Epidemiology of yersiniosis
- Robert V Tauxe, MD, MPH
Robert V Tauxe, MD, MPH
- Division of Bacterial and Mycotic Diseases
- Centers for Disease Control and Prevention
The genus Yersinia includes 11 species, three of which are important human pathogens: Yersinia pestis, Yersinia enterocolitica, and Yersinia pseudotuberculosis . The yersinioses are zoonotic infections of domestic and wild animals; humans are considered incidental hosts that do not contribute to the natural disease cycle.
Y. enterocolitica and Y. pseudotuberculosis cause yersiniosis, a diarrheal illness. Illness due to Y. enterocolitica is more common than illness due to Y. pseudotuberculosis. Overall, Y. enterocolitica infection occurs more frequently in Europe than in North America .
The epidemiology of yersiniosis (infection with Y. enterocolitica or Y. pseudotuberculosis) will be reviewed here. The microbiology, pathogenesis, clinical manifestations, diagnosis, and treatment of yersiniosis are discussed separately. (See "Microbiology and pathogenesis of Yersinia infections" and "Clinical manifestations and diagnosis of Yersinia infections" and "Treatment and prevention of Yersinia enterocolitica and Yersinia pseudotuberculosis infection".)
Y. pestis causes plague and is discussed separately. (See "Epidemiology, microbiology and pathogenesis of plague (Yersinia pestis infection)" and "Clinical manifestations, diagnosis, and treatment of plague (Yersinia pestis infection)".)
RESERVOIRS OF INFECTION
Y. enterocolitica strains have been isolated from a variety of vertebrate hosts, including domesticated animals as well as wildlife . Healthy pigs are frequently colonized with strains that cause human illness, such as serotype O:3 and serotype O:9. In pigs, the organism colonizes the tonsils and other oropharyngeal lymphoid tissues; from these sites it can be shed into the gastrointestinal tract. Y. enterocolitica in swine herds may spread as pigs are transferred from one pig farm to another, and then can persist on a farm for many years . The organisms can contaminate retail pork products, including neck trimmings, tonsillar tissue, tongue, and tripe, and can be transferred to other cuts of meat during slaughter [5,6]. Y. pseudotuberculosis has been isolated from a variety of mammals and birds. It causes epizootic disease in European brown hares in Northern Europe, sheep in Australia, and farmed deer in New Zealand [7-9].
- Butler T. Plague and other Yersinia infections, Plenum Medical Books Co., New York 1983.
- Schmitz AM, Tauxe RV. Yersinia enterocolitica infections. In: Bacterial Infections of Humans, 4th ed, Brachman PS, Abrutyn E (Eds), Springer, New York 2009. p.939.
- Bottone EJ. Yersinia enterocolitica: the charisma continues. Clin Microbiol Rev 1997; 10:257.
- Virtanen S, Nikunen S, Korkeala H. Introduction of infected animals to herds is an important route for the spread of Yersinia enterocolitica infection between pig farms. J Food Prot 2014; 77:116.
- de Boer E. Isolation of Yersinia enterocolitica from foods. Contrib Microbiol Immunol 1995; 13:71.
- Fredriksson-Ahomaa M, Hielm S, Korkeala H. High prevalence of yadA-positive Yersinia enterocolitica in pig tongues and minced meat at the retail level in Finland. J Food Prot 1999; 62:123.
- Wuthe HH, Aleksić S, Kwapil S. Yersinia in the European brown hare of northern Germany. Contrib Microbiol Immunol 1995; 13:51.
- Slee KJ, Skilbeck NW. Epidemiology of Yersinia pseudotuberculosis and Y. enterocolitica infections in sheep in Australia. J Clin Microbiol 1992; 30:712.
- Wilson PR. Advances in health and welfare of farmed deer in New Zealand. N Z Vet J 2002; 50:105.
- Wilson HD, McCormick JB, Feeley JC. Yersinia enterocolitica infection in a 4-month-old infant associated with infection in household dogs. J Pediatr 1976; 89:767.
