Abstract
Shiga toxin-producing Escherichia coli (STEC) are the most virulent diarrheagenic E. coli known to date. They can be spread with alarming ease via food as exemplified by a large sprout-borne outbreak of STEC O104:H4 in 2011 that was centered in northern Germany and affected several countries. Effective control of such outbreaks is an important public health task and necessitates early outbreak detection, fast identification of the outbreak vehicle and immediate removal of the suspected food from the market, flanked by consumer advice and measures to prevent secondary spread.In our view, opportunities to improve control of STEC outbreaks lie in early clinical suspicion for STEC infection, timely diagnosis of all STEC at the serotype-level and integrating molecular subtyping information into surveillance systems. Furthermore, conducting analytical studies that supplement patients' imperfect food history recall and performing, as an investigative element, product tracebacks, are pivotal but underutilized tools for successful epidemiologic identification of the suspected vehicle in foodborne outbreaks. As a corollary, these tools are amenable to tailor microbiological testing of suspected food.Please see related article: http://www.biomedcentral.com/1741-7015/10/12
Highlights
Among diarrheagenic Escherichia coli, those producing Shiga toxin, are the most virulent to date. These Shiga toxin-producing E. coli (STEC) can cause hemorrhagic colitis that may manifest as painful, grossly bloody diarrhea [1] as well as hemolytic uremic syndrome (HUS) - a potentially fatal thrombotic microangiopathy, typically affecting children
For apparently sporadic STEC-associated HUS, the casefatality ratio in the acute phase is between 2% and 5% [3,4], but it can be as high as 10% in outbreaks of the rare sorbitol-fermenting O157:H- STEC [5]
Germany Full list of author information is available at the end of the article. Since their first description in 1977 [6], many (> 100) different STEC serotypes, a categorization based on O and H antigens, have been associated with human disease
Summary
Among diarrheagenic Escherichia coli, those producing Shiga toxin (synonym: Vero toxin), are the most virulent to date. Timeliness of public health surveillance is the key to implementing effective control measures In foodborne outbreaks, this translates into the necessity for 1) early detection, 2) timely identification of the suspected food vehicle and 3) removing it from the market, accompanied by targeted consumer advice. Integration of molecular subtyping information into public health surveillance (currently requiring culture isolation) is powerful It greatly enhances sensitivity and timeliness of outbreak detection and focuses investigations by separating outbreak-related cases from geographically and temporally associated sporadic cases [35]. Difficulties in the prevention of secondary transmission of STEC O157 to children, mainly occurring in the household, have led to far-reaching recommendations such as prompt separation of siblings [48] or even hospitalization of pediatric cases on clinical grounds [49] This outbreak primarily affected adults who, compared to children, are less likely to transmit the pathogen to other persons [48,50]. This calls for an in-depth analysis of intra-household transmission to improve recommendations for its prevention
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