This leaflet has been put together to provide background information and advice on what to do if there is a risk of spread of Campylobacter in the home (household setting). This briefing material has been produced for those who work in the healthcare professions, the media and others who are looking for background understanding of hygiene issues related to Campylobacter and/or those who are responsible for providing guidance to the public on coping with hygiene issues associated with Campylobacter .
What is Campylobacter?
Campylobacter is a bacterium that causes gastroenteritis. Campylobacter has been known to be the cause of disease in animals since 1909, but has only been recognised since 1972 as a cause of human illness. Campylobacter is now the most commonly identified bacterial cause of diarrhoea in the developed and developing world. The main species that infect humans are Campylobacter jejuni and
Campylobacter coli . Infections occur more frequently in summer months than in the winter.
Symptoms include diarrhoea, vomiting, stomach pains and cramps, fever, and generally feeling unwell. They usually develop within two to five days, but can take as long as 10 days. Most cases start to clear up after two to three days of diarrhoea and from 80 to 90% settle within one week. Most people recover without the need for treatment.
Where is Campylobacter found?
Campylobacter live in the intestinal tracts of wild and domestic animals and birds
(especially poultry). During slaughtering a percentage of poultry carcasses become infected from the bacteria in the intestinal tract of infected birds. Campylobacter is thus found in raw poultry and raw meat. Mushrooms and shellfish can also be contaminated but this is unusual. It can be present in unpasteurised cow’s milk.
Campylobacter is also found in the gut and faeces of people who have become infected. Those who are infected with it can continue to shed the organism in their faeces for a time after recovery.
It is sometimes present in natural non-chlorinated water sources such as streams and ponds, or poorly maintained or under-chlorinated private water supplies.

Most data on GI disease comes from outbreaks reported to national surveillance. The annual Community Summary Report by the European Food Safety Authority (EFSA) and European Centre for Disease Prevention and Control (ECDC), gives an overview of the latest trends and figures on the occurrence of zoonoses and zoonotic agents in humans, animals and foodstuffs in the 27 European Union (EU) Member States and the European Free Trade Association (EFTA) countries.
1 Further information on the incidence and prevalence of Salmonella food borne infection can be found European
Centre for Disease Prevention and Control Annual Epidemiological Report.
2 These publications are updated annually. Data for the US is generated through the National
Outbreak Reporting System.
3
How does Campylobacter get into the home?

Through infected foodstuffs brought into the home (most commonly red and white meats, and milk):
- studies confirm that Campylobacter is present in retail poultry in many/most countries across the world, although the rates of infection (the percentage of samples which are contaminated) vary significantly from one country to another.
- the European Community Summary Report on foodborne infections states that
Campylobacter were most commonly detected in fresh poultry meat where on average 30% samples were positive, although rates varied considerably between differing countries, ranging from 3-86%.
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- a UK study showed that almost 6% of the outside of retail poultry packaging is contaminated with Campylobacter
- in the United States, more than half of raw chicken is estimated to be contaminated with Camplylobacter
- a survey of retail poultry in Bangkok and Nairobi revealed Campylobacter contamination rates of 40 and 77%

An infected family member or a person who is a Campylobacter carrier may act as the primary source of infection in the home.

Through domestic pets. In the United States, up to 39% of dogs may carry
Campylobacter .

Infection can occur from drinking contaminated water

Infection has been known to occur from doorstep milk pecked by infected birds
Campylobacter will not grow in food stored at room or fridge temperatures, but will survive. Campylobacter does not survive well on environmental surfaces, particularly dry surfaces. It will rapidly die out, but small numbers can survive for periods of 4 hours or more. This is important because the infectious dose (the number of surviving cells needed to cause infection) is small and may be as low as 100-500 cells.
How do people become infected?
Campylobacter spreads via the common routes for stomach bugs. It enters the body to infect the gastrointestinal tract via the mouth. It gets into the mouth either by eating contaminated food or by contaminated hands (fingers) touching the mouth. Most infections occur as a result of eating contaminated food.
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
Food can be contaminated with Campylobacter because it has not been properly cooked or properly stored, or because, after cooking, it has been contaminated from “dirty hands” or contact with contaminated raw food.