- Centers for Disease Control and Prevention (CDC). Red blood cell transfusions contaminated with Yersinia enterocolitica--United States, 1991-1996, and initiation of a national study to detect bacteria-associated transfusion reactions. MMWR Morb Mortal Wkly Rep 1997; 46:553.
- Guinet F, Carniel E, Leclercq A. Transfusion-transmitted Yersinia enterocolitica sepsis. Clin Infect Dis 2011; 53:583.
- Tauxe RV, Vandepitte J, Wauters G, et al. Yersinia enterocolitica infections and pork: the missing link. Lancet 1987; 1:1129.
- Ostroff SM, Kapperud G, Hutwagner LC, et al. Sources of sporadic Yersinia enterocolitica infections in Norway: a prospective case-control study. Epidemiol Infect 1994; 112:133.
- Thisted Lambertz S, Danielsson-Tham ML. Identification and characterization of pathogenic Yersinia enterocolitica isolates by PCR and pulsed-field gel electrophoresis. Appl Environ Microbiol 2005; 71:3674.
- Satterthwaite P, Pritchard K, Floyd D, Law B. A case-control study of Yersinia enterocolitica infections in Auckland. Aust N Z J Public Health 1999; 23:482.
- Lee LA, Taylor J, Carter GP, et al. Yersinia enterocolitica O:3: an emerging cause of pediatric gastroenteritis in the United States. The Yersinia enterocolitica Collaborative Study Group. J Infect Dis 1991; 163:660.
- Lee LA, Gerber AR, Lonsway DR, et al. Yersinia enterocolitica O:3 infections in infants and children, associated with the household preparation of chitterlings. N Engl J Med 1990; 322:984.
- Jones TF. From pig to pacifier: chitterling-associated yersiniosis outbreak among black infants. Emerg Infect Dis 2003; 9:1007.
- Centers for Disease Control and Prevention (CDC). Yersinia enterocolitica gastroenteritis among infants exposed to chitterlings--Chicago, Illinois, 2002. MMWR Morb Mortal Wkly Rep 2003; 52:956.
- Tacket CO, Ballard J, Harris N, et al. An outbreak of Yersinia enterocolitica infections caused by contaminated tofu (soybean curd). Am J Epidemiol 1985; 121:705.
- Tacket CO, Narain JP, Sattin R, et al. A multistate outbreak of infections caused by Yersinia enterocolitica transmitted by pasteurized milk. JAMA 1984; 251:483.
- Ackers ML, Schoenfeld S, Markman J, et al. An outbreak of Yersinia enterocolitica O:8 infections associated with pasteurized milk. J Infect Dis 2000; 181:1834.
- MacDonald E, Heier BT, Nygård K, et al. Yersinia enterocolitica outbreak associated with ready-to-eat salad mix, Norway, 2011. Emerg Infect Dis 2012; 18:1496.
- Longenberger AH, Gronostaj MP, Yee GY, et al. Yersinia enterocolitica infections associated with improperly pasteurized milk products: southwest Pennsylvania, March-August, 2011. Epidemiol Infect 2014; 142:1640.
- MacDonald E, Einöder-Moreno M, Borgen K, et al. National outbreak of Yersinia enterocolitica infections in military and civilian populations associated with consumption of mixed salad, Norway, 2014. Euro Surveill 2016; 21.
- Morse DL, Shayegani M, Gallo RJ. Epidemiologic investigation of a Yersinia camp outbreak linked to a food handler. Am J Public Health 1984; 74:589.
- Kuehnert MJ, Roth VR, Haley NR, et al. Transfusion-transmitted bacterial infection in the United States, 1998 through 2000. Transfusion 2001; 41:1493.
- Wagner SJ, Friedman LI, Dodd RY. Transfusion-associated bacterial sepsis. Clin Microbiol Rev 1994; 7:290.
