, and Kenya has the fourth highest HIV epidemic. Thus, by applying Campylobacter-specific phages to poultry products in Kenya, we aim to decrease the frequency of diarrhoea and thereby improve the overall well-being and productivity of the population for years to come.
Economic Impacts
Decreasing the number of Campylobacter-associated diarrhoea episodes would reduce the working days lost and also mean that families in Kenya could spend less time and money obtaining medical treatments. The mortality and long term effects of Campylobacter infection of children represent a significant loss in potential for the country.
Industry Impacts
Poultry meat producers could benefit, since applying Campylobacter phages to retail meat could circumvent negative market impact as the sources of Campylobacter are likely to become evident as Kenya addresses the root causes of child mortality.
Not only is there any commercial Campylobacter phage product available anywhere in the world, to our knowledge ours would be the first commercial application of any phage product on the African continent. In addition, ours would be the first project globally to incorporate dry powder formulated phage technology for an application in the food industry. This technology would enable the phages to be shipped and stored for extended periods of time without refrigeration, which would open the phage field more broadly to applications in developing countries. For all of these reasons, Campylobacter phages would be a first-in-class product.
Public Policy Impacts
The project hopes to bring the use of phage as a specific and sustainable anti-bacterial treatment to the attention of policymakers in Kenya. There is a general need for alternative ways to control bacterial exposure and treat bacterial infection as antibiotic resistant rates soar in developing countries.
Academic Impacts
The project offers a critical opportunity for capacity building and knowledge exchange for the Kenyan groups and the opportunity of the UK scientists to exploit research outcomes in Africa. There is opportunity for a Kenyan post-doctoral researcher to travel to the UK and work in the research laboratories to gain experience and apply the knowledge in Kenya.