Duration of shedding of Verocytotoxin-producing<i>Escherichia coli</i>in children and risk of transmission in childcare facilities in England

Dabke, Girija; Menach, Arnaud Le; Black, Allison; Gamblin, Jenny; Palmer, Miland N.; Boxall, Naomi; Booth, Linda

doi:10.1017/s095026881300109x

Cited by 20 publications

(21 citation statements)

References 31 publications

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“…Symptoms were self-reported and only available for four of the five health authorities in the province. Despite this, the proportion of cases with symptoms was similar to that observed in other studies (22,42). There is no reason to believe symptoms and outcomes for the same disease would be different for the one health authority from which these data were unavailable.…”

Section: Discussionsupporting

confidence: 82%

Shiga toxin–producing Escherichia coli in British Columbia, 2011–2017: Analysis to inform exclusion guidelines

Noftall¹,

Taylor²,

Hoang³

et al. 2019

CCDR

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Background: Shiga toxin-producing Escherichia coli (STEC) can cause severe illness including bloody diarrhea and hemolytic-uremic syndrome (HUS) through the production of Shiga toxins 1 (Stx1) and 2 (Stx2). E. coli O157:H7 was the most common serotype detected in the 1980s to 1990s, but improvements in laboratory methods have led to increased detection of non-O157 STEC. Non-O157 STEC producing only Stx1 tend to cause milder clinical illness. Exclusion guidelines restrict return to high-risk work or settings for STEC cases, but most do not differentiate between STEC serogroups and Stx type. Objective: To analyze British Columbia (BC) laboratory and surveillance data to inform the BC STEC exclusion guideline. Methods: For all STEC cases reported in BC in 2011-2017, laboratory and epidemiological data were obtained through provincial laboratory and reportable disease electronic systems, respectively. Incidence was measured for all STEC combined as well as by serogroup. Associations were measured between serogroups, Stx types and clinical outcomes. Results: Over the seven year period, 984 cases of STEC were reported. A decrease in O157 incidence was observed, while non-O157 rates increased. The O157 serogroup was significantly associated with Stx2. Significant associations were observed between Stx2 and bloody diarrhea, hospitalization and HUS. Conclusion: The epidemiology of STEC has changed in BC as laboratories increasingly distinguish between O157 and non-O157 cases and identify Stx type. It appears that non-O157 cases with Stx1 are less severe than O157 cases with Stx2. The BC STEC exclusion guidelines were updated as a result of this analysis.

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Section: Discussionsupporting

confidence: 82%

Shiga toxin–producing Escherichia coli in British Columbia, 2011–2017: Analysis to inform exclusion guidelines

Noftall¹,

Taylor²,

Hoang³

et al. 2019

CCDR

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“…Both symptoms of clinical infection and shedding of STEC O117:K1:H7 seem to be of much longer duration than described in any other group of STEC . The O117:K1:H7 clonal group thus seems to be an excellent colonizer of the human intestine, despite the absence of the eae and saa genes that are considered to be important adherence factors .…”

Section: Chapter 4 Verotoxin/shiga Toxin‐producing (Vtec/stec) O117:mentioning

confidence: 89%

“…The duration of shedding was 18–41 days in patients with non‐O157 infection vs 4 to >43 days in patients with O157:H7 infection. A recent English study reported a median duration of shedding of 31 days among 225 children aged <6 years attending 201 childcare facilities in England with microbiologically confirmed STEC in 2010–2011. In another study, one adult carrier who was involved in a German outbreak of STEC O104:H4 shed the outbreak strain for >7 months .…”

Section: Chapter 4 Verotoxin/shiga Toxin‐producing (Vtec/stec) O117:mentioning

confidence: 99%

Characterization of four Escherichia coli clonal groups

Olesen

2017

APMIS

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(1991)(1992) that involved an unusual multi-resistant E. coli O78:H10 strain. Surprisingly, the isolates qualified as enteroaggregative E. coli (EAEC), a diarrheagenic pathotype, making this the first reported involvement of EAEC in an extraintestinal disease outbreak. Paper IV reports an analysis of 51 archived E. coli O78:H10 isolates (1956 2000) that showed E. coli O78:H10 to be clonally heterogeneous, comprising one dominant clonal group (61% of isolates, including all 19 Copenhagen outbreak isolates) from ST10 (phylogenetic group A), plus several minor clonal groups (phylogenetic groups A and D). The outbreak clone exhibited both extraintestinal pathogenic E. coli (ExPEC) and EAEC characteristics. Paper V reports evidence that the outbreak strain adhered more extensively to human bladder epithelial cells than did prototype uropathogenic (ExPEC) strains thanks to its aggregative adherence fimbriae, the principal adhesins of EAEC, and was capable of extensive biofilm formation on urethral catheters. These findings suggest that certain EAEC-specific virulence factors increase uropathogenicity.Paper VI reports a search for ST131, a globally disseminated, recently emerged multiresistant ExPEC clonal group, among 115 extended-spectrum beta-lactamase (ESBL)-producing E. coli clinical isolates from Danish patients (2008 -2009), to assess ST131's prevalence in Copenhagen among ESBL-producing isolates. ST131 was the most prevalent clonal group (38% of isolates) and compared with other ESBL isolates was more often community-associated and exhibited distinctive and extensive virulence profiles.Paper VII reports temporal trends in antimicrobial resistance and virulence genes among historical E. coli ST131 isolates (1968 -2011). Antimicrobial resistance increased over time due to emergence of the (resistance-associated) H30 and H30-Rx ST131 subclones. Distinctive characteristics of the ST131 H30-Rx subclone including specific virulence factors (iutA, afa/dra, kpsM II), K100 capsule, multidrug resistance, and ESBL production possibly contributed to this lineage's epidemiologic success. These findings confirm that ST131 represents a group of distinctive subclones, not a unitary entity.In conclusion, all four clonal groups were multiresistant and demonstrated the potential to spread locally or globally. A combination of antimicrobial resistance and specific virulence genes likely contributed to their epidemiologic success. Future implementation of rapid methods to screen for such multiresistant high-risk clones and their cardinal virulence genes conceivably could assist in clinical management and prevention efforts.

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“…Le sérogroupe le plus signalé était O157 à tous les ans sauf en 2017, où les cas avec O121 étaient les plus fréquents. (22,42). Il n'existe aucune raison de penser que les symptômes et les résultats pour la même maladie seraient différents dans la seule région sociosanitaire pour laquelle ces données n'étaient pas disponibles.…”

Section: Résultatsunclassified

Les Escherichia coli producteurs de toxines de Shiga en Colombie-Britannique, entre 2011 et 2017 : Analyse visant à éclairer les directives d’exclusion

Noftall¹,

Taylor²,

Hoang³

et al. 2019

RMTC

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Duration of shedding of Verocytotoxin-producingEscherichia coliin children and risk of transmission in childcare facilities in England

Cited by 20 publications

References 31 publications

Shiga toxin–producing Escherichia coli in British Columbia, 2011–2017: Analysis to inform exclusion guidelines

Shiga toxin–producing Escherichia coli in British Columbia, 2011–2017: Analysis to inform exclusion guidelines

Characterization of four Escherichia coli clonal groups

Les Escherichia coli producteurs de toxines de Shiga en Colombie-Britannique, entre 2011 et 2017 : Analyse visant à éclairer les directives d’exclusion

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