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Campylobacter: What you need to know

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Campylobacter: What you need to know

Some Basics (foodsafety.gov)

Campylobacter is one of the most common causes of food poisoning in the United States. The vast majority of cases occur as isolated events, not as part of recognized outbreaks.

Sources - Raw and undercooked poultry, unpasteurized milk, contaminated water.

Incubation Period - 2-5 days

Symptoms - Diarrhea, cramps, fever, and vomiting; diarrhea may be bloody.

Duration of Illness - 2-10 days

What Do I Do? - Drink plenty of fluids and get rest. If you cannot drink enough fluids to prevent dehydration or if your symptoms are severe, call your doctor. In more severe cases, certain antibiotics can be used and can shorten the duration of symptoms if given early in the illness.


Campylobacter Questions and Answers (USDA)

"Campylobacter" bacteria are the second most frequently reported cause of foodborne illness. A comprehensive farm-to-table approach to food safety is necessary in order to reduce campylobacteriosis. Farmers, industry, food inspectors, retailers, food service workers, and consumers are each critical links in the food safety chain. This document answers common questions about the bacteria "Campylobacter," describes how the Food Safety and Inspection Service (FSIS) of the U.S. Department of Agriculture (USDA) is addressing the problems of "Campylobacter" contamination on meat and poultry products, and offers guidelines for safe food handling to prevent bacteria, such as "Campylobacter," from causing illness. 

Q. What is Campylobacter? 

A. Campylobacter [pronounced "kamp-e-lo-back-ter"] is a gram negative, microaerophilic bacterium and is one of the most common bacterial causes of diarrheal illness in the United States. Campylobacter jejuni, the strain associated with most reported human infections, may be present in the body without causing noticeable illness. Campylobacter organisms can be found everywhere and are commonly found in the intestinal tracts of cats, dogs, poultry, cattle, swine, rodents, monkeys, wild birds, and some humans. The bacteria pass through the body in the feces and cycle through the environment. They are also found in untreated water. 

Q. What harm can Campylobacter bacteria cause? 

A. Infection caused by Campylobacter bacteria is called campylobacteriosis and is usually caused by consuming unpasteurized milk, raw or undercooked meat or poultry, or other contaminated foods and water, and contact with feces from infected animals. While the bacteria can exist in the intestinal tracts of people and animals without causing any symptoms or illness, studies show that consuming as little as 500 Campylobacter cells can cause the illness. 

Symptoms of Campylobacter infection, which usually occur within 2 to 10 days after the bacteria are ingested, include fever, abdominal cramps, and diarrhea (often bloody). In some cases, physicians prescribe antibiotics when diarrhea is severe. The illness can last about a week. 

Complications can include meningitis, urinary tract infections, and possibly reactive arthritis (rare and almost always short-term), and rarely, Guillain-Barre syndrome, an unusual type of paralysis. While most people who contract campylobacteriosis recover completely within 2 to 5 days, some Campylobacter infections can be fatal, resulting in an estimated 124 deaths each year. 

Q. Are more people becoming ill from campylobacteriosis? 

A. The Foodborne Diseases Active Surveillance Network (FoodNet) found a substantial decline in the incidents of infections caused by Campylobacter between 1996 and 2004. According to the Centers for Disease Control and Prevention (CDC), campylobacteriosis causes an incidence of about 20 cases per 100,000 population diagnosed in the United States annually. From laboratory-confirmed bacterial infection cases reported from 10 sites in 2004, Campylobacter was identified as the second most common bacterial infection reported (42% Salmonella, 37% Campylobacter, 15% Shigella, 2.6% E. coli O157:H7, and 3.4% others such as Yersinia, Listeria, and Vibrio). 

FoodNet is a collaborative project among CDC, the 10 Emerging Infections Program sites (EPIs), USDA, and the U.S. Food and Drug Administration (FDA). One of the objectives of FoodNet is to measure effectiveness of a variety of preventive measures in reducing the incidence of foodborne illness attributable to the consumption of meat, poultry, and other foods. 

