Shiga Toxin-producing Escherichia coli Infection in Germany--Different Risk Factors for Different Age Groups

Abstract

The authors conducted a matched case-control study in Germany to identify risk factors for sporadic illness associated with Shiga toxin-producing Escherichia coli (STEC) infection, regardless of serogroup. From April 2001 through March 2003, cases were prospectively enrolled through a laboratory-based sentinel surveillance system located in 14 of the 16 German federal states. One control was identified per case, matched by age and region. Conditional logistic regression was used in the analysis, which was conducted separately for three age groups (<3 years, 3-9 years, and > or =10 years). The median age of the 202 enrolled cases was 2.5 years (range, 3 months-89 years). Hemolytic uremic syndrome developed in five patients. Non-O157 strains accounted for 85% of the isolated STEC. In children under 3 years of age, having touched a ruminant had the highest odds of disease, and raw milk was the only food identified as a risk factor. In contrast, in persons aged 10 years or older, only food items (i.e., lamb meat, raw spreadable sausages) were significantly associated with illness. In this study, risk factors were age-specific. Direct transmission through food played a lesser role in children under 3 years of age, the population at greatest risk of both acquiring STEC infection and developing hemolytic uremic syndrome.

Sorbitol-fermenting enterohaemorrhagicEscherichia coliO157:H−causes another outbreak of haemolytic uraemic syndrome in children

“…Future outbreaks as well as sporadic patients with an infection with this pathogen should be expediently investigated, including a more thorough exploration of possible environmental transmission routes. Considering the findings of this outbreak, in keeping with the results of a case-control study of risk factors for sporadic EHEC-associated illness in Germany [30], future outbreak investigations should place emphasis on extensive recording of outdoor activities, and outbreak investigations should also include screening of household contacts for possible SF EHEC O157:H x carriage.…”

Risk factors for sporadicYersinia enterocoliticainfections, Germany 2009–2010

“…Further investigation is needed to discover if sandboxes pose a true risk of yersiniosis, for example, via contamination of the sand with animal faeces, or if a sandbox is a place where the pathogen is transmitted directly or indirectly from person to person [21]. We have no plausible explanation as to why contact with birds would be associated with Y. enterocolitica infections.…”

Shiga Toxin–producingEscherichia coliSerogroups in Food and Patients, Germany

“…In Germany, identifi cation of STEC in patients' stool and in food is based on detection of Shiga toxin or of a Shiga toxin gene and subsequent isolation of STEC strains (4,5). This allows, in principle, ascertainment of all STEC strains, independent of their serogroup.…”