The role of environmental transmission of typically foodborne pathogens like Shiga toxin‐producing Escherichia coli (STEC) O157 is increasingly recognized. To gain more insights into spatially restricted risk factors that play a role in this transmission, we assessed the spatial association between sporadic STEC O157 human infections and the exposure to livestock (i.e. small ruminants, cattle, poultry, and pigs) in a densely populated country: the Netherlands. This was done for the years 2007–2016, using a state‐of‐the‐art spatial analysis method in which hexagonal areas with different sizes (90, 50, 25 and 10 km²) were used in combination with a novel probability of exposure metric: the population‐weighted number of animals per hexagon. To identify risk factors for STEC O157 infections and their population attributable fraction (PAF), a spatial regression model was fitted using integrated nested Laplace approximation (INLA). Living in hexagonal areas of 25, 50 and 90 km² with twice as much population‐weighted small ruminants was associated with an increase of the incidence rate of human STEC O157 infections in summer (RR of 1.09 [95%CI;1.01–1.17], RR of 1.17 [95%CI;1.07–1.28] and RR of 1.13 [95%CI;1.01–1.26]), with a PAF of 49% (95%CI;8–72%). Results suggest exposure to small ruminants to be a risk factor, although no evidence on the mode of transmission is provided. Therefore, the underlying mechanisms warrant further investigation and could offer new targets for control. The newly proposed exposure metric has potential to improve existing spatial modeling studies on infectious diseases related to livestock exposure, especially in densely populated countries like the Netherlands.

中文翻译：

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在较小但人口稠密的地区，畜牧业对产生志贺毒素的大肠杆菌O157感染人类的​​空间效应：以荷兰为例

环境传播对典型食源性病原体（如产生志贺毒素的大肠埃希菌O157）的作用日益得到认可。为了深入了解在这种传播中起作用的受空间限制的危险因素，我们在人口稠密的国家中评估了零星的STEC O157人感染与家畜（即小反刍动物，牛，家禽和猪）的暴露之间的空间关联： 荷兰人。这是在2007年至2016年期间使用最先进的空间分析方法完成的，其中六角形区域的大小不同（90、50、25和10 km ²）与一种新的暴露概率度量标准结合使用：每个六角形的种群加权动物数。为了确定STEC O157感染的危险因素及其人群归因分数（PAF），使用积分嵌套拉普拉斯近似（INLA）拟合了空间回归模型。居住在25、50和90 km ^2的六角形区域人群加权小反刍动物数量增加一倍与夏季人类STEC O157感染的发生率增加相关（RR为1.09 [95％CI; 1.01-1.17]，RR为1.17 [95％CI; 1.07-1.28] ]和RR为1.13 [95％CI; 1.01–1.26]，PAF为49％（95％CI; 8–72％）。结果表明，暴露于小反刍动物是一个危险因素，尽管没有提供有关传播方式的证据。因此，潜在的机制值得进一步调查，并可能提供新的控制目标。新提出的接触度量有潜力改善与牲畜接触有关的传染病的现有空间模型研究，尤其是在荷兰等人口稠密的国家。