Assessing the Relationship Between the Incidence of Campylobacteriosis and Ecological Risk Factors in Tennessee

Background: Campylobacteriosis although is the leading causes of bacterial diarrheal illnesses, have not gained prominent awareness and there are gaps in the understanding of transmission routes for sporadic, non-outbreak cases and their risk factors at the communal level to humans. This study, therefore, aimed to identify the campylobacteriosis risk factors and risk perception from the existing literature in the United States, determine the incidence and ecological risk factors for campylobacteriosis zip code level in Tennessee, and to perform spatiotemporal analysis of campylobacteriosis incidence cases in Tennessee. Method: To achieve the first aim, a scoping review was conducted to synthesize the risk factors for human campylobacteriosis from existing literature. To achieve the second aim, an ecological analysis was performed using negative binomial regression to identify sociodemographic, agricultural and environmental risk factors for campylobacteriosis at the zip code level in Tennessee. Finally, a trend analysis was performed to describe significant changes in the disease incidence and spatial techniques were employed to determine risk factors and hotspots of the disease at the county level. Results: The scoping review revealed that awareness level on campylobacteriosis was the least among all gastrointestinal diseases. Due to that, risk perception was very poor among the general population and even among high-risk occupations such as farmers. The magnitude of campylobacteriosis generally has increased since 2013 and this gradual increasing trend is expected to continue into the next five years. The risk factors for campylobacteriosis at the zip code level included population density, percentage of the population being white, presence of chicken operations in a zip code area and number of private wells in a zip code. The risk factors for campylobacteriosis at the county level includes increasing median age and number of cattle operations in the county. Implications: The risk factors associated with the disease were complex, coming from animals, the environments and sociodemographic characteristics. The practice relevance and implication of these findings are that the One Health approach is needed for devising public health control strategies for the disease. Some recommended One Health activities include enactment of regulations, intensified health education and environmental surveillance.