Verocytotoxin-producing Escherichia coli causes zoonotic food-or waterborne infection that may be associated with massive outbreaks and with the serious complication of hemolytic uremic syndrome (HUS). Serotypes O157:H7 and O157:NM are more commonly associated with HUS and outbreaks than other serotypes, such as O26:H11. To determine whether a genetic basis exists for why serotype O157:H7/NM causes HUS and outbreaks more often than other serotypes, such as O26:H11, we conducted suppression subtractive hybridization (SSH) between the genomes of the sequenced O157:H7 strain EDL933 and CL1, a clinical serotype O26:H11 isolate. Genes from four EDL933 fimbria-encoding genomic O islands (OIs) (OI-1, -47, -141, and -154) were identified in the SSH library. OI-47 encodes several additional putative virulence factors, including secreted and signaling proteins, a hemolysin locus, a lipoprotein, an ABC transport system, and a lipid biosynthesis locus. The distribution of the OIs was investigated by PCR and Southern hybridization (when PCR was negative) with 69 VTEC strains belonging to 39 different serotypes corresponding to 5 seropathotypes that differ in their disease and epidemic potential. The four OIs described here were distributed almost exclusively in serotypes O157:H7 and O157:NM, which indicates that they may be associated with the ability of these strains to colonize human and/or animal intestinal tracts and to cause epidemic and serious disease more frequently than other serotypes. The occurrence of the four OIs in enteropathogenic E. coli O55:H7 strains is consistent with their vertical inheritance by VTEC O157:H7/NM from this clonally related ancestor.Verocytotoxin-producing Escherichia coli (VTEC) (31), also referred to as Shiga toxin-producing E. coli (8), is a major cause of zoonotic food-or waterborne infection that may be associated with massive outbreaks and with the serious complication of hemolytic uremic syndrome (HUS) (15,27,29,30,39). More than 200 serotypes of VTEC have been isolated from humans (65), but their incidence and association with serious or epidemic disease are highly variable, suggesting differences in epidemicity and virulence between VTEC serotypes (28). To determine why some serotypes are more common and cause serious and epidemic disease more frequently than other serotypes, we have classified VTEC serotypes in the following five "seropathotypes" based on their relative incidence and their association with epidemic and/or serious disease, such as HUS (28). Serotypes O157:H7 and O157:NM, which are associated most commonly with outbreaks and HUS (3,15,16,22,26,39), are classified as seropathotype A. Seropathotype B comprises serotypes O26:H11, O103:H2, O111: NM, O121:H19, and O145:NM, which are associated with outbreaks and HUS but much less frequently than serotypes O157:H7 and O157: NM (6,16,22,34,65). Serotypes such as O91:H21 and O113:H21, which have an occasional association with sporadic HUS but not with outbreaks (6,22,39), are classified as seropathotype C. Seropathotype D c...