title: Increased recognition of non-O157 Shiga toxin-producing Escherichia coli infections in the United States during 2000-2010: epidemiologic features and comparison with E. coli O157 infections.
abstract: BACKGROUND
  Shiga toxin-producing Escherichia coli (STEC) are an important cause of diarrhea and the major cause of postdiarrheal hemolytic uremic syndrome. Non-O157 STEC infections are being recognized with greater frequency because of changing laboratory practices.
  
  
  METHODS
  Foodborne Diseases Active Surveillance Network (FoodNet) site staff conducted active, population-based surveillance for laboratory-confirmed STEC infections. We assessed frequency and incidence of STEC infections by serogroup and examined and compared demographic factors, clinical characteristics, and frequency of international travel among patients.
  
  
  RESULTS
  During 2000-2010, FoodNet sites reported 2006 cases of non-O157 STEC infection and 5688 cases of O157 STEC infections. The number of reported non-O157 STEC infections increased from an incidence of 0.12 per 100,000 population in 2000 to 0.95 per 100,000 in 2010; while the rate of O157 STEC infections decreased from 2.17 to 0.95 per 100,000. Among non-O157 STEC, six serogroups were most commonly reported: O26 (26%), O103 (22%), O111 (19%), O121 (6%), O45 (5%), and O145 (4%). Non-O157 STEC infections were more common among Hispanics, and infections were less severe than those caused by O157 STEC, but this varied by serogroup. Fewer non-O157 STEC infections were associated with outbreaks (7% versus 20% for O157), while more were associated with international travel (14% versus 3% for O157).
  
  
  CONCLUSIONS
  Improved understanding of the epidemiologic features of non-O157 STEC infections can inform food safety and other prevention efforts. To detect both O157 and non-O157 STEC infections, clinical laboratories should routinely and simultaneously test all stool specimens submitted for diagnosis of acute community-acquired diarrhea for O157 STEC and for Shiga toxin and ensure that isolates are sent to a public health laboratory for serotyping and subtyping.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. lgould@cdc.gov
authors.forename: L Hannah
authors.initials: LH
authors.lastname: Gould
authors.forename: Rajal K
authors.initials: RK
authors.lastname: Mody
authors.forename: Kanyin L
authors.initials: KL
authors.lastname: Ong
authors.forename: Paula
authors.initials: P
authors.lastname: Clogher
authors.forename: Alicia B
authors.initials: AB
authors.lastname: Cronquist
authors.forename: Katie N
authors.initials: KN
authors.lastname: Garman
authors.forename: Sarah
authors.initials: S
authors.lastname: Lathrop
authors.forename: Carlota
authors.initials: C
authors.lastname: Medus
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Spina
authors.forename: Tameka H
authors.initials: TH
authors.lastname: Webb
authors.forename: Patricia L
authors.initials: PL
authors.lastname: White
authors.forename: Katie
authors.initials: K
authors.lastname: Wymore
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Gierke
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Mahon
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Griffin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003710:Demography; D003967:Diarrhea; D004196:Disease Outbreaks; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D019453:Escherichia coli O157 / Q000302:isolation & purification*; D005260:Female; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000382:microbiology; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D008297:Male; D019081:O Antigens / Q000276:immunology; D011159:Population Surveillance; D012703:Serotyping; D022621:Shiga Toxin / Q000378:metabolism; D054323:Shiga-Toxigenic Escherichia coli / Q000145:classification / Q000302:isolation & purification*; D014195:Travel; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019081:O Antigens; D022621:Shiga Toxin