Characteristics of hospitalized patients during a large waterborne outbreak of Campylobacter jejuni in Norway

Nicolay Mortensen; Solveig Aalstad Jonasson; Ingrid Viola Lavesson; Knut Erik Emberland; Sverre Litleskare; Knut-Arne Wensaas; Guri Rortveit; Nina Langeland; Kurt Hanevik

doi:10.1371/journal.pone.0248464

Peer Review History

Original SubmissionDecember 23, 2020
18 Jan 2021 Decision Letter - Tai-Heng Chen, Editor PONE-D-20-40362 Characteristics of hospitalized patients during a large waterborne outbreak of Campylobacter jejuni in Norway PLOS ONE Dear Dr. Mortensen, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Mar 04 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This paper is well done and interesting. I have a couple of minor suggestions; the paper would benefit from grammatical editing, but these changes are relatively minor. The tables would be improved if the top headers (Total, Adult, Children) were centered over the two columns below. Otherwise, this is an excellent paper and worth publishing. Reviewer #2: This paper presents the clinical characteristics of hospitalized patienst suffering of campylobacteriosis during a large water-borne outbreak in Norway. The authors included 67 patients in their study. General comments: The manuscript is well written and concise. I understand that the patient included in the study were affected by the Alskoy outbreak previously described in Hyllestad et al. 2020. It would be useful for the reader to add more useful details about the outbreak in the introduction, in particular about the strains that caused the outbreak. Related to my previous point, the authors noticed lower prevalence of bloody diarrhea in their patent cohort and suggest that this might be related the genetic of the outbreak strain. Since the strains isolated during this outbreak, it might be possible for the authors to substantiate their claim by determining the presence of the associated genes in the sequenced genome. However, it seems that these genomes have not been deposited by Hyllestad et al. in appropriate database, so it might not be trivial to do this analysis. Specific comments: The y-axis of figure 2 is confusing since two dataset are presented: onset of symptoms and admission date. I guess the y-axis is also the number of people with onset of symptoms at a particular day of the outbreak? This should be clarified. Please define CRP. Reviewer #3: This paper provides a detailed description of hospitalized patients from a waterborne Campy outbreak in Norway using electronic healthcare records. The authors assess factors related to hospitalization and treatments in children and adults. Minor edits -line 67: typo “Judged” should be “Judging” -table 1: in row “Length of stay”, there is a typo “1,5” -table 3: in the last row, part of the OR appears to be deleted in the pdf I received -line 215: typo “38,5” Methods -lines 89-124: excellent description of the data collected and definitions used Results -figures are very nicely made -Table 1: consider adding the ages for adults/children under each heading i.e. Adults (17+) Children (<17) just as a reminder for readers -Table 1: because you use (% total) to refer to % of each category for most of the table (for Female and Comorbidity categories), it is a little confusing to use if for the first row (Total) where you mean % of all patients. I suggest you change the first row label to “Total, N (% of all patients)”. Also consider changing the style this table to the same as tables 2 and 3 (i.e. separate columns for n and %) -lines 158-163: It might be helpful to include the incubation time for Campy in this section -lines 208-209: Do you have any additional information on what this PCR was detecting? Discussion -line 244: Do you have any insights into why this might be? Are young adults less likely to seek healthcare or do you think they have less severe symptoms? -lines 303-304: Is this 1% among all patients for all primary healthcare services? Or just infectious disease patients? Overall comments This is a well-written paper and with a comprehensive and detailed clinical dataset. The information provided in the paper will be useful for clinicians or public health representatives in outbreak situations. The data additionally have potential for use in other studies or to answer additional research questions. I have no major concerns, only suggestions for edits and clarifications in the text. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No Reviewer #3: Yes:** Rachel Sippy [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0248464.r001
Revision 1
10 Feb 2021 Author Response Response to reviewers Manuscript: Mortensen et al. Characteristics of hospitalized patients during a large waterborne outbreak of Campylobacter jejuni in Norway Please find our responses marked by an asterix* below each comment from editor and reviewers. All changes are all visible in the file “Revised Manuscript with Track Changes”. Reviewer #1: This paper is well done and interesting. I have a couple of minor suggestions; the paper would benefit from grammatical editing, but these changes are relatively minor. The tables would be improved if the top headers (Total, Adult, Children) were centered over the two columns below. Otherwise, this is an excellent paper and worth publishing. We thank the reviewer for the kind remarks on our paper. Tables have been formatted so that the top headers center over their respective columns. Reviewer #2: This paper presents the clinical characteristics of hospitalized patients suffering of campylobacteriosis during a large water-borne outbreak in Norway. The authors included 67 patients in their study. General comments: The manuscript is well written and concise. We thank the reviewer for these kind remarks. I understand that the patient included in the study were affected by the Askoy outbreak previously described in Hyllestad et al. 2020. It would be useful for the reader to add more useful details about the outbreak in the introduction, in particular about the strains that caused the outbreak. We have in the revised manuscript introduction supplied more details on the outbreak itself with an emphasis on the outbreak strain of C. jejuni (lines 62-68) Related to my previous point, the authors noticed lower prevalence