Q. Who is most susceptible? 

A. Anyone may become ill from Campylobacter. However, infants and young children, pregnant women and their unborn babies, and older adults, are at a higher risk for foodborne illness, as are people with weakened immune systems (such as those with HIV/AIDS, cancer, diabetes, kidney disease, and transplant patients). 

Q. How can Campylobacter be controlled? 

A. Campylobacter can be stopped at a number of different points in the food production and marketing chain. 

On the farm:

Good sanitary practices on farms, as recommended by USDA, minimize the opportunity for the bacteria to spread among animals and birds.

Pasteurization of milk and treatment of municipal water supplies eliminate another route of transmission for Campylobacter and other bacteria.

In the plant:

Raw foods are not sterile, and there are no requirements that they be sterile. Food processing companies are accountable for following good, up-to-date manufacturing practices that minimize the opportunity for the spread of Campylobacter and other bacteria.

At retail:

A food recall is a voluntary action by a manufacturer or distributor to protect the public from products that may cause health problems or possible death. FSIS conducts a sufficient number of effectiveness checks to verify the recalling firm has contacted the distributor or retailer.

Q. What is FSIS doing to prevent Campylobacter infections?

A. In its commitment to ensure that the public has a safe, wholesome food supply, FSIS is constantly working to improve the level of safety and reduce contaminants in the meat and poultry supply. 

In 1998, FSIS began enforcing a combination of Hazard Analysis and Critical Control Points (HACCP) based process control, microbial testing, pathogen reduction performance standards, and sanitation standard operating procedures which significantly reduce contamination of meat and poultry with harmful bacteria and reduce the risk of foodborne illness. Establishments can choose to include Campylobacter in their HACCP analysis. 

HACCP clarifies the responsibilities of industry and FSIS in the production of safe meat and poultry products. The role of FSIS is to set appropriate food safety standards and maintain vigorous inspection oversight to ensure that those standards are met. 

USDA is supporting research to learn more about Campylobacter in food and how to control it. 

Finally, FSIS conducts extensive safe food handling education programs to help prevent and reduce the risks of foodborne illness. 

Q. What is the best way to prevent Campylobacter infections?

A. Meat and poultry can contain Campylobacter. However, the bacteria can be found in almost all raw poultry because it lives in the intestinal track of healthy birds. Improving safe food handling practices in kitchens will reduce the number of Campylobacter illnesses. Campylobacter bacteria are extremely fragile and are easily destroyed by cooking to a safe minimum internal temperature. They are also destroyed through typical water treatment systems. Freezing cannot be relied on to destroy the bacteria. Home freezers are generally not cold enough to destroy bacteria. 

To destroy Campylobacter and minimize the risk of foodborne illnesses: 

CLEAN: Wash Hands and Surfaces Often

Wash your hands with warm soapy water for 20 seconds before and after handling food and after using the bathroom, changing diapers, and handling pets.

Wash utensils, cutting boards, dishes, and countertops with hot soapy water after preparing each food item and before you go on to the next item.

Consider using paper towels to clean kitchen surfaces. If you use cloth towels, wash them often in the hot cycle of your washing machine.

SEPARATE: Don't Cross-contaminate

Separate raw meat, poultry, and seafood from other foods in your grocery shopping cart and in your refrigerator.

If possible, use one cutting board for fresh produce and a separate one for raw meat, poultry, and seafood.

Always wash cutting boards, dishes, countertops, and utensils with hot soapy water after they come in contact with raw meat, poultry, and seafood.

Never place cooked food on a plate which previously held raw meat, poultry, or seafood.

COOK: Cook to Safe Temperatures 

Use a clean food thermometer when measuring the internal temperature of meat, poultry, casseroles, and other foods to make sure they have reached a safe minimum internal temperature:

Beef, veal, and lamb steaks, roasts, and chops to 145 °F.

All cuts of pork to 160 °F.

Ground beef, veal and lamb to 160 °F.

Egg dishes, casseroles to 160 °F.

All poultry should reach a safe minimum internal temperature of 165 °F.

Stuffing whole poultry is not recommended. Cook stuffing separately to 165 °F.

