The epidemiology, microbiology and clinical impact of Shiga toxin-producingEscherichia coliin England, 2009–2012

Abstract

Between 1 January 2009 and 31 December 2012 in England, a total of 3717 cases were reported with evidence of Shiga toxin-producing E. coli (STEC) infection, and the crude incidence of STEC infection was 1·80/100 000 person-years. Incidence was highest in children aged 1-4 years (7·63/100 000 person-years). Females had a higher incidence of STEC than males [rate ratio (RR) 1·24, P < 0·001], and white ethnic groups had a higher incidence than non-white ethnic groups (RR 1·43, P < 0·001). Progression to haemolytic uraemic syndrome (HUS) was more frequent in females and children. Non-O157 STEC strains were associated with higher hospitalization and HUS rates than O157 STEC strains. In STEC O157 cases, phage type (PT) 21/28, predominantly indigenously acquired, was also associated with more severe disease than other PTs, as were strains encoding stx2 genes. Incidence of STEC was over four times higher in people residing in rural areas than urban areas (RR 4·39, P < 0·001). Exposure to livestock and/or their faeces was reported twice as often in cases living in rural areas than urban areas (P < 0·001). Environmental/animal contact remains an important risk factor for STEC transmission and is a significant driver in the burden of sporadic STEC infection. The most commonly detected STEC serogroup in England was O157. However, a bias in testing methods results in an unquantifiable under-ascertainment of non-O157 STEC infections. Implementation of PCR-based diagnostic methods designed to detect all STEC, to address this diagnostic deficit, is therefore important.

Shiga Toxin–ProducingEscherichia coliO157, England and Wales, 1983–2012

“…Additionally, outbreaks associated with meat and milk decreased, and outbreaks attributed to petting farms increased. These data support previous reports that PT21/28 is indigenous to Great Britain and PT8 is largely imported, because most PT8 outbreaks were foodborne and a greater proportion of PT21/28 were attributed to environmental or animal contact ( 19 , 21 ). …”

“…The destruction and restocking of UK cattle herds after concerns about bovine spongiform encephalopathy and foot and mouth disease might have been a causative factor. In Ireland, PT32 is the most commonly reported PT ( 27 ); PT21/28 is rarely detected outside the British Isles ( 19 ). …”

“…In January 2009, PHE introduced the National Enhanced Surveillance Scheme for STEC (Figure 1) ( 19 ). This scheme captured epidemiologic information through standardized questionnaires administered to all persons with STEC and linked to microbiological data in the Modular Open Laboratory Information System.…”

A geostatistical investigation of agricultural and infrastructural risk factors associated with primary verotoxigenicE. coli(VTEC) infection in the Republic of Ireland, 2008–2013

“…The main reservoirs of VTEC infection are considered to be agricultural animals, particularly cattle and other ruminants [13][14][15]. Consequently, annual infection peaks in Ireland typically occur during late summer [7], when the majority of livestock are grazing.…”

Haemolytic Uraemic Syndrome (HUS): Clinical Medicine Versus Clinical Anatomy

“…The annual incidence of the Verocytotoxin-producing Esherichia Coli (VTEC) infection varies geographically from year to year, ranging from 1-30 cases per 100,000 in industrialized countries and is associated with HUS. HUS occurs in sporadic cases epidemics; between 1st January [2] and 31 st December [2] in England, a total of 3717 cases were reported with evidence of Shiga Toxin-Producing E. Coli (STEC) infection; sometimes following outbreaks. In Hamburg [3], there was an outbreak with more than 900 cases.…”