Abstract
In August 2016, an outbreak of Shiga toxin-producing Escherichia coli (STEC) and enteropathogenic E. coli (EPEC) with 237 cases occurred in the Helsinki metropolitan area, Finland. Gastroenteritis cases were reported at 11 events served by one catering company. Microbiological and epidemiological investigations suggested rocket salad as the cause of the outbreak. STEC ONT:H11 and EPEC O111:H8 strains isolated from food samples containing rocket were identical to the patient isolates. In this outbreak, the reported symptoms were milder than considered before for STEC infection, and the guidelines for STEC control measures need to be updated based on the severity of the illness. Based on our experience in this outbreak, national surveillance criteria for STEC have been updated to meet the practice in reporting laboratories covering both PCR-positive and culture-confirmed findings. We suggest that EPEC could be added to the national surveillance since diagnostics for EPEC are routinely done in clinical laboratories.
Highlights
Escherichia coli are Gram-negative rod-shaped bacteria and part of the normal bacterial flora in the gastrointestinal tract, while diarrhoeagenic E. coli pathotypes such as Shiga toxin-producing E. coli (STEC) and enteropathogenic E. coli(EPEC) are able to cause gastrointestinal infections [1]
Both Shiga toxin-producing Escherichia coli (STEC) and EPEC are transmitted through the faecaloral route, and outbreaks caused by STEC and atypical EPEC (aEPEC) have been described after ingestion of contaminated
All STEC-positive findings from August to September reported to Finnish Infectious Disease Registry (FIDR) were linked to the names, ages and places of residency on the participant lists of the 11 events with reported gastroenteritis cases, and to the interviews of STECpositive persons done by the local infectious diseases nurses
Summary
Escherichia coli are Gram-negative rod-shaped bacteria and part of the normal bacterial flora in the gastrointestinal tract, while diarrhoeagenic E. coli pathotypes such as Shiga toxin-producing E. coli (STEC) and enteropathogenic E. coli(EPEC) are able to cause gastrointestinal infections [1]. The virulence of STEC is largely based on the production of Shiga toxin 1 or 2 and is identified by detecting the presence of stx or stx genes [1,4]. The pathogenity of aEPEC has been questioned but their involvement with diarrhoeal outbreaks supports the idea that certain strains are diarrhoeagenic [1,7] Both STEC and EPEC are transmitted through the faecaloral route, and outbreaks caused by STEC and aEPEC have been described after ingestion of contaminated. Most studies on STEC have focused on the serotype O157:H7, but infections and outbreaks caused by non-O157 strains are increasingly reported in Europe and elsewhere [10,11,12,13]. We investigated the outbreak to identify its extent and source together with the regional and local health and environmental health officials in affected municipalities in the Hospital District of Helsinki and Uusimaa in order to prevent further cases and outbreaks
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