Vero Cytotoxic-Producing Escherichia Coli 0157 Epidemiology Report The incidence of 0157 VTEC infections is variable throughout the UK, with the highest rate in Scotland. In England and Wales, laboratories in the PHLS and NHS refer isolates of 0157 VTEC to the Laboratory of Enteric Pathogens (LEP), Central Public Health Laboratory for confirmation and further typing. The numbers of laboratory confirmed cases of 0157 VTEC infections for England and Wales since 1982 are given below: When allowance is made for the improvements in ascertainment in the 1980 s the incidence of the disease still appears to be increasing. In Scotland, between 1986 and 1996, the trend is similar, but the graph below shows the dramatic impact of a large outbreak in 1996: Data is not readily available for all countries in the world, but in Canada, there is a similar increase over time between 1988 and 1998.
In 2000, a single outbreak caused 7 deaths and infected 2300 others. The majority of cases of 0157 VTEC infection are apparently sporadic although outbreaks, some very large, do occur. According to PHLS reports, there were 18 general outbreaks between 1992 and 1994, and 67 general outbreaks between 1995 and 1998. In England and Wales, sporadic cases have been associated with non-0157 VTEC, but outbreaks have not been described. The table and graph below show the location where most of these outbreaks occur. Note the larger numbers in both private houses and in the community: Escherichia coli O 157 GENERAL OUTBREAKS England and Wales, by Place of Outbreak, 1992 – 1998 PLACE OF OUTBREAK: 1992 1993 1994 1995 1996 1997 1998 SUM Private House 0 1 0 0 3 2 4 10 Hotel/GuestHouse/Residential Pub 1 0 0 2 0 0 0 3 Restaurant/Caf’e 0 1 0 1 0 2 1 5 Pub/Bar 0 0 0 0 0 0 0 0 Mobile Retailer 0 0 0 0 0 0 0 0 Armed Services Camp 0 0 0 0 0 0 0 0 Canteen 0 0 0 0 1 0 0 1 Shop/Retailer 1 2 0 2 2 0 0 7 Hospital 0 0 0 0 0 1 0 1 Residential Institution 1 0 0 2 0 1 2 6 School 1 0 1 1 0 2 1 6 Community 0 3 2 1 2 2 1 11 Farm 0 0 2 0 0 4 1 7 Hall/Caterer 0 1 0 0 0 1 0 2 Holiday Camp 0 0 0 0 1 0 0 1 University/College 0 0 0 0 0 0 0 0 Other 1 0 0 0 1 1 1 4 TOTAL 5 8 5 9 10 16 11 64 The PHLS are currently co-ordinating a EU funded project called Enter-net which aims to create an international surveillance network for E.
Coli 0157 infections The network has been set up to help identify the dimension of the E-Coli problem in Europe and is able to identify unusual clusters and international outbreaks of infection. The identification of such events allows for public health intervention measures to be implemented. Enter-net will lead to the improved surveillance and understanding of this infection throughout Europe. Serious illness resulting from E-coli 0157 VTEC, characterised by bloody diarrhoea, sever abdominal cramps, acute renal failure and haemolytic anaemia, usually occurs in young children and is the major cause of acute renal failure in children in Britain and several other countries. Haemolytic uremic syndrome (HUS) develops in up to 10% of patients infected with 0157 VTEC. The fatality rate of 0157 VTEC infections is very variable and depends on the ages of the groups affected.
It is generally the elderly or the very young who are most at risk. Fatality rates ranging from 1 to 5% have been reported, but may be much higher in some institutional outbreaks, and for some age groups. Major outbreaks have occurred internationally, with Japan seeing one of the worst outbreaks in 1996 when some 6500 cases were reported just in Sakai, a small suburb on the outskirts of Osaka. The vast majority of victims were elementary school children.
With more cases around the world each year, the threat of E. coli O 157 VTEC remains high on the danger scale. web > Public Health Laboratory Service Last updated July 2001 Accessed 08/11/01 web > Health Canada, Population and Public Health Last updated August 2000 Accessed 08/11/01 web > Canada Communicable Disease Report – Volume 22-23, 1 December 1996 (international notes) Accessed 08/11/01.