An outbreak of Shiga toxin-producing Escherichia coli O121 infections associated with flour—Canada, 2016–2017†

Morton, Vanessa; Cheng, Joyce; Sharma, D. K.; Kearney, Ashley

doi:10.14745/ccdr.v43i78a03

Cited by 22 publications

(13 citation statements)

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“…In the early 2000s, laboratories began to implement methods to detect other STEC serotypes (6,7). This led to the recognition that non-O157 STEC can contaminate a wide variety of sources and cause large outbreaks (8,9). However, non-O157 STEC remain underreported because many frontline laboratories…”

Section: Introductionmentioning

confidence: 99%

Shiga toxin–producing Escherichia coli in British Columbia, 2011–2017: Analysis to inform exclusion guidelines

Noftall¹,

Taylor²,

Hoang³

et al. 2019

CCDR

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Background: Shiga toxin-producing Escherichia coli (STEC) can cause severe illness including bloody diarrhea and hemolytic-uremic syndrome (HUS) through the production of Shiga toxins 1 (Stx1) and 2 (Stx2). E. coli O157:H7 was the most common serotype detected in the 1980s to 1990s, but improvements in laboratory methods have led to increased detection of non-O157 STEC. Non-O157 STEC producing only Stx1 tend to cause milder clinical illness. Exclusion guidelines restrict return to high-risk work or settings for STEC cases, but most do not differentiate between STEC serogroups and Stx type. Objective: To analyze British Columbia (BC) laboratory and surveillance data to inform the BC STEC exclusion guideline. Methods: For all STEC cases reported in BC in 2011-2017, laboratory and epidemiological data were obtained through provincial laboratory and reportable disease electronic systems, respectively. Incidence was measured for all STEC combined as well as by serogroup. Associations were measured between serogroups, Stx types and clinical outcomes. Results: Over the seven year period, 984 cases of STEC were reported. A decrease in O157 incidence was observed, while non-O157 rates increased. The O157 serogroup was significantly associated with Stx2. Significant associations were observed between Stx2 and bloody diarrhea, hospitalization and HUS. Conclusion: The epidemiology of STEC has changed in BC as laboratories increasingly distinguish between O157 and non-O157 cases and identify Stx type. It appears that non-O157 cases with Stx1 are less severe than O157 cases with Stx2. The BC STEC exclusion guidelines were updated as a result of this analysis.

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Section: Introductionmentioning

confidence: 99%

Shiga toxin–producing Escherichia coli in British Columbia, 2011–2017: Analysis to inform exclusion guidelines

Noftall¹,

Taylor²,

Hoang³

et al. 2019

CCDR

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“…However, non-O157 serotypes account for a significant proportion of VTEC isolated from both sporadic cases and outbreaks of clinical diarrheal disease ( Wang et al, 2005 , 2013 ; Buvens et al, 2012 ; EFSA, 2013 ; Momtaz et al, 2013 ; Bettelheim and Goldwater, 2014 ). Non-O157 VTEC have been isolated from many sources including, environmental and drinking water ( Johnson et al, 2014 ), flour ( Morton et al, 2017 ), lettuce ( Taylor et al, 2013 ), unpasteurized cheese and apple juice ( Schaffzin et al, 2012 ; Guzman-Hernandez et al, 2016 ), meat ( Bosilevac and Koohmaraie, 2011 ; Momtaz et al, 2013 ), bovine carcasses and hides ( Arthur et al, 2002 ; Barkocy-Gallagher et al, 2003 ; Monaghan et al, 2012 ), and cattle feces ( Hussein and Bollinger, 2005 ; Monaghan et al, 2011 ).…”

Section: Introductionmentioning

confidence: 99%

Multi-Year Persistence of Verotoxigenic Escherichia coli (VTEC) in a Closed Canadian Beef Herd: A Cohort Study

Wang

Jokinen²,

Laing

et al. 2018

Front. Microbiol.

