Abstract
A hybrid strain of enteroaggregative and Shiga toxin 2-producing Escherichia coli (EAEC-STEC) serotype O104:H4 strain caused a large outbreak of haemolytic uraemic syndrome and bloody diarrhoea in 2011 in Europe. Two surveys were performed in the European Union (EU) and European Economic Area (EEA) countries to assess their laboratory capabilities to detect and characterise this previously uncommon STEC strain. Prior to the outbreak, 11 of the 32 countries in this survey had capacity at national reference laboratory (NRL) level for epidemic case confirmation according to the EU definition. During the outbreak, at primary diagnostic level, nine countries reported that clinical microbiology laboratories routinely used Shiga toxin detection assays suitable for diagnosis of infections with EAEC-STEC O104:H4, while 14 countries had NRL capacity to confirm epidemic cases. Six months after the outbreak, 22 countries reported NRL capacity to confirm such cases following initiatives taken by NRLs and the European Centre for Disease Prevention and Control (ECDC) Food- and Waterborne Disease and Zoonoses laboratory network. These data highlight the challenge of detection and confirmation of epidemic infections caused by atypical STEC strains and the benefits of coordinated EU laboratory networks to strengthen capabilities in response to a major outbreak.
Highlights
Between May and August 2011, an outbreak of Shiga toxin 2-producing Escherichia coli (STEC) affected over 4,000 individuals in Europe
To adress the concerns raised in terms of laboratory diagnostics, European Centre for Disease Prevention and Control (ECDC) investigated how well the European Union (EU)/Economic Area (EEA) countries were able to diagnose and confirm STEC O104:H4 cases according to the EU epidemic case definition and whether rapid laboratory capacity building initiatives were needed
Human infections caused by STEC O157:H7 account for nearly half of reported cases of STEC disease in the EU/EEA countries [19]
Summary
Between May and August 2011, an outbreak of Shiga toxin 2-producing Escherichia coli (STEC) affected over 4,000 individuals in Europe. It was associated with the highest number of cases of haemolytic uraemic syndrome (HUS) reported to date (782 confirmed and 119 suspected cases) in the European Union (EU)/European Economic Area (EEA) [1]. The outbreak strain was identified as STEC with unusual characteristics. These included the rare serotype O104:H4, lack of attaching/effacing pathogenicity island of virulent STEC strains, as indicated by the lack of the eae gene, but harbouring virulence markers of enteroaggregative E. coli, e.g. presence of aggR gene, and exhibiting a multidrug resistance phenotype, including production of CTX-M-15 extended spectrum beta-lactamase (ESBL) [4,5,6]. At the beginning of June 2011, the European Centre for Disease Prevention and Control (ECDC) published an EU epidemic case definition for this outbreak strain [7] to allow standardised reporting by the EU/EEA countries and comparison of data at EU level for outbreak monitoring
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