Leftovers to 165 °F.

Do not eat or drink foods containing raw, unpasteurized milk.

Fish should reach 145 °F as measured with a food thermometer.

Bring sauces, soups, and gravy to a boil when reheating.

Reheat other leftovers thoroughly to at least 165 °F.

CHILL: Refrigerate Promptly

Keep food safe at home, refrigerate promptly and properly. Refrigerate or freeze perishables, prepared foods, and leftovers within 2 hours (1 hour if the temperature is above 90 °F).

Freezers should register 0 °F or below and refrigerators 40 °F or below.

Thaw food in the refrigerator, in cold water, or in the microwave. Foods should not be thawed at room temperature. Foods thawed in the microwave or in cold water must be cooked to a safe minimum internal temperature before refrigerating.

Marinate foods in the refrigerator.

Divide large amounts of leftovers into shallow containers for quick cooling in the refrigerator.

Don't pack the refrigerator. Cool air must circulate to keep food safe.

For more information about Campylobacter, see the Centers for Disease Control and Prevention (CDC) Web site at: www.cdc.gov/ncidod/dbmd/diseaseinfo/campylobacter_g.htm


Frequently Asked Questions (CDC)

What is campylobacteriosis?

Campylobacteriosis is an infectious disease caused by bacteria of the genus Campylobacter. Most people who become ill with campylobacteriosis get diarrhea, cramping, abdominal pain, and fever within two to five days after exposure to the organism. The diarrhea may be bloody and can be accompanied by nausea and vomiting. The illness typically lasts one week. Some infected persons do not have any symptoms. In persons with compromised immune systems, Campylobacter occasionally spreads to the bloodstream and causes a serious life-threatening infection.

How common is Campylobacter?

Campylobacter is one of the most common causes of diarrheal illness in the United States. The vast majority of cases occur as isolated, sporadic events, not as part of recognized outbreaks. Active surveillance through FoodNet indicates that about 13 cases are diagnosed each year for each 100,000 persons in the population. Many more cases go undiagnosed or unreported, and campylobacteriosis is estimated to affect over 2.4 million persons every year, or 0.8% of the population. 

Campylobacteriosis occurs much more frequently in the summer months than in the winter. The organism is isolated from infants and young adults more frequently than from persons in other age groups and from males more frequently than females. Although Campylobacter does not commonly cause death, it has been estimated that approximately 124 persons with Campylobacter infections die each year.

What sort of germ is Campylobacter?

Campylobacter organisms are spiral-shaped bacteria that can cause disease in humans and animals. Most human illness is caused by one species, called Campylobacter jejuni, but human illness can also be caused by other species. Campylobacter jejuni grows best at the body temperature of a bird, and seems to be well adapted to birds, who carry it without becoming ill. These bacteria are fragile. They cannot tolerate drying and can be killed by oxygen. They grow only in places with less oxygen than the amount in the atmosphere. Freezing reduces the number of Campylobacter bacteria on raw meat.

How is the infection diagnosed?

Many different kinds of infections can cause diarrhea and bloody diarrhea. Campylobacter infection is diagnosed when a culture of a stool specimen yields the organism.

How can campylobacteriosis be treated?

Almost all persons infected with Campylobacter recover without any specific treatment. Patients should drink extra fluids as long as the diarrhea lasts. In more severe cases, antibiotics such as azithromycin or erythromycin can shorten the duration of symptoms if given early in the illness. Your doctor will decide whether antibiotics are necessary.

Are there long-term consequences?

Most people who get campylobacteriosis recover completely within two to five days, although sometimes recovery can take up to 10 days. Rarely, Campylobacter infection results in long-term consequences. Some people develop arthritis. Others may develop a rare disease called Guillain-Barré syndrome that affects the nerves of the body beginning several weeks after the diarrheal illness. 

This occurs when a person's immune system is "triggered" to attack the body's own nerves resulting in paralysis that lasts several weeks and usually requires intensive care. It is estimated that approximately one in every 1,000 reported Campylobacter illnesses leads to Guillain-Barré syndrome. As many as 40% of Guillain-Barré syndrome cases in this country may be triggered by campylobacteriosis.

