ECDC: Infants and children most affected by STEC

By Joseph James Whitworth contact

- Last updated on GMT

Picture: iStock/miluxian
Picture: iStock/miluxian
More than 6,000 confirmed cases of infections with Shiga toxin/verocytotoxin-producing E. coli (STEC/VTEC) were reported in Europe in 2015.

The highest confirmed case rates were in 0-4 year-old children, according to the European Centre for Disease Prevention and Control (ECDC).

The top rate was in this age group for both genders (7.8 cases per 100,000 population) and particularly in males (8 cases per 100,000 population).

Infants and children most affected

The age group affected the most were infants and children up to four years of age, who accounted for almost one-third of confirmed cases in 2015.

This was also seen in HUS cases where two thirds were reported in patients 0-4 years old.

Notification rate in the age group 0-4 is four to nine times higher than the rate in older age groups.

Data comes from The European Surveillance System (TESSy) and additional epidemic intelligence.

In 2015, 30 EU/EEA countries reported data on STEC/VTEC infections.

The average proportion of hospitalised STEC/VTEC cases was relatively high (40%).

Notification of infections is mandatory in most EU/EEA countries except for six Member States where it is voluntary (Belgium, France, Italy, Luxembourg and Spain) or based on another system (UK).

In France, STEC/VTEC surveillance is centred on paediatric haemolytic-uraemic syndrome (HUS) surveillance and in Italy it is primarily based on the national registry of HUS.

Fourth most common zoonosis in EU

For 2015, 6,246 cases of STEC/VTEC infections were reported and 6,151 were confirmed. Of 6,139 confirmed cases with known gender in 2015, 55% were female.

This makes it the fourth most commonly reported zoonosis in the EU.

The highest country-specific notification rates were in Ireland, Sweden, the Netherlands and Denmark, with 12.9, 5.7, 5.1 and 3.6 cases per 100,000 population, respectively.

Germany had the most cases (1,647 and 1,616 confirmed), followed by the UK (1,328 cases), Netherlands (858) and Sweden (551).

Bulgaria, Croatia, Cyprus, Poland, Portugal and Romania all reported no cases.

A clear seasonal trend in confirmed STEC/VTEC cases was reported in the EU/EEA between 2011 and 2015, with more cases during the summer months.

STEC/VTEC serogroups most frequently found in food samples are those most commonly reported in human infections with serotype O157 representing about half of the cases.

In 2015, STEC/VTEC was the causative agent in four outbreaks with known food source accounting for 1.2% of all the foodborne outbreaks reported at the EU level. Three outbreaks were caused by STEC/VTEC O157.

The food vehicles implicated were ‘mixed leaf lettuce and raw minced lamb’, ‘chicken burgers and beef burgers’ and ‘various meat products’.

Good hygiene practices can reduce risk

ECDC said adequate cooking of food, particularly beef and pasteurised milk reduce the risk of foodborne STEC/VTEC infections.

“As STEC/VTEC infection is mainly acquired by contact with animals and/or their faeces and by consuming contaminated food, good hygiene practices in premises dealing with animals and food processing can decrease the risk of infection.”

From 2007 to 2010, the EU/EEA notification rate was below 1 STEC/VTEC case per 100,000 population.

In summer 2011, a large enteroaggregative STEC O104:H4 outbreak was associated with contaminated raw sprouted fenugreek seeds.

More than 3,800 people in Germany were affected with cases in another 15 countries.

Sprouted seeds are the sole food category for which microbiological criteria for STEC/VTEC have been established in the EU after the 2011 outbreak.

In 2012, a 1.8-fold increase in the EU/EEA notification rate was observed compared with the years before the outbreak.

This was partly due to increased awareness, increased use of PCR for detection of VTEC in stool samples and more laboratories testing for serogroups other than O157.

The EU/EEA notification rate for human STEC/VTEC infections has since stabilised.

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