- Nuorti JP, Niskanen T, Hallanvuo S, et al. A widespread outbreak of Yersinia pseudotuberculosis O:3 infection from iceberg lettuce. J Infect Dis 2004; 189:766.
- Niskanen T, Fredriksson-Ahomaa M, Korkeala H. Occurrence of Yersinia pseudotuberculosis in iceberg lettuce and environment. Adv Exp Med Biol 2003; 529:383.
- Nowgesic E, Fyfe M, Hockin J, et al. Outbreak of Yersinia pseudotuberculosis in British Columbia--November 1998. Can Commun Dis Rep 1999; 25:97.
- Rimhanen-Finne R, Niskanen T, Hallanvuo S, et al. Yersinia pseudotuberculosis causing a large outbreak associated with carrots in Finland, 2006. Epidemiol Infect 2009; 137:342.
- Adamkiewicz TV, Berkovitch M, Krishnan C, et al. Infection due to Yersinia enterocolitica in a series of patients with beta-thalassemia: incidence and predisposing factors. Clin Infect Dis 1998; 27:1362.
- Worldwide spread of infections with Yersinia enterocolitica. WHO Chron 1976; 30:494.
- Ostroff S. Yersinia as an emerging infection: epidemiologic aspects of Yersiniosis. Contrib Microbiol Immunol 1995; 13:5.
- Verhaegen J, Charlier J, Lemmens P, et al. Surveillance of human Yersinia enterocolitica infections in Belgium: 1967-1996. Clin Infect Dis 1998; 27:59.
- Stolk-Engelaar VM, Hoogkamp-Korstanje JA. Clinical presentation and diagnosis of gastrointestinal infections by Yersinia enterocolitica in 261 Dutch patients. Scand J Infect Dis 1996; 28:571.
- Nesbakken T, Eckner K, Høidal HK, Røtterud OJ. Occurrence of Y. enterocolitica in slaughter pigs and consequences for meat inspection, slaughtering and dressing procedures. Adv Exp Med Biol 2003; 529:303.
- Ong KL, Gould LH, Chen DL, et al. Changing epidemiology of Yersinia enterocolitica infections: markedly decreased rates in young black children, Foodborne Diseases Active Surveillance Network (FoodNet), 1996-2009. Clin Infect Dis 2012; 54 Suppl 5:S385.
- Crim SM, Griffin PM, Tauxe R, et al. Preliminary incidence and trends of infection with pathogens transmitted commonly through food - Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 2006-2014. MMWR Morb Mortal Wkly Rep 2015; 64:495.
- Long C, Jones TF, Vugia DJ, et al. Yersinia pseudotuberculosis and Y. enterocolitica infections, FoodNet, 1996-2007. Emerg Infect Dis 2010; 16:566.
- Centers for Disease Control and Prevention (CDC) Foodborne Diseases Active Surveillance Network. Number and incidence of infections by site, 2014. http://www.cdc.gov/foodnet/trends/2014/number-of-infections-by-site-2014.html (Accessed on September 02, 2015).
- Wright J, Fenwick S, McCarthy M. Yersiniosis: An emerging problem in New Zealand. N Z Public Health Rep 1995; :65.
- Fenwick SG, McCarthy MD. Yersinia enterocolitica is a common cause of gastroenteritis in Auckland. N Z Med J 1995; 108:269.
- Ostroff SM, Kapperud G, Lassen J, et al. Clinical features of sporadic Yersinia enterocolitica infections in Norway. J Infect Dis 1992; 166:812.
- Centers for Disease Control (CDC). Yersinia enterocolitica infections during the holidays in black families--Georgia. MMWR Morb Mortal Wkly Rep 1990; 39:819.
- Fukushima H, Ito Y, Saito K, et al. Ecological studies of Yersinia enterocolitica. III. Cross-protection against fecal excretion between Y. enterocolitica serovars 3 and 5.27 in pigs. Vet Microbiol 1984; 9:383.