Hands can be contaminated in a whole variety of ways such as visiting the toilet, handling contaminated food or touching a surface which has been in contact with contaminated food (e.g. a chopping board) or has been touched by someone else with contaminated hands (tap handles). The hands can also become contaminated by direct contact with animals or their faeces.
This means that:
1. Foodborne infection can occur by:

Eating undercooked contaminated meat or meat products, poultry or poultry products, eggs and eggs products

Direct or indirect cross-contamination from contaminated raw food e.g. poultry or other food which may be eaten without further cooking, e.g. salads.
- following preparation of Salmonella and Campylobacter -contaminated chickens in domestic kitchens, these species were isolated from 17.3% of hands, and hand and food contact surfaces. Isolation rates were highest for hands, chopping boards and cleaning cloths (25, 35 and 60%, respectively, of surfaces sampled).

Infected food handlers (who may have no symptoms of illness) can contaminate food during preparation and handling.
It is impossible to tell from its appearance whether food is contaminated with
Campylobacter . It will look, smell and taste normal so correct handling and cooking are very important.
2. Person-to-person spread of infection:
Transmission from an infected person to other family members is less common, but can occur especially when someone has diarrhoea or is faecally-incontinent. Person to person transmission is most likely to occur among toddlers who are not toilet trained. Family members and playmates of these children are at high risk of becoming infected. Person to person spread from a case by close contact usually occurs during the acute diarrhoeal phase of the illness.
Campylobacter infection from infected pets and other animals is also possible.
Further information on the occurrence, survival and transmission of Campylobacter in a 2013 IFH report 4
Incidence of Campylobacter infections
Worldwide, bacterial food-borne zoonotic infections are the most commonly reported cause of human intestinal disease, with Salmonella and Campylobacter accounting for over 90% of all reported cases of bacteria-related food poisonings. It is estimated that one third of populations in developed countries are affected by food-borne diseases every year. The 2003 World Health Organization (WHO) report concluded that about 30% of reported foodborne outbreaks in the WHO European Region over the previous decade were caused by food consumed in private homes.
The European Community Summary Report on foodborne infections
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states that the notification rate and confirmed number of human
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campylobacteriosis in the European Union increased in 2010 compared with 2009.
Human campylobacteriosis has followed a significant increasing five-year trend in the
European Union, since 2006 and continued to be the most commonly reported zoonosis with 212,064 confirmed cases. The proportions of Campylobacter -positive food and animal samples remained at similar levels as in previous years, with the occurrence of Campylobacter continuing to be high in broiler meat, at European
Union level
In reality only a small proportion of the total cases (which includes outbreaks and sporadic (individual) infections) gastrointestinal infections are reported to surveillance. An estimate of the true infection rates comes from a UK study of the incidence of GI in the UK in the community which indicates that there are up to 17 million sporadic community cases of infectious intestinal disease annually. Of these,
Campylobacter accounts for 500,000 cases and 130,000 GP consultations.
5 The data suggest that up to 1 in 4 people in the UK suffer from a GI illness every year.
This community-based study, estimated that, for every one reported case of
Campylobacter , another 9.3 cases occur in the community.
In the US, a 1999 report on food-related illness estimated that foodborne pathogens cause 76 million illnesses each year.
6 Most frequently recorded pathogens were
Campylobacter , Salmonella and norovirus, which accounted for 14.2, 9.7 and 66.5%, respectively, of estimated foodborne illnesses. Data suggest that the total number of reported outbreaks has not declined substantially in recent years, ranging from 980-
1400 outbreaks, and between 20,000 and 80,000 cases per year for the years 2000-
2005. The report assessed that 20% of Campylobacter cases (490,785 of 2,453,926 cases) reported annually were non-foodborne. The 2013 summary of acute gastroenteritis using data reported the US national Reporting system for 2009-2011 reported 69 confirmed or suspected outbreaks of Campylobacter infection and 1550
illnesses (1.7 of total illnesses) 52 hospitalisations and zero deaths.
3
The 2010 OzFoodNet summarises the incidence of diseases potentially transmitted by food in Australia.
7 OzFoodNet reported 30,035 notifications of 9 diseases or conditions that are commonly transmitted by food. The most frequently notified infections were Campylobacter (16,968 notifications) and Salmonella (11,992 notifications).
In New Zealand t
8
Although Campylobacter is considered as predominantly a foodborne pathogen, water-borne outbreaks are quite often reported, and usually occur when surface water becomes contaminated with sewage from farm animals and wildlife.
Campylobacter outbreaks are most often associated with wells providing private supplies which are most likely to be contaminated with animal waste.
In the 2002 WHO report (Water and Health in Europe) it was estimated that, of
534,732 reported cases of gastroenteritis attributed to bacterial causes (bacterial dysentery, cholera, typhoid fever, Salmonella and Campylobacter ), 15,167 (2.8%) were waterborne.
9
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Coker (2002) assessed that Campylobacter is one of the most frequently isolated bacteria from stools of people infected with diarrhoea in developing countries with isolation rates for diarrhoea cases in children <5 years old ranging from 5 to 20 %.
Campylobacteriosis is considered to be a particular burden in the developing world, partly because Campylobacter -associated diarrhoea and bacteraemia occur in
HIV/AIDS patients.
10
Further information on the incidence and prevalence of Salmonella food borne infection can be found in a 2009 IFH report 11
Who is at risk?
Anyone can be infected by Campylobacter but those most at risk are babies, young children under 5 years of age, those over 60 and others with reduced immunity.
People who work with farm animals or in the meat industry and travellers to developing countries are also at greater risk
The infectious dose of Campylobacter varies depending on the type of
Campylobacter , the person infected and the nature of the food. Even for healthy adults the infectious dose may be as low as 100-500 cells.
Symptoms and complications of disease
Sometimes long-term consequences can result from a Campylobacter infection.
Some people may have arthritis following Campylobacter infection, others may develop a rare disease called GuillainBarré syndrome (GBS). This is an acute disease of the peripheral nervous system in which the nerves in the arms and legs become inflamed and stop working. This causes sudden weakness leading to limb paralysis, and a loss of sensation, sometimes with pain. It is estimated that approximately one in every 1000 reported Campylobacter cases leads to Guillain-
Barré syndrome. GBS is an illness that affects about 1500 people every year in the
UK. In the US, it is estimated that approximately 1 in every 1000 reported campylobacteriosis cases leads to GuillainBarré syndrome.
Preventing the spread of Campylobacter infection in the home
In situations where there is risk of spread of Campylobacter infection in the home the following hygiene measures should be rigorously implemented. It must be remembered that Campylobacter can also be shed by people who have no symptoms – both those who have apparently recovered and those who have not yet developed symptoms.
Since the risk of introducing Campylobacter into the home, either via people, foods or domestic pets is constant and may not be recognised until an outbreak of infection occurs within the family, this means that good day-to-day hygiene including good food hygiene makes sense.
General hygiene
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To prevent transmission of infection from an infected family member (or a family member who may have been exposed to infection outside the home) to other family members or to food:

Good hand washing practice is the single most important infection control measure. Hands should be thoroughly washed with soap and running water*. If access to soap and running water is a problem, use an alcohol hand rub or hand sanitiser. In “high risk” situations where there is an outbreak of Campylobacter in the home, it is suggested that handwashing followed by use of an alcohol rub/sanitiser should be encouraged.

Hygienically clean surfaces in the bathroom and toilet, with particular attention to washbasins, baths and toilet seat and toilet handles. This can be achieved by cleaning with a detergent cleaner followed by thorough rinsing under running water, or when this is not possible, e.g. for toilet seats, toilet flush handles etc., use a disinfectant cleaner. If someone has diarrhoea, toilets etc should be disinfected each time they use it.
 Keep the infected person’s immediate environment hygienically clean. The most important surfaces are those which come into contact with the hands, e.g. door handles, telephones, bedside tables and bed frames. To make these surfaces hygienically clean you need to use a disinfectant product. In a busy household it is not always possible to keep hand contact surfaces hygienically clean at all times. This is why it is so important to wash hands as frequently as possible to break the chain of infection.

Cleaning cloths can easily spread Campylobacter infection around the home.
They should be hygienically cleaned after each use, particularly after use in the immediate area of the infected person or the bathroom and toilet used by that person. This can be done in any of the following ways:
- wash in a washing machine at 60ºC using a powder or tablet detergent containing active oxygen bleach (see ingredients on back of pack) .
- clean with detergent and warm water, rinse and then immerse in disinfectant solution which is effective against Campylobacter ** for at least
20 minutes or as prescribed
- clean with detergent and water then immerse in boiling water for 20 minutes.
- alternatively, consider using disposable cloths.

Where floors or other surfaces become contaminated with faeces or vomit, they should be hygienically cleaned at once:
- remove as much as possible of the excreta, from the surface using paper or a disposable cloth, then
- apply disinfectant cleaner** which is effective against Campylobacter to the surface using a fresh cloth or paper towel to remove residual dirt – then
- apply disinfectant cleaner** to the surface a second time using a fresh cloth or paper towel to destroy any residual contamination
- disposable gloves should be worn if in contact with faeces, and hands should be washed after removing gloves.

