StrachanIJFMliver_draft_15thSep2011refssubmit

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Source attribution, prevalence and enumeration of Campylobacter spp. from
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retail liver.
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Strachan NJC1*, MacRae M2, Thomson A2, Rotariu O1, Ogden ID2 & Forbes KJ2.
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University of Aberdeen, Cruickshank Building, St Machar Drive, Aberdeen, AB23
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8GN
Instutute of Biological and Environmental Sciences, School of Biological Sciences,
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AB25 2ZD
School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen
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* Corresponding Author:
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Norval Strachan, Institute of Biological and Environmental Sciences, School of
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Biological Sciences, University of Aberdeen, Cruickshank Building, Aberdeen, AB24
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3UU, UK. (email: n.strachan@abdn.ac.uk, Tel: +44 1224 272699, Fax: +44 1224
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272703).
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Running headline: Campylobacter in retail liver
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Abstract
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Campylobacter prevalence from retail liver (chicken, cattle, pig and sheep) was found
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to be 81%, 69%, 79% and 78% respectively. Molecular source attribution
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demonstrated that strains from chicken liver were most similar to those found
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commonly in humans. This provides further evidence of liver being a probable source
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of human infection.
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Keywords: Campylobacter, outbreak, liver, source attribution, pâté
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Campylobacter jejuni and C. coli are the major recognised cause of bacterial
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gastroenteritis worldwide. There is a growing epidemic of human campylobacteriosis
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in the UK (Strachan et al., 2010) with laboratory reports showing 69,281 cases in the
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UK in 2010 a 35 % increase since 2005. These rates are likely to be substantial
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underestimates of the actual disease burden because it is estimated that only 1 in 7
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cases are reported in the United Kingdom (Wheeler et al., 1999). But, despite its
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significance as a public health problem, the relative contributions of different sources
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of infection remains complex with food (Adak et al., 2005), water (Said et al., 2003),
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and environmental sources (Strachan et al., 2009) also being recognised contributing.
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Source attribution methods employing multi-locus sequence typing (MLST) have
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indicated that between 40 to 80% of cases are associated with chicken meat (Sheppard
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et al., 2009) and it is known that 65% of broiler meat at retail is contaminated with
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Campylobacter in the UK (Anonymous, 2011) (Gormley et al., 2008).
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Although outbreaks of Campylobacter are apparently uncommon there have been a
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growing number associated with chicken liver pâté (or parfait) particularly from food
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service establishments (Little et al., 2010). Indeed, in England and Wales during
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2010, out of the 16 recognised foodborne outbreaks of Campylobacter infection, 10
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were linked to poultry liver pâté or parfait consumption and one other to pâté prepared
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from duck liver. Further, in Scotland three recent events have been associated with the
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consumption of chicken liver pâté (Oshin, 2005; Forbes et al., 2009; O'Leary et al.,
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2009).
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Surveys of Campylobacter in raw liver from different animal species have revealed
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diverse contamination rates. High prevalence (>90%) of Campylobacter in chicken
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livers were reported in Chile (Fernandez and Pison, 1996) and in New Zealand
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(Whyte et al., 2006) but in the USA (Cox et al., 2009), significantly lower values of
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13% and 17% were observed in two separate flocks and in the UK prevalence ranged
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widely between 8 and 54 % (Jennings et al., 2011). Two Japanese studies of cattle
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livers showed a low prevalence of 1.4% (Matsumoto et al., 2008) and 5% (Enokimoto
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et al., 2007). In N. Ireland (Moore and Madden, 2003) a prevalence of 6% was found
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in pig livers whilst in New Zealand (Cornelius et al., 2005) 62% of sheep livers were
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contaminated with Campylobacter. The aims of the current study were to provide
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further evidence for the potential of liver from a number of host species to cause
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infection in humans by determining (i) the prevalence and concentration of
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Campylobacter and (ii) the MLST genotypes found and whether these were typical of
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both the host species and those observed commonly in human clinical cases.
