Surveillance and outbreak report Open Access
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The first documented British outbreak of Shiga toxin-producing (STEC) O55:H7 began in the county of Dorset, England, in July 2014. Since then, there have been a total of 31 cases of which 13 presented with haemolytic uraemic syndrome (HUS). The outbreak strain had Shiga toxin (Stx) subtype 2a associated with an elevated risk of HUS. This strain had not previously been isolated from humans or animals in England. The only epidemiological link was living in or having close links to two areas in Dorset. Extensive investigations included testing of animals and household pets. Control measures included extended screening, iterative interviewing and exclusion of cases and high risk contacts. Whole genome sequencing (WGS) confirmed that all the cases were infected with similar strains. A specific source could not be identified. The combination of epidemiological investigation and WGS indicated, however, that this outbreak was possibly caused by recurrent introductions from a local endemic zoonotic source, that a highly similar endemic reservoir appears to exist in the Republic of Ireland but has not been identified elsewhere, and that a subset of cases was associated with human-to-human transmission in a nursery.


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  1. Fitzpatrick M. Haemolytic uraemic syndrome and E coli O157. BMJ. 1999;318(7185):684-5.  https://doi.org/10.1136/bmj.318.7185.684  PMID: 10073994 
  2. Launders N, Byrne L, Jenkins C, Harker K, Charlett A, Adak GK. Disease severity of Shiga toxin-producing E. coli O157 and factors influencing the development of typical haemolytic uraemic syndrome: a retrospective cohort study, 2009-2012. BMJ Open. 2016;6(1):e009933.  https://doi.org/10.1136/bmjopen-2015-009933  PMID: 26826153 
  3. Sánchez S, Llorente MT, Echeita MA, Herrera-León S. Development of three multiplex PCR assays targeting the 21 most clinically relevant serogroups associated with Shiga toxin-producing E. coli infection in humans. PLoS One. 2015;10(1):e0117660.  https://doi.org/10.1371/journal.pone.0117660  PMID: 25629697 
  4. De Schrijver K, Buvens G, Possé B, Van den Branden D, Oosterlynck O, De Zutter L, et al. Outbreak of verocytotoxin-producing E. coli O145 and O26 infections associated with the consumption of ice cream produced at a farm, Belgium, 2007. Euro Surveill. 2008;13(7):8041. PMID: 18445416 
  5. McAllister LJ, Bent SJ, Petty NK, Skippington E, Beatson SA, Paton JC, et al. Genomic Comparison of Two O111:H- Enterohemorrhagic Escherichia coli Isolates from a Historic Hemolytic-Uremic Syndrome Outbreak in Australia. Infect Immun. 2016;84(3):775-81.  https://doi.org/10.1128/IAI.01229-15  PMID: 26729762 
  6. Kanayama A, Yahata Y, Arima Y, Takahashi T, Saitoh T, Kanou K, et al. Enterohemorrhagic Escherichia coli outbreaks related to childcare facilities in Japan, 2010-2013. BMC Infect Dis. 2015;15(1):539.  https://doi.org/10.1186/s12879-015-1259-3  PMID: 26589805 
  7. Luna-Gierke RE, Griffin PM, Gould LH, Herman K, Bopp CA, Strockbine N, et al. Outbreaks of non-O157 Shiga toxin-producing Escherichia coli infection: USA. Epidemiol Infect. 2014;142(11):2270-80.  https://doi.org/10.1017/S0950268813003233  PMID: 24398154 
  8. Werber D, Fruth A, Liesegang A, Littmann M, Buchholz U, Prager R, et al. A multistate outbreak of Shiga toxin-producing Escherichia coli O26:H11 infections in Germany, detected by molecular subtyping surveillance. J Infect Dis. 2002;186(3):419-22.  https://doi.org/10.1086/341457  PMID: 12134240 
  9. Noll LW, Shridhar PB, Dewsbury DM, Shi X, Cernicchiaro N, Renter DG, et al. A Comparison of Culture- and PCR-Based Methods to Detect Six Major Non-O157 Serogroups of Shiga Toxin-Producing Escherichia coli in Cattle Feces. PLoS One. 2015;10(8):e0135446.  https://doi.org/10.1371/journal.pone.0135446  PMID: 26270482 
  10. Byrne L, Jenkins C, Launders N, Elson R, Adak GK. The epidemiology, microbiology and clinical impact of Shiga toxin-producing Escherichia coli in England, 2009-2012. Epidemiol Infect. 2015;143(16):3475-87.  https://doi.org/10.1017/S0950268815000746  PMID: 25920912 
  11. Muniesa M, Jofre J. Abundance in sewage of bacteriophages infecting Escherichia coli O157:H7. Methods Mol Biol. 2004;268:79-88. PMID: 15156020 
  12. Zhou Z, Li X, Liu B, Beutin L, Xu J, Ren Y, et al. Derivation of Escherichia coli O157:H7 from its O55:H7 precursor. PLoS One. 2010;5(1):e8700.  https://doi.org/10.1371/journal.pone.0008700  PMID: 20090843 