How do people get infected with this germ?

Campylobacteriosis usually occurs in single, sporadic cases, but it can also occur in outbreaks, when a number of people become ill at one time. Most cases of campylobacteriosis are associated with eating raw or undercooked poultry meat or from cross-contamination of other foods by these items. 

Infants may get the infection by contact with poultry packages in shopping carts. Outbreaks of Campylobacter are usually associated with unpasteurized milk or contaminated water. Animals can also be infected, and some people have acquired their infection from contact with the stool of an ill dog or cat. The organism is not usually spread from one person to another, but this can happen if the infected person is producing a large volume of diarrhea.

A very small number of Campylobacter organisms (fewer than 500) can cause illness in humans. Even one drop of juice from raw chicken meat can infect a person. One way to become infected is to cut poultry meat on a cutting board, and then use the unwashed cutting board or utensil to prepare vegetables or other raw or lightly cooked foods. The Campylobacter organisms from the raw meat can thus spread to the other foods.

How does food or water get contaminated with Campylobacter?

Many chicken flocks are infected with Campylobacter but show no signs of illness. Campylobacter can be easily spread from bird to bird through a common water source or through contact with infected feces. When an infected bird is slaughtered, Campylobacter organisms can be transferred from the intestines to the meat. In 2005, Campylobacter was present on 47% of raw chicken breasts tested through the FDA-NARMS Retail Food program. Campylobacter is also present in the giblets, especially the liver.

Unpasteurized milk can become contaminated if the cow has an infection with Campylobacter in her udder or the milk is contaminated with manure. Surface water and mountain streams can become contaminated from infected feces from cows or wild birds. This infection is common in the developing world, and travelers to foreign countries are also at risk for becoming infected with Campylobacter.

What can be done to prevent Campylobacter infection?

Some simple food handling practices can help prevent Campylobacter infections.

Cook all poultry products thoroughly. Make sure that the meat is cooked throughout (no longer pink) and any juices run clear. All poultry should be cooked to reach a minimum internal temperature of 165 °F.

If you are served undercooked poultry in a restaurant, send it back for further cooking.

Wash hands with soap before preparing food

Wash hands with soap after handling raw foods of animal origin and before touching anything else.

Prevent cross-contamination in the kitchen by using separate cutting boards for foods of animal origin and other foods and by carefully cleaning all cutting boards, countertops, and utensils with soap and hot water after preparing raw food of animal origin.

Avoid consuming unpasteurized milk and untreated surface water.

Make sure that persons with diarrhea, especially children, wash their hands carefully and frequently with soap to reduce the risk of spreading the infection.

Wash hands with soap after contact with pet feces.

Physicians who diagnose campylobacteriosis and clinical laboratories that identify this organism should report their findings to the local health department. If many cases occur at the same time, it may mean that many people were exposed to a common contaminated food item or water source which might still be available to infect more people. When outbreaks occur, community education efforts can be directed toward proper food handling techniques, and toward avoiding consumption of raw (not pasteurized) milk.

What are public health agencies doing to prevent or control campylobacteriosis?

To learn more about how Campylobacter causes disease and is spread, CDC began a national surveillance program in 1982. A more detailed active surveillance sentinel system, FoodNet (www.cdc.gov/foodnet), was instituted in five sites in 1996 and subsequently expanded to ten sites. 

FoodNet monitors the incidence and trends of human Campylobacter infection over time and conducts studies to identify risk factors for infection. The U.S. Department of Agriculture conducts research on how to prevent the infection in chickens. The Food and Drug Administration has produced the Model Food Code for restaurants. Adherence to it will decrease the risk of Campylobacter infection.


