• Ravit Bassal, Rita Dichtiar, and BokerLital KeinanLKIsrael Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel.School of Public Health, University of Haifa, Haifa, Israel..
• Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel.
• Isr Med Assoc J. 2022 Jun 1; 24 (6): 360-363.

BackgroundSalmonella, Shigella, and Campylobacter are highly prevalent among children. Reports on risk factors of patients infected with all three pathogens, not simultaneously, are scarce.ObjectivesTo identify risk factors for multiple infection with Salmonella, Shigella, and Campylobacter in the same child.MethodsUsing the Israel Sentinel Laboratory-Based Surveillance Network, we conducted a retrospective observational case-case-control study among children aged 0-9 years. A case was defined as a child infected with Salmonella, Shigella, and Campylobacter at different occasions between January 1999 and December 2020. A control was defined as a child infected with a single pathogen once, during the same period. Logistic regression models were applied to determine the association between multiple infections and demographic characteristics.ResultsWe identified 109 cases (0.1%) infected with Salmonella, Shigella, and Campylobacter, and 86,511 controls (99.9%) infected with only one bacteria type. In a multivariable analysis, we showed that being Jewish (odds ratio [OR] 2.4, 95% confidence interval [95%CI] 1.3-4.4), having residency in Jerusalem (OR 3.2, 95%CI 1.3-7.7), or in the southern district (OR 3.7, 95%CI 1.5-8.8) were independent risk factors for multiple infection.ConclusionsAlthough very rare, non-simultaneous infection with multiple bacteria does occur in Israel. National and local authorities should promote programs to encourage proper hygiene practices, which are culture-adjusted.

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