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In this study, fecal samples were collected from a closed beef herd in Alberta, Canada from 2012 to 2015. To limit serotype bias, which was observed in enrichment broth cultures, Verotoxigenic Escherichia coli (VTEC) were isolated directly from samples using a hydrophobic grid-membrane filter verotoxin immunoblot assay. Overall VTEC isolation rates were similar for three different cohorts of yearling heifers on both an annual (68.5 to 71.8%) and seasonal basis (67.3 to 76.0%). Across all three cohorts, O139:H19 (37.1% of VTEC-positive samples), O22:H8 (15.8%) and O?(O108):H8 (15.4%) were among the most prevalent serotypes. However, isolation rates for serotypes O139:H19, O130:H38, O6:H34, O91:H21, and O113:H21 differed significantly between cohort-years, as did isolation rates for some serotypes within a single heifer cohort. There was a high level of VTEC serotype diversity with an average of 4.3 serotypes isolated per heifer and 65.8% of the heifers classified as “persistent shedders” of VTEC based on the criteria of >50% of samples positive and ≥4 consecutive samples positive. Only 26.8% (90/336) of the VTEC isolates from yearling heifers belonged to the human disease-associated seropathotypes A (O157:H7), B (O26:H11, O111:NM), and C (O22:H8, O91:H21, O113:H21, O137:H41, O2:H6). Conversely, seropathotypes B (O26:NM, O111:NM) and C (O91:H21, O2:H29) strains were dominant (76.0%, 19/25) among VTEC isolates from month-old calves from this herd. Among VTEC from heifers, carriage rates of vt1, vt2, vt1+vt2, eae, and hlyA were 10.7, 20.8, 68.5, 3.9, and 88.7%, respectively. The adhesin gene saa was present in 82.7% of heifer strains but absent from all of 13 eae+ve strains (from serotypes/intimin types O157:H7/γ1, O26:H11/β1, O111:NM/θ, O84:H2/ζ, and O182:H25/ζ). Phylogenetic relationships inferred from wgMLST and pan genome-derived core SNP analysis showed that strains clustered by phylotype and serotype. Further, VTEC strains of the same serotype usually shared the same suite of antibiotic resistance and virulence genes, suggesting the circulation of dominant clones within this distinct herd. This study provides insight into the diverse and dynamic nature of VTEC populations within groups of cattle and points to a broad spectrum of human health risks associated with these E. coli strains.

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“…STEC infections acquired through foods remain a significant source of death and severe complications in WA. Many of the STEC outbreaks (2007–2017) were associated with previously reported high-risk food vehicles particularly undercooked beef, raw sprouts, and unpasteurized milk (Erickson and Doyle, 2007; Neil et al , 2012; Luna-Gierke et al , 2014; Morton et al , 2017) in addition to flour, which has emerged as a risk factor for STEC infections in recent years (Morton et al , 2017). Animal exposures at petting zoos and state fairs are also a significant source of STEC infections.…”

Section: Discussionmentioning

confidence: 99%

Laboratory Review of Foodborne Disease Investigations in Washington State 2007–2017

Swoveland

Stewart

Eckmann

et al. 2019

Foodborne Pathogens and Disease

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The Washington State Department of Health Public Health Laboratories (WAPHL) has tested 11,501 samples between 2007 and 2017 for a foodborne disease using a combination of identification, serotyping, and subtyping tools. During this period there were 8037 total clinical and environmental samples tested by pulsed-field gel electrophoresis (PFGE), including 512 foodborne disease clusters and 2176 PFGE patterns of Salmonella enterica subsp. enterica . There were 2446 Shiga toxin–producing Escherichia coli samples tested by PFGE, which included 158 foodborne disease clusters and 1174 PFGE patterns. There were 332 samples of Listeria monocytogenes tested by PFGE, including 35 foodborne disease clusters and 104 PFGE patterns. Sources linked to outbreaks included raw chicken, unpasteurized dairy products, various produce types, and undercooked beef among others. As next-generation sequencing (NGS) replaces PFGE, the impact of this transition is expected to be significant given the enhanced cluster detection power NGS brings. The measures presented here will be a reference baseline in future years.

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An outbreak of Shiga toxin-producing Escherichia coli O121 infections associated with flour—Canada, 2016–2017†

Cited by 22 publications

References 0 publications

Shiga toxin–producing Escherichia coli in British Columbia, 2011–2017: Analysis to inform exclusion guidelines

Shiga toxin–producing Escherichia coli in British Columbia, 2011–2017: Analysis to inform exclusion guidelines

Multi-Year Persistence of Verotoxigenic Escherichia coli (VTEC) in a Closed Canadian Beef Herd: A Cohort Study

Laboratory Review of Foodborne Disease Investigations in Washington State 2007–2017

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