The epidemiology, microbiology and clinical impact of Shiga toxin-producing Escherichia coli in England, 2009-2012.
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.
Public Health England Department of Gastrointestinal,Emerging and Zoonotic Infections,Centre for Infectious Disease Surveillance and Control,London,UK.
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Byrne
Public Health England Gastrointestinal Bacteria Reference Unit,London,UK.
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Jenkins
Public Health England Department of Gastrointestinal,Emerging and Zoonotic Infections,Centre for Infectious Disease Surveillance and Control,London,UK.
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Launders
Public Health England Department of Gastrointestinal,Emerging and Zoonotic Infections,Centre for Infectious Disease Surveillance and Control,London,UK.
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Elson
Public Health England Department of Gastrointestinal,Emerging and Zoonotic Infections,Centre for Infectious Disease Surveillance and Control,London,UK.
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Adak
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002648:Child; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D004927:Escherichia coli Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology* / Q000473:pathology; D005006:Ethnicity; D005260:Female; D005517:Foodborne Diseases / Q000150:complications / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D005759:Gastroenteritis / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology* / Q000473:pathology; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D065288:Serogroup; D012737:Sex Factors; D054323:Shiga-Toxigenic Escherichia coli / Q000145:classification / Q000302:isolation & purification*; D014505:Urban Population; D055815:Young Adult; D015047:Zoonoses / Q000150:complications / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology
Escherichia coli; foodborne zoonoses; gastrointestinal infections; infectious disease epidemiology; zoonotic foodborne diseases