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Materials and Methods
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Sampling and microbiology
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Liver samples were purchased from retail supermarkets and butcher’s shops in
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Aberdeen, NE Scotland between April 2006 and March 2008. Choice of liver types
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was determined by availability in sentinel shops. Samples were chilled for transport
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back to the laboratory for testing. Whole samples (median 382g) were rinsed in 300
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mL Campylobacter enrichment broth (see below) and 0.1mL decimal dilutions plated
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directly onto the modified Campylobacter Blood-Free Selective Agar Base (CCDA
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base, CM0739; Oxoid, Basingstoke, UK) with CCDA selective supplement (SR 155;
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Oxoid) for target enumeration (minimum detection limit of the plate count was
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therefore 3 x103 cfu/ sample). The presence or absence of Campylobacter was
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ascertained by incubating the remaining enrichment broth microaerobically in an
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atmosphere of 10% CO2, 5% O2, balance N2, 100mL volumes of nutrient broth base
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(Mast, Bootle, UK) with 5% horse blood, growth supplement (Mast Selectavial
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SV61), amphotericin (2 mg/mL), cefoperazone (15 mg/mL), and trimethoprim (10
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mg/mL); polymixin B (2500 IU/L) and rifampicin (5 mg/mL) were added, and the
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broths incubated for 2 days at 37ºC (Bull et al., 2006). All antimicrobials were
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purchased from Sigma-Aldrich (Gillingham, UK). Enrichment broths (0.1 mL) were
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plated onto mCCDA agar incubated microaerobically for 2 days at 37ºC. Five
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colonies were taken from each plate and presumptively identified as Campylobacter
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by agglutination with Microscreen latex (Microgen, Camberley, UK). Individual
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colonies were stored (-80ºC, nutrient broth, glycerol added to 15% [v/v]) for MLST.
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Campylobacter presence was confirmed as C. jejuni or C. coli using isolate ST as
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determined by MLST.
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Genotyping
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Presumptive positive isolates were genotyped by traditional 7 locus multilocus
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sequence typing (MLST) as described previously (Sheppard et al., 2009) and allele
3
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profiles and STs were assigned using the public Campylobacter MLST profile
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database (http://www.pubmlst.org).
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Attribution
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Data (MLST) at the level of sequence type were used to identify the reservoir origin
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(cattle, chicken, sheep, pigs or wild birds) based on source attribution scores
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generated from the software programme STRUCTURE (Pritchard et al., 2000)
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calibrated with data from the CaMPS study (Sheppard et al., 2009; Forbes, 2009). The
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PopTools (available from http://www.cse.csiro.au/poptools) add-in to Microsoft Excel
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was used to generate 95% confidence intervals. The percentage of strains (ST) from
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each of the liver source species that were identical by MLST to the 10 most common
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human clinical strains from the pan Scotland 2005/06 CaMPS study (Forbes, 2009)
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was determined; these 10 strains accounted for nearly 50% of all clinical cases.
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Binomial confidence intervals were calculated and significant differences were
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calculated using @RISK software (Palisade, Ivybridge, UK) with the assumption that
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the data were binomially distributed.
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Results and Discussion
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The prevalence of Campylobacter ranged from 81% to 69% (chicken and cattle livers
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respectively) indicating significant contamination across all liver types tested and
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confirming the putative role of this food as a source of infection for humans (Table 1).
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The high prevalence in chicken is in line with a 2006 Campylobacter study in retail
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chicken meat which showed 90.4% positive from 114 samples tested (Gormley et al.,
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2008). Further, it has been demonstrated (Whyte et al., 2006) that 90% of positive
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Campylobacter chicken liver samples contained the pathogen in internal tissue and
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that flash frying, as recommended in many recipes, to leave the centre of the liver
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pink, may be ineffective at killing all Campylobacter present because there is a very
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small margin of error between pink and undercooked.