BBB - Campylobacter jejuni (FDA)

Bad Bug Book:

Foodborne Pathogenic Microorganisms and Natural Toxins Handbook

Campylobacter jejuni

1. Name of the Organism:

Campylobacter jejuni (formerly known as Campylobacter fetus subsp. jejuni)

Campylobacter jejuni is a Gram-negative slender, curved, and motile rod. It is a microaerophilic organism, which means it has a requirement for reduced levels of oxygen. It is relatively fragile, and sensitive to environmental stresses (e.g., 21% oxygen, drying, heating, disinfectants, acidic conditions). Because of its microaerophilic characteristics the organism requires 3 to 5% oxygen and 2 to 10% carbon dioxide for optimal growth conditions. This bacterium is now recognized as an important enteric pathogen. Before 1972, when methods were developed for its isolation from feces, it was believed to be primarily an animal pathogen causing abortion and enteritis in sheep and cattle. Surveys have shown that C. jejuni is the leading cause of bacterial diarrheal illness in the United States. It causes more disease than Shigella spp. and Salmonella spp. combined.

Although C. jejuni is not carried by healthy individuals in the United States or Europe, it is often isolated from healthy cattle, chickens, birds and even flies. It is sometimes present in non-chlorinated water sources such as streams and ponds.

Because the pathogenic mechanisms of C. jejuni are still being studied, it is difficult to differentiate pathogenic from nonpathogenic strains. However, it appears that many of the chicken isolates are pathogens.

2. Name of Disease:

Campylobacteriosis is the name of the illness caused by C. jejuni. It is also often known as campylobacter enteritis or gastroenteritis.

3. Major Symptoms:

C. jejuni infection causes diarrhea, which may be watery or sticky and can contain blood (usually occult) and fecal leukocytes (white cells). Other symptoms often present are fever, abdominal pain, nausea, headache and muscle pain. The illness usually occurs 2-5 days after ingestion of the contaminated food or water. Illness generally lasts 7-10 days, but relapses are not uncommon (about 25% of cases). Most infections are self-limiting and are not treated with antibiotics. However, treatment with erythromycin does reduce the length of time that infected individuals shed the bacteria in their feces.

The infective dose of C. jejuni is considered to be small. Human feeding studies suggest that about 400-500 bacteria may cause illness in some individuals, while in others, greater numbers are required. A conducted volunteer human feeding study suggests that host susceptibility also dictates infectious dose to some degree. The pathogenic mechanisms of C. jejuni are still not completely understood, but it does produce a heat-labile toxin that may cause diarrhea. C. jejuni may also be an invasive organism.

4. Isolation Procedures:

C. jejuni is usually present in high numbers in the diarrheal stools of individuals, but isolation requires special antibiotic-containing media and a special microaerophilic atmosphere (5% oxygen). However, most clinical laboratories are equipped to isolate Campylobacter spp. if requested.

5. Associated Foods:

C. jejuni frequently contaminates raw chicken. Surveys show that 20 to 100% of retail chickens are contaminated. This is not overly surprising since many healthy chickens carry these bacteria in their intestinal tracts. Raw milk is also a source of infections. The bacteria are often carried by healthy cattle and by flies on farms. Non-chlorinated water may also be a source of infections. 

However, properly cooking chicken, pasteurizing milk, and chlorinating drinking water will kill the bacteria.

6. Frequency of the Disease:

C. jejuni is the leading cause of bacterial diarrhea in the U.S. There are probably numbers of cases in excess of the estimated cases of salmonellosis (2- to 4,000,000/year).

7. Complications:

Complications are relatively rare, but infections have been associated with reactive arthritis, hemolytic uremic syndrome, and following septicemia, infections of nearly any organ. The estimated case/fatality ratio for all C. jejuni infections is 0.1, meaning one death per 1,000 cases. 

Fatalities are rare in healthy individuals and usually occur in cancer patients or in the otherwise debilitated. Only 20 reported cases of septic abortion induced by C. jejuni have been recorded in the literature.

Meningitis, recurrent colitis, acute cholecystitis and Guillain-Barre syndrome are very rare complications.

8. Target Populations:

Although anyone can have a C. jejuni infection, children under 5 years and young adults (15-29) are more frequently afflicted than other age groups. Reactive arthritis, a rare complication of these infections, is strongly associated with people who have the human lymphocyte antigen B27 (HLA-B27).


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