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Redefining the population at risk of listeriosis in England and Wales
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Mook, Piers A. N. (2012) Redefining the population at risk of listeriosis in England and Wales. PhD thesis, University of Warwick.
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Official URL: http://webcat.warwick.ac.uk/record=b2691249~S1
Abstract
Listeriosis is a rare but severe food‐borne disease caused by the opportunistic,
bacterial pathogen Listeria monocytogenes. The elderly, those who are
immunocompromised and pregnant women and their unborn or newborn infants
are disproportionately affected. Listeriosis has a high case fatality ratio (up to 44%)
and is the commonest cause of death ascribed to a food‐borne pathogen in the
United Kingdom (UK).
The number of cases of listeriosis in England and Wales reported to the Health
Protection Agency (HPA) ‐ the arms length governmental body mandated with
protecting the health of the population ‐ increased from an average of 110 cases
per year between 1990 and 2000 to an average of 192 cases per year between 2001
and 2009. The epidemiology of listeriosis appeared to change with the observed
increase almost exclusively among non‐pregnancy related cases, aged ≥60 years
presenting with bacteraemia in the absence of central nervous system infection
(CNS). Given the potential severity of listeriosis and that, as a predominantly foodborne
disease, these infections are largely avoidable, there was a public health
imperative to investigate the observed increase.
Disease presentation, concurrent conditions, medications, deprivation, diet and
mortality risk factors amongst non‐pregnancy related listeriosis cases and ethnicity
amongst pregnancy related cases were investigated using national surveillance
data. The increased incidence of bacteraemic cases occurred in those with cancer,
particularly digestive organ malignancies (Odds ratio (OR) [95% confidence interval (CI)]: 16.7 [3.8 – 73]) and, to a lesser degree, those with conditions that necessitate
treatment with stomach acid inhibiting medication (3.2 [1.5 – 6.6]).
Ethnicity and/or deprivation were found to be important drivers for infection.
Compared to the most affluent areas, disease incidence was 38% (95% CI: 16 to 65)
higher in the most deprived areas of the country. Cases were more likely than the
general population to purchase foods from convenience stores (OR [95% CI]: 5.37
[3.53 – 8.17]) or from local services ‐ bakers (3.40 [2.39 – 4.86]), butchers (1.62
[1.11 – 2.34]), fishmongers (5.05 [3.19 – 7.99]) and greengrocers (1.92 [1.32 – 2.78])
‐ and their risk profile changed with increasing deprivation. The proportion of
pregnancy related cases classed as ethnic increased significantly from 2001 to 2008
(chi‐square test for trend; p=0.002). The increase in the proportion of pregnancy
related cases that were ethnic was most marked in 2006, 2007 and 2008, when the
incidence was higher than expected given the underlying population (Relative risk
(RR) [95% CI]: 2.38 [1.07 – 5.29], 3.82 [1.82 – 8.03] and 4.33 [1.74 – 10.77],
respectively).
A wide range of underlying conditions appeared to increase the risk of infection,
most notably diseases of the liver (RR [95% CI]: 22.4 [17.7 – 28.4]), systemic
connective tissue disorders (18.3 [12.6 – 26.6]), neoplasms of the lymphoid,
hematopioetic, and related tissues (17.6 [15.1 – 20.6]), psychoactive substance
(alcohol related in 96% of reports; 12.3 [9.4 – 16.1]) and renal failure (12.2 [9.8 –
15.1]). Associated medications, including cytotoxic drugs (RR [95% CI]: 320.9 [228.5
– 450.7]), drugs affecting the immune response (18.5 [11.6 – 29.5]) and
corticosteroids (11.1 [8.5 – 14.6]), and food groups, most notably smoked salmon (OR [95% CI]: 4.82 [2.99 – 7.76]), other cold cooked fish (22.32 [15.85 – 31.44]),
camembert (4.80 [2.32 – 9.90]), hard cheese other than cheddar (2.37 [1.69 –
3.30]), blue cheese (2.24 [1.47 – 3.43]), also appeared to be associated with
increased risk of infection.
Underlying conditions, particularly malignancies of the breast (OR [95% CI]: 3.2 [1.7
– 6.2]) and respiratory and intrathoracic organs (3.9 [2.2 – 7.1]), alcoholism (2.7 [1.6
– 4.3]), cardiovascular diseases (1.4 [1.01 – 1.9]), treatment to reduce stomach acid
secretion (1.6 [1.1 – 2.3])and increasing age (cases ≥80 years versus less than 60
years; 3.1 [2.3 – 4.2]) increased the risk of death amongst cases.
This cohesive body of work redefines the population at risk of listeriosis and
indicates that there is added value in actively targeting appropriate food safety
advice at a range of vulnerable groups other than pregnant women, to whom
information has previously been routinely and preferentially disseminated.
Item Type: | Thesis (PhD) | ||||
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Subjects: | Q Science > QR Microbiology R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RC Internal medicine |
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Library of Congress Subject Headings (LCSH): | Listeriosis -- Great Britain, Health risk assessment -- Great Britain, Listeria monocytogenes | ||||
Official Date: | November 2012 | ||||
Dates: |
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Institution: | University of Warwick | ||||
Theses Department: | Warwick Medical School | ||||
Thesis Type: | PhD | ||||
Publication Status: | Unpublished | ||||
Supervisor(s)/Advisor: | Gillespie, Iain, Dr.; Stranges, Saverio | ||||
Sponsors: | Health Protection Agency (Great Britain) (HPA) | ||||
Description: | Ph.D. by published work. Abridged version. |
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Extent: | 1 volume (various pagings) : charts. | ||||
Language: | eng |
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