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Enumeration data showed the majority of samples were positive only after enrichment
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(79%) indicating low numbers of Campylobacter on many retail livers. The higher
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counts observed from direct plating were most frequently from associated with
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chicken and cattle liver washes (>25%). This was not unexpected for chicken
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(Gormley et al., 2008) which showed 65% retail chicken meat with Campylobacter
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concentrations >100 cfu / sample). Only 3% of pig and 10% of sheep livers had
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higher counts.
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In comparison to published studies, prevalence and counts here agreed with the sheep
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data from New Zealand (Cornelius et al., 2005) but differed from the two Japanese
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cattle studies (Matsumoto et al., 2008; Enokimoto et al., 2007) and the N. Ireland pig
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data (Moore and Madden, 2003) (all with lower prevalence values). The chicken data
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reported here is in line with the high prevalence and enumeration data in the reports
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from Chile (Fernandez and Pison, 1996) and New Zealand (Whyte et al., 2006) but
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USA studies (Cox et al., 2009) (2009) showed significantly lower values of 13% and
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17% in two separate flocks. Meanwhile, the large variation in flock prevalence in the
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UK (Jennings et al., 2011) does encompass the findings of the current study but it
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must be remembered that there may be opportunity for cross contamination of livers
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post abattoir. Finally, the difference in reported data may reflect microbiological
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methodology, animal husbandry in the country of origin and source (animal species)
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of the liver samples tested.
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Source attribution showed that the MLST types found in chicken livers were more
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similar to those found in retail broiler meat compared to other sources (Table 1).
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There was relatively poor attribution of cattle isolates (29%) which was not
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significantly better than random (25%). However, most of the misclassifications of
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liver isolates from cattle were as sheep (and vice-versa) and when the analysis was
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repeated treating sheep and cattle as one “ruminant” species then the attribution was
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much improved (81%). This commonality of MLST genotypes from cattle and sheep
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has already been reported elsewhere (McCarthy et al., 2007).
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Comparison of the MLST genotypes from liver with those commonly found in
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humans showed that those of chicken origin had the greatest overlap (56%, P<0.05).
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This provides further evidence, beyond outbreak case questionnaires, that chicken
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livers are a risk to humans. It is unclear why the degree of overlap was less for the
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other species but this could be due to a number of reasons that include: less
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consumption of livers from species other than chicken; the strains found in these other
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hosts are less infectious to humans and livers/liver products from hosts other than
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chicken may be more likely to be cooked correctly.
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The growing number of chicken liver outbreaks may not explain the whole reason for
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the recent rise of human campylobacteriosis in the UK, since these outbreaks only
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encompass a small of fraction of cases. However, here we have shown that the
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prevalence of Campylobacter in chicken livers is high and that a number of these
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strains are identical to those found commonly in humans. Further, we have also
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shown that there is a high prevalence in all the species of livers tested and although
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the most common human strains are not so frequently found in these other livers, they
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presumably do pose a risk to human health. Therefore it is important that food
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caterers treat raw liver as a foodstuff likely to be contaminated with Campylobacter
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and that it should be handled in a manner to minimise cross contamination with other
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foodstuffs and surfaces as well as requiring adequate cooking to ensure successful
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killing of this pathogen. Only once this has been achieved will the number of reported
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outbreaks decline.
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Acknowledgements
We thank Food Standards Agency, Scotland for funding this work.
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Table 1 Campylobacter spp. from retail livera: prevalence, counts, attribution of
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genotypes to source species and similarity to common human genotypes.
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Animal
Prevalence
species
Campylobacter
of High
countsb Liver isolates’ Percentage of all
(%)
(%)
genotype
liver
isolates
correctly
belonging to the
attributed
to top 10 human
source species genotypes (%)
(%)
Chicken
21/26 (81)
7/26 (27)
64
56
Cattle
22/32 (69)
8/32 (25)
30
20
Pig
23/29 (79)
1/29 (3)
41
18
Sheep
31/40 (78)
4/40 (10)
43
13
Total
97/127 (76)
20/127 (16)
45
26
270
a
271
information.
272
b
273
x103 cfu/ sample).