  13. Kintz E, Brainard J, Hooper L, Hunter P. Transmission pathways for sporadic Shiga-toxin producing E. coli infections: A systematic review and meta-analysis. Int J Hyg Environ Health. 2017;220(1):57-67.  https://doi.org/10.1016/j.ijheh.2016.10.011  PMID: 27842895 
  14. Public Health England (PHE). Vero cytotoxin-producing Escherichia coli Enhanced surveillance questionnaire 2013. London: PHE; 2013. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/323423/VTEC_Questionnaire.pdf
  15. Enigma project. The Study of Campylobacter. Sources, seasonality, transmission and control: Campylobacter and human behaviour in a changing environment. Liverpool: Enigma. [Accessed Nov 2016]. Available from: http://enigmaproject.org.uk/the-project/
  16. Chart H, Cheasty T. Human infections with verocytotoxin-producing Escherichia coli O157--10 years of E. coli O157 serodiagnosis. J Med Microbiol. 2008;57(Pt 11):1389-93.  https://doi.org/10.1099/jmm.0.2008/003632-0  PMID: 18927417 
  17. Jenkins C, Lawson AJ, Cheasty T, Willshaw GA. Assessment of a real-time PCR for the detection and characterization of verocytotoxigenic Escherichia coli. J Med Microbiol. 2012;61(Pt 8):1082-5.  https://doi.org/10.1099/jmm.0.041517-0  PMID: 22516135 
  18. Health Protection Agency (HPA). The VTEC operational manual. Operational guidance for HPA staff dealing with cases and incidents of VTEC infection. London: HPA; 2011. Available from: https://www.gov.uk/government/publications/vero-cytotoxin-producing-escherichia-coli-operational-guidelines-for-public-health-management
  19. Li H, Durbin R. Fast and accurate long-read alignment with Burrows-Wheeler transform. Bioinformatics. 2010;26(5):589-95.  https://doi.org/10.1093/bioinformatics/btp698  PMID: 20080505 
  20. Stamatakis A. RAxML version 8: a tool for phylogenetic analysis and post-analysis of large phylogenies. Bioinformatics. 2014;30(9):1312-3.  https://doi.org/10.1093/bioinformatics/btu033  PMID: 24451623 
  21. Atkinson PW, Robinson RA, Clark JA, Miyar T, Downie IS, du Feu CR, et al. Migratory movements of waterfowl: a web-based mapping tool. The European Union for Bird Ringing (EURING) report to the EU Commission. EURING; 2007. Available from: http://blx1.bto.org/ai-eu/
  22. Bayliss L, Carr R, Edeghere O, Knapper E, Nye K, Harvey G, et al. School outbreak of Escherichia coli O157 with high levels of transmission, Staffordshire, England, February 2012. J Public Health (Oxf). 2016;38(3):e247-53.  https://doi.org/10.1093/pubmed/fdv122  PMID: 26364319 
  23. Jenkins C, Dallman TJ, Launders N, Willis C, Byrne L, Jorgensen F, et al. Public Health Investigation of Two Outbreaks of Shiga Toxin-Producing Escherichia coli O157 Associated with Consumption of Watercress. Appl Environ Microbiol. 2015;81(12):3946-52.  https://doi.org/10.1128/AEM.04188-14  PMID: 25841005 
  24. Milnes AS, Stewart I, Clifton-Hadley FA, Davies RH, Newell DG, Sayers AR, et al. Intestinal carriage of verocytotoxigenic Escherichia coli O157, Salmonella, thermophilic Campylobacter and Yersinia enterocolitica, in cattle, sheep and pigs at slaughter in Great Britain during 2003. Epidemiol Infect. 2008;136(6):739-51.  https://doi.org/10.1017/S0950268807009223  PMID: 17655782 
  25. Adams NL, Byrne L, Smith GA, Elson R, Harris JP, Salmon R, et al. Shiga Toxin-Producing Escherichia coli O157, England and Wales, 1983-2012. Emerg Infect Dis. 2016;22(4):590-7.  https://doi.org/10.3201/eid2204.151485  PMID: 26982243 
  26. Ejidokun OO, Walsh A, Barnett J, Hope Y, Ellis S, Sharp MW, et al. Human Vero cytotoxigenic Escherichia coli (VTEC) O157 infection linked to birds. Epidemiol Infect. 2006;134(2):421-3.  https://doi.org/10.1017/S0950268805004917  PMID: 16490148 
  27. Busch U, Hörmansdorfer S, Schranner S, Huber I, Bogner K-H, Sing A. Enterohemorrhagic Escherichia coll excretion by child and her cat. Emerg Infect Dis. 2007;13(2):348-9.  https://doi.org/10.3201/eid1302.061106  PMID: 17479915 
  28. Rumi MV, Irino K, Deza N, Huguet MJ, Bentancor AB. First isolation in Argentina of a highly virulent Shiga toxin-producing Escherichia coli O145:NM from a domestic cat. J Infect Dev Ctries. 2012;6(4):358-63. PMID: 22505447 
  29. Dallman TJ, Byrne L, Ashton PM, Cowley LA, Perry NT, Adak G, et al. Whole-genome sequencing for national surveillance of Shiga toxin-producing Escherichia coli O157. Clin Infect Dis. 2015;61(3):305-12.  https://doi.org/10.1093/cid/civ318  PMID: 25888672 
  30. Chattaway MA, Dallman TJ, Gentle A, Wright MJ, Long SE, Ashton PM, et al. Whole Genome Sequencing for Public Health Surveillance of Shiga Toxin-Producing Escherichia coli Other than Serogroup O157. Front Microbiol. 2016;7:258.  https://doi.org/10.3389/fmicb.2016.00258  PMID: 26973632 

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