Sources, Seasonality, Transmission and Control: Campylobacter and human behaviour in a changing environment

Lead Research Organisation: University of Liverpool
Department Name: Clinical Sciences

Abstract

Few of us would expect to die after a bout of diarrhoea. But the fact is that diarrhoeal disease kills. It can also lead to long-term, debilitating illnesses that adversely affect our industrial productivity and drain significant financial resource from our health and social services. Yet, much about what causes these potentially fatal diseases remains a mystery, not least because research to date has focused largely on one corner of the jigsaw. Our research will change this. Many of the organisms that cause diarrhoea occur naturally in animals. Some are easily transmitted to humans and have managed to adapt to - and thrive in - their new habitat. These organisms are abundant in the environment and there are countless ways for them to get into the human body. Until now, research has concentrated on contaminated food or water as the potential source of disease. No-one has yet studied the extent to which humans collude in their own misfortune. Is there something we do or fail to do that makes some of us more susceptible than others to these diseases? Our research unites experts from a wide variety of disciplines to answer these and other questions about what causes and spreads diarrhoeal disease. We will use Campylobacter spp, the most common bacterial cause of diarrhoea in the developed world, as our case study. In 2010, there were an estimated 700,000 cases of Campylobacter spp in the UK. Around 200 people died; others developed irritable bowel syndrome, arthritis and paralysis. The annual UK cost of acute Campylobacter infection alone tops #600 million, more than the cost of Salmonella, Listeria and E. coli O157 combined. Yet we still do not know how half the cases arose. About 40% of cases occur during the spring peak . Yet we know little if anything about what happens in the environment, or to our food supply, or to our own behaviour to cause this. So our research will investigate and capture what does happen - to us, to our environment and to society - at a number of different intervals, in a variety of locations and over a range of different time periods so we can understand how all these factors combine to influence Campylobacter infection. This type of analysis will benefit future research into how social and ecological systems interact with and affect other organisms that cross the species boundary between animals and people.

Technical Summary

Diarrhoeal disease is an important global killer that causes major health and economic problems. Many organisms that cause it are zoonotic. They are widely distributed in the environment and there are several pathways to human disease. Research into diarrhoeal disease to date has been largely biomedical and focussed mainly on transmission through contaminated food or water. Fundamental gaps in our knowledge remain, namely the contributions of human behaviour and human-environment interactions influencing exposure to organisms and risk of disease. We propose a ground-breaking programme, bringing together scientists from a wide variety of disciplines in a ?one health? approach to tackle these fundamental knowledge gaps using Campylobacter spp. as an example. Important in its own right, Campylobacter is the most common bacterial cause of diarrhoeal disease in the developed world. It caused an estimated 700,000 cases in the UK in 2010 with ~200 deaths. Extreme outcomes include irritable bowel syndrome, arthritis and paralysis. The current, underestimated, annual UK cost of Campylobacter infection alone is #600m, exceeding that from Salmonella, Listeria and E. coli O157 combined. The transmission pathways for ~50% of human cases are unknown. Seasonal dynamics are central to the disease burden because ~40% of cases occur during the ?spring peak?, yet the relative roles of environmental and food pathways, and their interaction, in this seasonal emergence are poorly understood. To make major progress we face two important challenges. The first is to develop new methods that incorporate environmental and social systems to understand how they interact with Campylobacter. Secondly, since the behaviours of both humans and Campylobacter involve processes that play out over different temporal and spatial scales, the new methods we develop need to capture this. The challenge of analysing systems and data at different scales, whilst minimising loss of information in so doing, will be generally applicable to research on the interaction of social and ecological systems and zoonoses.