Full details on samples and types of individual isolates are in the supplementary
High counts are designated as those samples that gave direct plate counts (i.e.> 3
274
275
276
277
10
278
279
280
281
282
283
284
Isolate
R014
7496B
R071
7494A
7498B
R022
R066
R067
R068
7499A
10011
8920
R029
R001
R080
R027
R050
7499B
R081
7439
R019
7553B
7591B
R010
R079
R006
R039
R052
R082
7486
7506
7771
7843
8094
8289
8945
8962
R035
R062
R044
Supplementary information
The following table contains details on each of the samples:
Table S1 Sample details, enumeration and STs of C. jejuni/coli in retail liver
Date
collected
13/11/2007
12/04/2006
26/02/2008
12/04/2006
12/04/2006
04/12/2007
19/02/2008
19/02/2008
19/02/2008
12/04/2006
10/10/2006
22/06/2006
11/12/2007
06/11/2007
04/03/2008
04/12/2007
22/01/2008
12/04/2006
11/03/2008
31/03/2006
27/11/2007
24/04/2006
26/04/2006
13/11/2007
04/03/2008
06/11/2007
14/01/2008
24/01/2008
11/03/2008
07/04/2006
12/04/2006
23/05/2006
31/05/2006
05/07/2006
19/07/2005
27/09/2006
04/10/2006
08/01/2008
12/02/2008
14/01/2008
Animal
species
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
sheep
Counts
Counts
Sample
Counts MLST
Campylobacter per
per ml
weight (g) per g
Sequence
present / absent sample
wash
typea
present
<900
<3
420
<2
42
present
<900
<3
416
<2
50
present
<900
<3
400
<2
50
present
99000
330
332
298
52
present
<900
<3
310
<3
53
present
<900
<3
315
<3
61
present
<900
<3
205
<4
61
present
<900
<3
200
<5
61
present
<900
<3
600
<2
190
present
15000
50
226
66
206
present
<900
<3
273
present
<900
<3
526
<2
422
present
<900
<3
368
<2
422
present
<900
<3
418
<2
520
present
<900
<3
426
<2
618
present
<900
<3
500
<2
822
present
<900
<3
372
<2
822
present
<900
<3
226
<4
827b
present
<900
<3
236
<4
827 b
present
<900
<3
210
<4
962 b
present
<900
<3
356
<3
2340
present
<900
<3
342
<3
2666
present
<900
<3
356
<3
2670
present
12000
40
252
48
UA
present
<900
<3
398
<2
UA
present
<900
<3
512
<2 Camp. spp.
present
<900
<3
315
<3 Camp. spp.
present
<900
<3
604
<1
UA
present
3000
10
264
11
UA
present
<900
<3
300
<3 Camp. spp.
present
<900
<3
300
<3 Camp. spp.
absent
425
absent
absent
384
absent
556
absent
392
absent
absent
424
absent
234
absent
294
11
7593
R036
R090
R091
7732
R056
R047
R032
7592
R016
R075
R076
R013
R058
8095
100551
R072
R005
R028
R070
R085
R042
R055
7495
7497
7554
7672
8946
R002
8776
R008
7941
R031
R063
R087
7362
7474B
R078
R088
R025
R043
R077
R034
R020
R073
R059
8425B
R048
R049
R060
26/04/2006
08/01/2008
18/03/2008
18/03/2008
17/05/2006
24/01/2008
22/01/2008
12/12/2007
26/04/2006
27/11/2007
04/03/2008
04/03/2008
13/11/2007
12/02/2008
05/07/2006
24/10/2006
26/02/2008
06/11/2007
04/12/2007
26/02/2008
11/03/2008
14/01/2008
24/01/2008
12/04/2006
12/04/2006
24/04/2006
10/05/2006
27/09/2006
06/11/2007
05/09/2006
13/11/2007
07/06/2006
11/12/2007
19/02/2008
18/03/2008
14/03/2006
07/04/2006
04/03/2008
18/03/2008
