Epidemiology and Infection

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Epidemiology and Infection (2010), 138:907-914 Cambridge University Press
Copyright © The Public Health Agency of Canada and the Government of Canada, and by J. S. Weese of the University of Guelph [2010]

Original Papers

Modelling and methods

Disease transmission model for community-associated Clostridium difficile infection

A. M. OTTENa1 c1, R. J. REID-SMITHa1a2, A. FAZILa1 and J. S. WEESEa3

a1 Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, Guelph, Ontario, Canada
a2 Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
a3 Department of Clinical Studies, Ontario Veterinary College, Guelph, Ontario, Canada
Article author query
otten am [PubMed]  [Google Scholar]
reid-smith rj [PubMed]  [Google Scholar]
fazil a [PubMed]  [Google Scholar]
weese js [PubMed]  [Google Scholar]


Participating researchers and public health personnel at a Canadian workshop in 2007, noted considerable gaps in current understanding of community-associated Clostridium difficile infection (CA-CDI), specifically infection sources and risk factors. A disease transmission model for CA-CDI was requested as an initial step towards a risk assessment, to analyse infection sources and risk factors, addressing priority research areas. The developed model contains eight infection states (susceptible, gastrointestinal exposure, colonized, diseased, deceased, clinically resolved colonized, relapse diseased, and cleared) and notes directional transfers between the states. Most published research used focused on hospital-associated C. difficile infection (HA-CDI) and further studies are needed to substantiate the use of HA-CDI knowledge in the transmission of CA-CDI. The aim was to provide a consistent framework for researchers, and provide a theoretical basis for future quantitative risk assessment of CA-CDI.

(Accepted December 08 2009)

(Online publication January 22 2010)

Key Words:Clostridium difficile; infectious disease epidemiology; transmission


c1 Author for correspondence: Mrs A. M. Otten, Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 110 Stone Road West, Guelph, ON, N1G 3W4, Canada. (Email: Ainsley.Otten@phac-aspc.gc.ca)