Clothing, bedlinens and pillows from the infected person (or carrier) should be kept separate from the rest of the family laundry and should be laundered in a manner which kills any Campylobacter . Either:
- for preference, wash at 60

C or above, using a powder or tablet detergent containing active oxygen bleach (see ingredients on back of pack) .
- alternatively wash at 40

C with a powder or tablet detergent containing active oxygen bleach (see ingredients on back of pack)
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Note: washing at 40

C without the presence of active oxygen bleach will not destroy bacteria and viruses

Do not share towels, facecloths, toothbrushes and other personal hygiene items with the infected or carrier person.

Where young children are ill, or at particular risk:
- their handwashing, personal and toilet hygiene may need supervision
- nappies should be disposed of safely, or cleaned, disinfected and washed.
Contrary to popular perception, the faeces of babies can be highly infectious.
Always wash hands after changing a baby’s nappy

Where possible, infected people should stay in their own room and use their own facilities, cutlery, crockery etc. Infected people should particularly avoid contact with those who may be more vulnerable to infection, and their personal items.
Food and kitchen hygiene
Rigorous food hygiene is important in preventing the spread of Campylobacter in the home. Where there is an infected person in the home, food hygiene practices should focus on preventing contamination of food, particularly ready-to-eat foods. Where there is a suspected food source of Campylobacter in the home, food hygiene practice should focus on containing and destroying the source, and preventing transfer to other foods:

Infected people should try to stay away from the kitchen and should not prepare food for others.

Wash hands after handling food which may be contaminated and disinfect using an alcohol handrub or sanitiser

Wash hands before handling ready to eat foods and disinfect using an alcohol handrub or sanitiser

Hygienically clean all food contact surfaces, utensils and cloths after handling and preparation of raw foods using a disinfectant cleaner which is effective against
Campylobacter **. Hygienically clean all contact surfaces, utensils and cloths before handling and/or preparing ready-to-eat foods

Cook foods thoroughly

Wash any foods such as fruit and vegetables to be eaten raw thoroughly under clean running water

Store foods carefully in a refrigerator or freezer. Ensure that raw foods are kept separate from cooked foods
In an outbreak situation where the primary source has not been identified and removed from circulation, avoid or take particular care with known sources such as poultry, cooked meat products and unpasteurised milk.
Also:

Wash your hands thoroughly with soap and warm water:
- after contact with pets and other animals
- after working in the garden

Do not drink untreated water from lakes, rivers or streams
How to wash hands
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Handwashing “technique” is very important. Rubbing with soap and water lifts the germs off the hands, but rinsing under running water is also vital, because it is this process which actually removes the germs from the hands. The accepted procedure for handwashing is:

Ensure a supply of liquid soap, warm running water, clean hand towel/disposable paper towels and a foot-operated pedal bin

Always wash hands under warm running water

Apply soap

Rub hands together for 15 –30 seconds, paying particular attention to fingertips, thumbs and between the fingers.

Rinse well and dry thoroughly.
In situations where soap and running water is not available an alcohol- based hand rub or hand sanitiser should be used to achieve hand hygiene:

Apply product to the palm of one hand.

Rub hands together.

Rub the product over all surfaces of hands and fingers until your hands are dry.
Note: the volume needed to reduce the number of germs on hands varies by product.
In high risk situations where there is an outbreak in the home, handwashing followed use of an alcohol rub/sanitiser should be encouraged
One very simple thing which people can do which can significantly reduce the risk of disease is to avoid putting their fingers to their mouth.
Disinfectants and disinfectant cleaners
Make sure you use a disinfectant or disinfectant/cleaner such as a bleach-based product, which is active against Campylobacter . For more details on choosing the appropriate disinfectant, consult the IFH information sheet “Cleaning and disinfection:
Chem ical Disinfectants Explained”. Also consult the manufacturers’ instructions for information on the “spectrum of action”, and method of use (dilution, contact time etc). For bleach (hypochlorite) products, use a solution of bleach, diluted to 0.5%w/v or 5000ppm available chlorine. Household bleach (both thick and thin bleach) for domestic use typically contains 4.5 to 5.0% w/v (45,000-50,000 ppm) available chlorine. In situations where “concentrated bleach” is recommended a solution containing not less than 4.5% w/v available chlorine should be used. Bleach/cleaner formulations (e.g sprays) are formulated to be used “neat” (i.e. without dilution). It is always advisable however to check the label as concentrations and directions for use can vary from one formulation to another.
Other “facts about” sheets giving information on Campylobacter

UK National Electronic Library on Infections (NELI) Campylobacter. http://www.neli.org.uk/IntegratedCRD.nsf/NeLI_Organisms1?OpenForm&Seq=1#_
RefreshKW_Bacteria

Public Health England: http://www.hpa.org.uk/infections/topics_az/salmonella/gen_inf.htm.