04/12/2007
14/01/2008
04/03/2008
08/01/2008
27/11/2007
26/02/2008
12/02/2008
02/08/2006
22/01/2008
22/01/2008
12/02/2008
pig
pig
pig
pig
pig
pig
pig
pig
pig
pig
pig
pig
pig
pig
pig
pig
pig
pig
pig
pig
pig
pig
pig
pig
pig
pig
pig
pig
pig
chicken
chicken
chicken
chicken
chicken
chicken
chicken
chicken
chicken
chicken
chicken
chicken
chicken
chicken
chicken
chicken
chicken
chicken
chicken
chicken
chicken
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
absent
absent
absent
absent
absent
absent
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
<900
<900
<900
<900
<900
<900
<900
<900
<900
<900
<900
<900
<900
<900
<900
<900
<900
3000
<900
<900
<900
<900
<900
<3
<3
<3
<3
<3
<3
<3
<3
<3
<3
<3
<3
<3
<3
<3
<3
<3
10
<3
<3
<3
<3
<3
<900
<900
<900
1200
<900
<900
<900
<900
<900
<900
33000
<900
<900
12000
<900
<900
291000
<900
27000
12000
3000
<3
<3
<3
40
<3
<3
<3
<3
<3
<3
110
<3
<3
40
<3
<3
970
<3
90
40
10
209
458
382
459
502
336
471
340
382
424
434
300
249
340
367
393
242
488
360
439
414
516
340
340
394
340
380
400
400
227
400
238
400
10
250
400
400
400
400
400
400
400
400
400
400
400
400
<4
<2
<2
<2
<2
<3
<2
<3
<2
<2
<2
<3
<4
<3
<2
8
<4
<2
<3
<2
<2
19
21
21
21
58
206
270
1058 b
1096 b
1096 b
1096 b
1096 b
1143 b
2219
2508 b
2697
3609
UA
UA
UA
UA
Camp. spp.
UA
<2
<2
<4
30
<4
<2
90
<4
<2
<2
83
<2
<2
30
<2
<2
728
68
30
8
19
22
45
45
45
50
257
257
257
257
574
574
574
586
699
828 b
872 b
2687
UA
UA
UA
12
7297
7324
7325
7326
R089
7473B
8426
7555
R011
R004
R069
R084
R024
10057
R057
8098
8065
R054
8919
7493B
R053
R033
7590B
7939A
7939B
R017
R086
7733
7772
7940
8288
8293
10012
R009
R023
R064
R065
285
286
287
27/02/2006
07/03/2006
07/03/2006
07/03/2006
18/03/2008
07/04/2006
02/08/2006
24/04/2006
13/11/2007
06/11/2007
26/02/2008
11/03/2008
04/12/2007
24/10/2006
12/02/2008
05/07/2006
28/06/2006
24/01/2008
22/09/2006
12/04/2006
24/01/2008
11/12/2007
26/04/2006
07/06/2006
07/06/2006
27/11/2007
11/03/2008
17/05/2006
23/05/2006
07/06/2006
19/07/2005
19/07/2005
10/10/2006
13/11/2007
04/12/2007
19/02/2008
19/02/2008
a
b
chicken
chicken
chicken
chicken
chicken
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
cattle
absent
absent
absent
absent
absent
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
present
absent
absent
absent
absent
absent
absent
absent
absent
absent
absent
<900
<900
<900
15000
6000
<900
21000
<900
<900
<900
<900
<900
<900
<900
<900
30000
15000
<900
9000
<900
15000
12000
<3
<3
<3
50
20
<3
70
<3
<3
<3
<3
<3
<3
<3
<3
100
50
<3
30
<3
50
40
19
400
250
241
211
373
379
442
385
492
550
255
253
498
418
362
440
413
414
386
470
470
386
449
360
250
412
626
484
205
219
<4
<4
<4
40
16
<2
55
<2
<2
<4
<4
<2
<2
<2
<2
73
36
<2
19
<2
39
27
19
21
50
61
206
206
206
262
266
273
505
574
575
806
827 b
827 b
854 b
2669
2676
2677
Camp. spp.
UA
Unassigned to sequence type (UA)
C. coli
13
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