BACKGROUND The burden of diarrheal diseases remains high among children in low-income countries. Enteropathogens are challenging to control because they are transmitted via multiple pathways. Chickens are an important animal protein source, but live chickens and their products are often highly contaminated with enteropathogens. OBJECTIVES We conducted this study to a) understand the contribution of multiple transmission pathways to the force of infection of Campylobacter spp. and nontyphoidal Salmonella spp., b) quantify the potential impact of reducing each pathway on human infection, and c) quantify hypothesized pathway reduction from the context of Maputo, Mozambique. METHODS We developed transmission models for Campylobacter and Salmonella that captured person-to-person, water-to-person, food-to-person, soil-to-person, animal-to-person, and all-other-sources-to-person in an urban, low-income setting in Mozambique. We calibrated these models using prevalence data from Maputo, Mozambique and estimates of attributable fraction of transmission pathways for the region. We simulated the prevalence of human infection after reducing transmission through each pathway. RESULTS Simulation results indicated that if foodborne transmission were reduced by 90%, the prevalence of Campylobacter and Salmonella infection would decline by [52.2%; 95% credible interval (CrI): 39.7, 63.8] and (46.9%; 95% CrI: 39, 55.4), respectively. Interruption of any other pathway did not have a substantial impact. Combined with survey and microbiology data, if contamination of broiler chicken meat at informal markets in Maputo could be reduced by 90%, the total infection of Campylobacter and Salmonella could be reduced by 21% (16-26%) and 12% (10-13%), respectively. DISCUSSION Our transmission models showed that the foodborne transmission has to be reduced to control enteropathogen infections in our study site, and likely in other similar contexts, but mitigation of this transmission pathway has not received sufficient attention. Our model can serve as a tool to identify effective mitigation opportunities to control zoonotic enteropathogens. https://doi.org/10.1289/EHP12314.

中文翻译：

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莫桑比克马普托家禽源肠道病原体传播的阻断机会：传播模型分析。

背景技术低收入国家儿童的腹泻疾病负担仍然很高。肠道病原体很难控制，因为它们通过多种途径传播。鸡是重要的动物蛋白来源，但活鸡及其产品往往受到肠道病原体的高度污染。目的 我们进行这项研究是为了 a) 了解多种传播途径对弯曲杆菌属感染力的贡献。和非伤寒沙门氏菌，b) 量化减少每种途径对人类感染的潜在影响，c) 量化莫桑比克马普托背景下假设的途径减少。方法 我们开发了弯曲杆菌和沙门氏菌的传播模型，捕获了人与人、水与人、食物与人、土壤与人、动物与人以及所有其他来源与莫桑比克城市低收入环境中的人。我们使用莫桑比克马普托的流行率数据以及对该地区传播途径的可归因部分的估计来校准这些模型。我们模拟了减少每种途径的传播后人类感染的流行情况。结果模拟结果表明，如果食源性传播减少90%，弯曲杆菌和沙门氏菌感染的患病率将下降[52.2%；95% 可信区间 (CrI)：39.7、63.8] 和（46.9%；95% CrI：39、55.4）。任何其他途径的中断不会产生实质性影响。结合调查和微生物学数据，如果马普托非正规市场肉鸡肉的污染能够减少90%，弯曲杆菌和沙门氏菌的总感染量可减少21%（16-26%）和12%（10-26%）。 13%），分别。讨论我们的传播模型表明，必须减少食源性传播，以控制我们研究地点以及其他类似环境中的肠道病原体感染，但缓解这种传播途径尚未得到足够的重视。我们的模型可以作为一种工具来确定有效的缓解机会来控制人畜共患肠道病原体。https://doi.org/10.1289/EHP12314。