Publications

10 25 50
 
Description Acting Together on Campylobacter - Accelerated Solutions Event
Geographic Reach National 
Policy Influence Type Participation in a national consultation
Impact This Accelerated Solutions Event (ASE) was designed to develop effective interventions against Campylobacter in the Food Chain. The output has directly influenced the Campylobacter Risk Management plan developed by the Food Standards Agency with a view to decreasing the human toll of Campylobacter infection by reducing contamination on poultry carcases.
URL https://www.food.gov.uk/news-updates/campaigns/campylobacter/actnow
 
Description Advisory Committee Sub-Group on Campylobacter
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description NIHR Health Protection Research Unit Competition
Amount £3,816,917 (GBP)
Funding ID HPRU-2012-10038 
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 03/2014 
End 04/2019
 
Description Tender: Estimating Quality Adjusted Life Years and Willingness to Pay Values for Microbiological Foodborne Disease (Phase 2)
Amount £279,015 (GBP)
Funding ID FS102087 
Organisation Food Standards Agency (FSA) 
Sector Public
Country United Kingdom
Start 11/2015 
End 12/2016
 
Description The GCRF One Health Poultry HUB
Amount £20,000,000 (GBP)
Organisation Research Councils UK (RCUK) 
Sector Public
Country United Kingdom
Start 02/2019 
End 02/2024
 
Description United Kingdom Food Standards Agency Electronic Tender System
Amount £2,101,482 (GBP)
Funding ID FS101040 
Organisation Food Standards Agency (FSA) 
Sector Public
Country United Kingdom
Start 01/2014 
End 05/2017
 
Description Wellcome Trust/Department of Health Health Innovation Challenge Fund
Amount £4,240,745 (GBP)
Funding ID HICF-T5-354 
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 04/2013 
End 03/2016
 
Description "Walking the Seasons" 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation Workshop Facilitator
Geographic Reach Regional
Primary Audience Participants in your research and patient groups
Results and Impact Members of the public attended recruitment sessions for "Walking the Seasons" and we were overwhelmed with volunteers, who have supported each other and us in sampling the landscape throughout the year.

The walkers that we have recruited, who are all volunteers from rambling groups, have embraced the study. One group, based in Cheshire, baked a Campylobacter-themed birthday cake whilst another group, based in Lancashire, have written a poem about the study!
Year(s) Of Engagement Activity 2013
 
Description ESEI Funders' Meeting 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach National
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Presentation to other people funded under the ESEI and EEHI intiatives.

Formed links with Eric Fevre's ESEI project through a joint PhD studentship supervised by Jonathan Rushton at LCIRAH.
Year(s) Of Engagement Activity 2013
 
Description ESRC Impact Accelerator Award 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Schools
Results and Impact Using an ESRC Impact Accelerator Award we have worked with the Chilled Education and the Food Teachers Centre to develop the "Food Bug Club" website. The site brings together inspiring food safety classroom resources for food and science teachers as well as providing a platform for new material as it is developed.
Year(s) Of Engagement Activity 2015,2016
URL http://foodbugclub.net/
 
Description Food Safety Week 2014 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact The purpose of the meeting was to brief journalists about the Food Standards Agency's Food Safety Week campaign on Campylobacter and to demonstrate to journalists how to cook chicken properly. It took place at the Good Housekeeping Institute, where the cookery demonstration also took place. As well as the journalists who attended in person there was also a Google Drop-in event so that people who could not attend in person could still take part and ask questions. The event sparked a lot of discussion about not washing chicken before cooking it and few of the journalists realised how serious an illness Campylobacter could be or how many people were affected in a year. There was a lot of coverage of the event in the national press.

Participation in the event prompted more media interviews and briefings.
Year(s) Of Engagement Activity 2014
URL https://www.food.gov.uk/news-updates/campaigns/campylobacter/fsw-2014/fsw-2014
 
Description Great British Biosicence Festival - A twisted bug's life 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Can't answer this yet because meeting is next week
Year(s) Of Engagement Activity 2014
URL http://www.bbsrc.ac.uk/society/exhibitions/gb-bioscience-festival/twisted-bugs-life.aspx
 
Description Presentation to Roslin Inst Edinburgh 25th October 2016 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Postgraduate students
Results and Impact A presentation to the BBSRC Roslin Institute in Edinburgh entitled: A pot-pourri of GI pathogen anecdotes: Campylobacter, STEC and Anisakiasis
Year(s) Of Engagement Activity 2016