Obscure bacteria
sickening hundreds

The Health Department
will study high rates of
campylobacter infection

By Alan Matsuoka
Star-Bulletin

The state Health Department, worried about a steady rise in campylobacter infections over the past six years, plans to investigate particularly high rates on Maui.

"There seems to be an especially big problem there," spokesman Patrick Johnston said yesterday. "Why that is, we're not altogether sure."

Campylobacter has emerged as the leading bacterial cause of diarrhea in Hawaii, easily outstripping better known causes like salmonella, said Dr. Darwin Chan, a University of Hawaii preventative health resident who recently wrote a paper on the illness.

According to the paper, the statewide incident rate per 100,000 population mushroomed from 17.8 in 1991 to 78.3 in 1996.

Maui led the counties with a 95.2 per 100,000 rate, followed by Kauai (59.8), the Big Island (52.1) and Oahu (40.8).

Health Department figures for the first half of this year show the trend is continuing, with more than 500 cases in the islands through July, compared to 179 salmonella infections and 32 caused by shigella, another bacteria.

The department said its Maui investigation will start next year since its epidemiology specialist is being transferred to Oahu and the position must be filled.

Improper handling of poultry and beef is the prime suspect, Johnston said.

"We want to find out a little bit more about what's causing this, and then we can use that information to inform the general public about steps they can take to avoid this illness," he said.

Experts cautioned the Hawaii figures should be interpreted carefully. Chan said the steady rise could reflect better testing and reporting, noting that campylobacteriosis became a notifiable disease here in May 1990, and only relatively recently the focus of national attention.

"We're not sure if it's going to keep increasing, or if it's just going to stay at the level that it's at," he said.

Victims of campylobacter may suffer from cramps, fever and watery or bloody diarrhea, with symptoms lasting from three to 10 days. Health officials estimate it infects from 2 million to 4 million people nationwide each year, and causes 200 to 800 deaths.

The bacteria commonly is found in the intestines of healthy poultry and other animals. The onset of ailments, two to five days after exposure, is linked to consuming contaminated products such as chicken, raw milk and, to a lesser extent, red meat and seafood.

Concern is heightened because of studies showing that about a third of patients with Guillain-Barre syndrome, an acute paralytic illness, were infected by the bacteria in the weeks before neurologic problems developed.

The Hawaii data parallel national patterns with victim peaks reported among children less than 5 years old, and young adults. Seasonal increases were seen from mid-July through September, and in December. Race does not appear to be a factor.

Chan, working with limited information from other states, said he wouldn't be surprised if Hawaii had one of the highest infection rates. By comparison, he said Washington in 1992 reported a rate of 21 per 100,000, and Louisiana in 1994 showed a 3.8 rate.

"Exposure to certain potentially undercooked foods, e.g. home barbecues, barbecued chicken and certain chicken dishes in Chinese restaurants may be more common here than in other states," he wrote.

But Sean Altekruse, a Food and Drug Administration veterinary epidemiologist assigned to the Centers for Disease Control's Foodborne and Diarrheal Diseases Branch in Atlanta, said Hawaii's rate is similar to the national incidence of 100 cases per 100,000 people annually.

Altekruse said state-by-state figures are sporadic, largely because laboratories need special environments to grow and test for the bacteria.

Altekruse said campylobacter now is considered the nation's leading cause of foodborne bacterial infection, with gastroenteritis symptoms that may be even more severe than salmonella.

He urged people to take the same precautions they would take with salmonella, including cooking meat thoroughly, and washing hands and utensils after handling raw poultry.