Background Campylobacteriosis is the lexicon used to denote the group of infectious diseases caused by several species of Campylobacter. A form of Campylobacteriosis of significant public health importance is Campylobacter enteritis. Campylobacter species are increasingly being recognized as leading agents of gastroenteritis. In South Africa, it has been suspected that Campylobacter infection could be endemic. Freshwater environments are under pressure from climate change and consequent drought, change in conditions and migration of new species into these systems. Environmental management and managing environmental risk factors will control and prevent the epidemic or at least could significantly reduce the vulnerability of communities to Campylobacteriosis. This study provides knowledge-based recommendations for controlling and preventing Campylobacteriosis in South Africa.

Methods Collection of secondary data of at least five years of culture-confirmed cases of Campylobacter infection in two Municipalities in the Eastern Cape was conducted to establish community infection and infection rates. River water samples were also collected and analysed for Campylobacter spp. In addition, this study utilized a literature review and interviews of residents to identify local environmental risk factors of Campylobacteriosis in the two populations.

Results Campylobacter infection could be endemic in the Eastern Cape region of South Africa. Direct contact and consumption of surface waters faecal-contaminated local rivers are likely risk factors for Campylobacteriosis. Also, protecting surface water from access by animals is critical to interrupting the transmission of Campylobacter from animals to humans in these rivers.

Conclusion Campylobacteriosis in South Africa may be environmentally mediated. Rivers in South Africa are platforms for transmission of Campylobacter spp., and so prevention of Campylobacteriosis can be achieved by reducing their Campylobacter burden by protecting these platforms from contamination. The findings of this study are policy levers to mitigate Campylobacteriosis risk in South Africa.