of bloody diarrhea in their patent cohort and suggest that this might be related the genetic of the outbreak strain. Since the strains isolated during this outbreak, it might be possible for the authors to substantiate their claim by determining the presence of the associated genes in the sequenced genome. However, it seems that these genomes have not been deposited by Hyllestad et al. in appropriate database, so it might not be trivial to do this analysis. We agree that a possible correlation between the presence of genes coding for specific virulence factors and our clinical data would be most interesting to explore. The C. jejuni isolates from patients in our study may become available for whole genome sequencing at a later stage. Specific comments: The y-axis of figure 2 is confusing since two dataset are presented: onset of symptoms and admission date. I guess the y-axis is also the number of people with onset of symptoms at a particular day of the outbreak? This should be clarified. We agree with the reviewer and have changed the figure 2 text has been changed to better describe the y-axis. Please define CRP. CRP has been defined (line 107). Reviewer #3 This paper provides a detailed description of hospitalized patients from a waterborne Campy outbreak in Norway using electronic healthcare records. The authors assess factors related to hospitalization and treatments in children and adults. Minor edits -line 67: typo “Judged” should be “Judging” -table 1: in row “Length of stay”, there is a typo “1,5” -table 3: in the last row, part of the OR appears to be deleted in the pdf I received -line 215: typo “38,5” Thank you for pointing this out. Typos have been corrected and the p-value that was missing is added. Methods -lines 89-124: excellent description of the data collected and definitions used Results - figures are very nicely made -Table 1: consider adding the ages for adults/children under each heading i.e. Adults (17+) Children (<17) just as a reminder for readers This is a good suggestion. The table has been corrected accordingly. Note also that we have specified the definition of a child in the text (line 113). It originally said that a patient was considered a child if sixteen years or younger. It should say below sixteen years, and this has been corrected. No included patients are around this age. All statistics have been performed based on the intended definition. -Table 1: because you use (% total) to refer to % of each category for most of the table (for Female and Comorbidity categories), it is a little confusing to use if for the first row (Total) where you mean % of all patients. I suggest you change the first row label to “Total, N (% of all patients)”. Also consider changing the style this table to the same as tables 2 and 3 (i.e. separate columns for n and %) We have changed the first row label as suggested. As the variables in table 1 have different parameters (mean, range, %, etc.) for each row the style with separate columns for “n” and “%” used in tables 2 and 3 has not been applied for table 1. -lines 158-163: It might be helpful to include the incubation time for Campy in this section We agree that the incubation time would be helpful. Since we unfortunately do not know the exact date of exposure for each patient we have not been able to calculate incubation time. -lines 208-209: Do you have any additional information on what this PCR was detecting? Information on additional PCR results have been added to the text (lines 208-214). Discussion -line 244: Do you have any insights into why this might be? Are young adults less likely to seek healthcare or do you think they have less severe symptoms? Thank you for interesting questions. It appears that the reason for why young adults tend to be over-represented in outbreaks of campylobacteriosis is not well understood among researchers. Also, there is a difference in age distribution for campylobacteriosis between high- and low-income countries, possibly due to degree of exposure during childhood and acquired immunity. As to why the age distribution in our cohort differed from what is most often reported in high income countries we hypothesize that part of the reason could be the demographics in Askøy municipality where young adults in their twenties are less numerous compared to other age groips. We have added this to the discussion, including a reference to Statistics Norway that shows the age distribution of Askøy inhabitants https://www.ssb.no/kommunefakta/askoy (lines 250-255). -lines 303-304: Is this 1% among all patients for all primary healthcare services? Or just infectious disease patients? The 1% is among all patients who made contact to the Askøy primary health care services during the initial phase of the outbreak. This has now been clarified in the text (lines 314-315). Overall comments This is a well-written paper and with a comprehensive and detailed clinical dataset. The information provided in the paper will be useful for clinicians or public health representatives in outbreak situations. The data additionally have potential for use in other studies or to answer additional research questions. I have no major concerns, only suggestions for edits and clarifications in the text. We thank the reviewer for kind and constructive remarks. Attachments Attachment Submitted filename: Response to Reviewers.docx* https://doi.org/10.1371/journal.pone.0248464.r002
1 Mar 2021 Decision Letter - Tai-Heng Chen, Editor Characteristics of hospitalized patients during a large waterborne outbreak of Campylobacter jejuni in Norway PONE-D-20-40362R1 Dear Dr. Mortensen, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Tai-Heng Chen, M.D. Academic Editor PLOS ONE Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: (No Response) Reviewer #2: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No https://doi.org/10.1371/journal.pone.0248464.r003
Formally Accepted
12 Mar 2021 Acceptance Letter - Tai-Heng Chen, Editor PONE-D-20-40362R1 Characteristics of hospitalized patients during a large waterborne outbreak of Campylobacter jejuni in Norway Dear Dr. Hanevik: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Tai-Heng Chen Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0248464.r004

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