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Increased domestic, laboratory confirmed, Campylobacter notifications were reported in Siderhamn municipality, December 2002 and January 2003. Concurrently, during preliminary investigations a large outbreak of acute gastroenteritis was detected. Simultaneously, two studies were completed to identify risk factors for infection with Campylobacter and acute gastrointestinal infection (AGI): (1) a case-cohort study using Campylobacter cases (N = 101) with a large random sample from the municipal population as referents (N = 1000) and (2) a retrospective cohort study for the outcome AGI using the same sample. A postal questionnaire was used to collect demographic, clinical, water and food consumption data. Measures of association (risk ratio (RR), odds ratio (OR)) and 95% confidence intervals (CI) were calculated. Stool, environmental and water samples were tested by standard methods at Gävle Hospital and SMI laboratories respectively. In the case-cohort study, Camplylobacter cases were more likely than referents to consume communal water (OR = 12.6 (95% CI 1.7-92.3)). In the cohort study, risk of gastroenteritis was 2.3 times higher in those who consumed water (AR = 27.3%) than others (AR = 12%). Risk of illness was associated with the amount of water consumed in both studies. Campylobacter was detected in stools and Escherichia coli (E. coli) from routine communal water (CW) samples. Results suggest both Söderhamn outbreaks of Campylobacter and AGI were associated with consumption of CW. The method used strengthened epidemiological evidence and was efficient in the use of time and resources.

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Commercially available latex agglutination and coagglutination reagents were evaluated for their ability to detect bacterial antigens in the sera of 165 patients to determine their suitability for rapid diagnosis of pneumonia. These reagents were used to detect the polysaccharide capsular antigens of Haemophilus influenzae type b and Streptococcus pneumoniae in nonbacteremic patients known to be respiratory culture positive for these organisms. The reagents were unable to detect the polysaccharide antigens in sera from nonbacteremic patients. Patients with a clinical diagnosis of pneumonia who had respiratory or extrarespiratory infections with a variety of organisms were also tested. No evidence of cross-reactivity or of false-positive reactions was observed with either reagent. Because a negative agglutination test may occur during the course of a nonbacteremic infection, these reagents should not be used alone, and if used, they should be used only in conjunction with standard bacteriological tests.