a1 Department of Epidemiological Surveillance, Hellenic Centre for Disease Control and Prevention (KEELPNO), Athens, Greece
a2 Laboratory of Microbiology, General Hospital of Chania, Chania, Greece
a3 Central Public Health Laboratory (KEDY), Hellenic Centre for Diseases Control and Prevention, Athens, Greece
a4 National School of Public Health, Athens, Greece
a5 Laboratory of Clinical Microbiology, Parasitology, Zoonoses and Geographical Medicine, University of Crete, Irakleio, Greece
A case-control and a case-crossover study were performed to investigate a Campylobacter jejuni outbreak in Crete in 2009. Most cases originated from rural areas, served by a different water-supply system from that of the adjacent town. Thirty-seven cases and 79 controls were interviewed; cases were interviewed for two different time periods for the case-crossover study. Stool cultures, PFGE and MLST subtyping were run in human samples. Univariately, consumption of tap water was associated with C. jejuni infection. Stratified analysis revealed that water-supply system was an effect modifier of this association. In the multivariable analysis, the rural areas' water supplier and drinking tap water were risk factors. No risk factors were revealed in the case-crossover study. No Campylobacter were isolated in the tested water samples. There is strong epidemiological evidence that tap water was the vehicle of the outbreak.
(Accepted August 11 2010)
(Online publication September 14 2010)