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Abstract

We managed a complex outbreak of Shiga toxin-producing (STEC) and -negative O157 (non-STEC) cases in four nurseries in two neighbouring towns in south-east Scotland, with epidemiological links through shared management, staff or other visits. There were 57 confirmed cases between July and October 2022. Nurseries voluntarily closed to support outbreak control. Subsequent whole genome sequencing identified two separate, unlinked outbreaks of 2a-positive O157:H7 (19 confirmed cases in Nursery 1) and negative O157:H39 (17 confirmed cases in Nursery 2). Smaller numbers of six additional STEC and O157 (non-STEC) strains were identified in the four nurseries. Five children from Nursery 1 who tested positive for 2a-positive O157:H7 required hospitalisation, one of whom developed haemolytic uraemic syndrome. Children with other STEC and O157 (non-STEC) strains had few or no symptoms. Overall, five of 19 cases with s2a subtypes were asymptomatic, compared with seven of nine for 2f subtypes, and 14 of 25 for -negative subtypes. Given the findings in this setting, further information on the prevalence of asymptomatic STEC carriage by strain, age and geography, and in other contexts, will support understanding and risk management of future outbreaks.

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/content/10.2807/1560-7917.ES.2025.30.46.2500340
2025-11-20
2025-12-08
/content/10.2807/1560-7917.ES.2025.30.46.2500340
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References