US Centre for Disease Control and
.
Prevention.
 http://www.cdc.gov/DiseasesConditions/.
European Centre for Disease Control and Prevention: http://www.ecdc.europa.eu/en/healthtopics/campylobacteriosis/Pages/index.aspx
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IFH Guidelines and Training Resources on Home Hygiene

Guidelines for prevention of infection and cross infection the domestic environment. International Scientific Forum on Home Hygiene. Available from: http://www.ifh-homehygiene.com/best-practice-care-guideline/guidelinesprevention-infection-and-cross-infection-domestic

Guidelines for prevention of infection and cross infection the domestic environment: focus on issues in developing countries. International Scientific
Forum on Home Hygiene. Available from: http://www.ifhhomehygiene.org/best-practice-care-guideline/guidelines-preventioninfection-and-cross-infection-domestic-0

Recommendations for suitable procedure for use in the domestic environment
(2001). International Scientific Forum on Home Hygiene. http://www.ifhhomehygiene.org/best-practice-care-guideline/recommendations-suitableprocedure-use-domestic-environment-2001

Home hygiene - prevention of infection at home: a training resource for carers and their trainers. (2003) International Scientific Forum on Home Hygiene.
Available from: http://www.ifh-homehygiene.com/best-practice-training/homehygiene-%E2%80%93-prevention-infection-home-training-resource-carersand-their

Home Hygiene in Developing Countries: Prevention of Infection in the Home and Peridomestic Setting. A training resource for teachers and community health professionals in developing countries. International Scientific Forum on
Home Hygiene. Available from: www.ifh-homehygiene.org/best-practicetraining/home-hygiene-developing-countries-prevention-infection-home-andperi-domestic. (Also available in Russian, Urdu, Bengali and Hindi)
This fact advice sheet was last updated in March2014
References
1 The European Union Summary Report on Trends and Sources of Zoonoses,
Zoonotic Agents and Food-borne Outbreaks in 2010. Scientific report of EFSA and
ECDC Downloadable from http://www.efsa.europa.eu/en/efsajournal/doc/2597.pdf
2 European Centre for Disease Prevention and Control. Annual Epidemiological
Report 2013. http://www.ecdc.europa.eu/en/publications/Publications/annual-epidemiologicalreport-2013.pdf
3 Hall AJ, Wikswo ME, Manikonda K, Roberts VA, Yoder JS, Gould LH. Acute gastroenteritis surveillance through the National Outbreak Reporting System,
United States. Emerg Infect Dis. 2013. http://dx.doi.org/10.3201/eid1908.130482
.
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4 Bloomfield SF. Exner M, Signorelli C, Nath KJ, Scott EA. 2012. The chain of infection transmission in the home and everyday life settings, and the role of hygiene in reducing the risk of infection. http://www.ifh-homehygiene.com/best-practice-review/chain-infectiontransmission-home-and-everyday-life-settings-and-role-hygiene
5 The Longitudinal study of infectious intestinal disease in the UK (IID2 study): incidence in the community and presenting to general practice Tam CC,
Rodrigues LC, Viviani L, et al. Gut (2011). doi:10.1136/gut.2011.238386.
6 Mead PS, Slutsker L, Dietz V, McCaig LF, Bresee JS, Shapiro C, et al. Foodrelated illness and death in the United States. Emerg Infect Dis 1999;5:607-25.
7 Monitoring the incidence and causes of diseases potentially transmitted by food in
Australia: annual report of the ozfoodnet network, 2010. http://www.health.gov.au/internet/main/publishing.nsf/content/cda-cdi3603-pdfcnt.htm/$file/cdi3603a.pdf
8 Summary of Outbreaks in New Zealand 2011. Institute of Environmental Science and Research Limited. July 2012. https://surv.esr.cri.nz/PDF_surveillance/AnnualRpt/AnnualOutbreak/2011/2011Out breakRpt.pdf
9 WHO. Water and health in Europe: A Joint Report from the European
Environment Agency and the WHO Regional Office for Europe. 2002. Eds:
Bartram J, Thyssen N, Gowers A, Pond K, Lack T.
10 Coker AO, Isokpehi RD, Thoma BN, Amisu KO, Obi CL. Human campylobacteriosis in developing countries. Emerging Infectious Diseases 2002;
8: 237-243.
11 Bloomfield SF, Exner M, Fara GM, Nath KJ, Scott, EA; Van der Voorden C. The global burden of hygiene-related diseases in relation to the home and community.
(2009) International Scientific Forum on Home Hygiene. http://www.ifh-homehygiene.org/review/global-burden-hygiene-related-diseasesrelation-home-and-community.
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