  1. EFSA BIOHAZ PanelKoutsoumanis K, Allende A, Alvarez-Ordonez A, Bover-Cid S, Chemaly M, et al. Pathogenicity assessment of Shiga toxin-producing Escherichia coli (STEC) and the public health risk posed by contamination of food with STEC. EFSA J. 2020;18(1):305967.
  2. Scottish Health Protection Network. Guidance for the public health management of Escherichia coli O157 and other Shiga toxin producing (STEC) infections. Glasgow: Health Protection Scotland; 2018. Available from: https://edinburghlabmed.co.uk/sites/default/files/2020-09/SHPN%20Guidance%20for%20the%20Public%20Health%20Management%20of%20Escherichia%20coli%20O157%20and%20other%20Shiga%20toxin-producing%20%28STEC%29%20infections.pdf
  3. Belongia EA, Osterholm MT, Soler JT, Ammend DA, Braun JE, MacDonald KL. Transmission of Escherichia coli O157:H7 infection in Minnesota child day-care facilities. JAMA. 1993;269(7):883-8.  https://doi.org/10.1001/jama.1993.03500070063030  PMID: 8426447 
  4. Public Health Scotland. Gastrointestinal and zoonoses. Biennial report 2020 to 2021. An Official Statistics release for Scotland. Glasgow: Public Health Scotland; 2023. Available from: https://publichealthscotland.scot/publications/gastrointestinal-and-zoonoses/gastrointestinal-and-zoonoses-biennial-report-2020-to-2021
  5. Cunningham N, Jenkins C, Williams S, Garner J, Eggen B, Douglas A, et al. An outbreak of Shiga toxin-producing Escherichia coli (STEC) O157:H7 associated with contaminated lettuce and the cascading risks from climate change, the United Kingdom, August to September 2022. Euro Surveill. 2024;29(36):2400161.  https://doi.org/10.2807/1560-7917.ES.2024.29.36.2400161  PMID: 39239728 
  6. Public Health Scotland. Surveillance form: Escherichia coli and verotoxigenic Escherichia coli (VTEC). Glasgow: Public Health Scotland; 2021. Available from: https://publichealthscotland.scot/publications/surveillance-form-escherichia-coli-and-verotoxigenic-escherichia-coli-vtec/surveillance-form-escherichia-coli-and-verotoxigenic-escherichia-coli-vtec-january-2021
  7. Ahmed R, Bopp C, Borczyk A, Kasatiya S. Phage-typing scheme for Escherichia coli O157:H7. J Infect Dis. 1987;155(4):806-9.  https://doi.org/10.1093/infdis/155.4.806  PMID: 3546523 
  8. Khakhria R, Duck D, Lior H. Extended phage-typing scheme for Escherichia coli O157:H7. Epidemiol Infect. 1990;105(3):511-20.  https://doi.org/10.1017/S0950268800048135  PMID: 2249715 
  9. European Centre for Disease Prevention and Control (ECDC). EpiPulse – the European surveillance portal for infectious diseases. Stockholm; ECDC. [Accessed 25 August 2025]. Available from: https://www.ecdc.europa.eu/en/publications-data/epipulse-european-surveillance-portal-infectious-diseases
  10. Scottish Parliament. Public Health etc. (Scotland) Act 2008. Edinburgh: Scottish Parliament; 2008. Available from:www.legislation.gov.uk/asp/2008/5/contents
  11. Werber D, Mason BW, Evans MR, Salmon RL. Preventing household transmission of Shiga toxin-producing Escherichia coli O157 infection: promptly separating siblings might be the key. Clin Infect Dis. 2008;46(8):1189-96.  https://doi.org/10.1086/587670  PMID: 18444854 
  12. Parry SM, Salmon RL. Sporadic STEC O157 infection: secondary household transmission in Wales. Emerg Infect Dis. 1998;4(4):657-61.  https://doi.org/10.3201/eid0404.980419  PMID: 9866745 
  13. Sin MA, Takla A, Flieger A, Prager R, Fruth A, Tietze E, et al. Carrier prevalence, secondary household transmission, and long-term shedding in 2 districts during the Escherichia coli O104:H4 outbreak in Germany, 2011. J Infect Dis. 2013;207(3):432-8.  https://doi.org/10.1093/infdis/jis702  PMID: 23175763 
  14. Ludwig K, Sarkim V, Bitzan M, Karmali MA, Bobrowski C, Ruder H, et al. Shiga toxin-producing Escherichia coli infection and antibodies against Stx2 and Stx1 in household contacts of children with enteropathic hemolytic-uremic syndrome. J Clin Microbiol. 2002;40(5):1773-82.  https://doi.org/10.1128/JCM.40.5.1773-1782.2002  PMID: 11980959 
  15. 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 
  16. Mannix M, O’Connell N, McNamara E, Fitzgerald A, Prendiville T, Norris T, et al. Large E. coli O157 outbreak in Ireland, October-November 2005. Euro Surveill. 2005;10(12):E051222.3. PMID: 16794302 
  17. Sayk F, Hauswaldt S, Knobloch JK, Rupp J, Nitschke M. Do asymptomatic STEC-long-term carriers need to be isolated or decolonized? New evidence from a community case study and concepts in favor of an individualized strategy. Front Public Health. 2024;12:1364664.  https://doi.org/10.3389/fpubh.2024.1364664  PMID: 38699424 
  18. EFSA BIOHAZ PanelKoutsoumanis K, Allende A, Alvarez-Ordóñez A, Bover-Cid S, Chemaly M, et al. Pathogenicity assessment of Shiga toxin-producing Escherichia coli (STEC) and the public health risk posed by contamination of food with STEC. EFSA J. 2020;18(1):5967.
  19. Scottish Health Protection Network. Public health management of Shiga toxin-producing Escherichia coli (STEC) infection. Glasgow: Public Health Scotland; 2025. Available from: https://www.publichealthscotland.scot/publications/public-health-management-of-shiga-toxin-producing-escherichia-coli-stec-infection/public-health-management-of-shiga-toxin-producing-escherichia-coli-stec-infection-version-2/overview
  20. Public Health Scotland Guidance Team. Evidence review to inform public health guidance for STEC. Glasgow: Public Health Scotland; 2025. Available from: https://publichealthscotland.scot/media/33557/2025-06-stec-guidance-phs-evidence-review.pdf
Concurrent outbreaks of Escherichia coli O157:H7 and O157:H39 with high asymptomatic carriage of other Shiga toxin-producing E. coli in nursery children, south-east Scotland, United Kingdom, July to October 2022
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Amir+Kirolos&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kirolos Amir</a>, <a href="/search?value1=Marion+Muir&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Muir Marion</a>, <a href="/search?value1=Andrew+Douglas&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Douglas Andrew</a>, <a href="/search?value1=Genna+Leckenby&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Leckenby Genna</a>, <a href="/search?value1=Lesley+Allison&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Allison Lesley</a>, <a href="/search?value1=Graham+Mackenzie&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mackenzie Graham</a>, <a href="/search?value1=on+behalf+of+the+Incident+Management+Team&option1=author&noRedirect=true" class="nonDisambigAuthorLink">on behalf of the Incident Management Team</a></span>. Concurrent outbreaks of Escherichia coli O157:H7 and O157:H39 with high asymptomatic carriage of other Shiga toxin-producing E. coli in nursery children, south-east Scotland, United Kingdom, July to October 2022. <a href="/content/ecdc">Euro Surveill.</a> 2025;30(46):pii=2500340. <a href="https://doi.org/10.2807/1560-7917.ES.2025.30.46.2500340" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2025.30.46.2500340</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 14 May 2025;&nbsp;&nbsp; <span class="generated">Accepted</span>: 04 Sept 2025 </span> </p>
/content/10.2807/1560-7917.ES.2025.30.46.2500340
/content/10.2807/1560-7917.ES.2025.30.46.2500340
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