Identification of verocytotoxin-producing Escherichia coli O117:H7 in men who have sex with men, England, November 2013 to August 2014

Simms, Ian; Gilbart, V L; Byrne, Lisa; Jenkins, Claire; Adak, Goutam; Hughes, Gwenda; Crook, Paul

doi:10.2807/1560-7917.es2014.19.43.20946

Cited by 38 publications

(29 citation statements)

References 7 publications

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“…This risk assessment may provide valuable information to aid community health services in estimating the level of action required (with regard to source/contact tracing and intervention measures to minimize secondary transmission) to address the potential threat and may be a useful tool for public health surveillance. However, the proposed risk categorization should be regarded as presumptive and interpreted with care, as infections with STEC serotypes categorized in PT group III, such as O117: H7, can still pose a public health concern, as has been shown recently (51). Currently, a multicenter, prospective, cohort study is being conducted that will verify the performance of the proposed molecular-based pathotyping approach on a larger scale in order to justify its application in the case of STEC infections for determining if swift action by community health services is warranted or not.…”

Section: Discussionmentioning

confidence: 99%

Assessing the Public Health Risk of Shiga Toxin-Producing Escherichia coli by Use of a Rapid Diagnostic Screening Algorithm

et al. 2015

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dShiga toxin-producing Escherichia coli (STEC) is an enteropathogen of public health concern because of its ability to cause serious illness and outbreaks. In this prospective study, a diagnostic screening algorithm to categorize STEC infections into risk groups was evaluated. The algorithm consists of prescreening stool specimens with real-time PCR (qPCR) for the presence of stx genes. The qPCR-positive stool samples were cultured in enrichment broth and again screened for stx genes and additional virulence factors (escV, aggR, aat, bfpA) and O serogroups (O26, O103, O104, O111, O121, O145, O157). Also, PCR-guided culture was performed with sorbitol MacConkey agar (SMAC) and CHROMagar STEC medium. The presence of virulence factors and O serogroups was used for presumptive pathotype (PT) categorization in four PT groups. The potential risk for severe disease was categorized from high risk for PT group I to low risk for PT group III, whereas PT group IV consists of unconfirmed stx qPCRpositive samples. In total, 5,022 stool samples of patients with gastrointestinal symptoms were included. The qPCR detected stx genes in 1.8% of samples. Extensive screening for virulence factors and O serogroups was performed on 73 samples. After enrichment, the presence of stx genes was confirmed in 65 samples (89%). By culture on selective media, STEC was isolated in 36% (26/73 samples). Threshold cycle (C T ) values for stx genes were significantly lower after enrichment compared to direct qPCR (P < 0.001). In total, 11 (15%), 19 (26%), 35 (48%), and 8 (11%) samples were categorized into PT groups I, II, III, and IV, respectively. Several virulence factors (stx 2 , stx 2a , stx 2f , toxB, eae, efa1, cif, espA, tccP, espP, nleA and/or nleB, tir cluster) were associated with PT groups I and II, while others (stx 1 , eaaA, mch cluster, ireA) were associated with PT group III. Furthermore, the number of virulence factors differed between PT groups (analysis of variance, P < 0.0001). In conclusion, a diagnostic algorithm enables fast discrimination of STEC infections associated with a high to moderate risk for severe disease (PT groups I and II) from less-virulent STEC (PT group III). Shiga toxin-producing Escherichia coli (STEC) is a zoonotic pathogen frequently identified as causative agent of acute diarrheal disease in humans. The outcomes of STEC infections may range from asymptomatic carriage and mild diarrhea to severe disease, such as hemorrhagic colitis (HC) and hemolytic-uremic syndrome (HUS) (1-3).Based on pathogenic properties, a subgroup of STEC is also designated enterohemorrhagic E. coli (EHEC); this subgroup of stx-positive strains also contains the locus of enterocyte effacement (LEE) pathogenicity island (4). EHEC belongs to certain serotypes that are frequently associated with outbreaks and lifethreatening illnesses (5). Worldwide, the most common EHEC serotype both in outbreaks and in sporadic cases of severe disease is E. coli O157:H7 (4, 6, 7). Consequently, public health and regulatory responses have been focuse...

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Section: Discussionmentioning

confidence: 99%

Assessing the Public Health Risk of Shiga Toxin-Producing Escherichia coli by Use of a Rapid Diagnostic Screening Algorithm

et al. 2015

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“…However, overall levels of unsafe sexual practice were high. Mephedrone use and injecting has been associated with sexual risk in some populations, specifically subgroups of MSM where it has been linked to high risk behaviours and infections [12,13,33,34], and mephedrone use has also been reported to have positive effects on libido [35]. Those injecting mephedrone in our study were more likely to have used a sexual health service, suggesting that mephedrone injection may be related to increased sexual health needs that may not have been detected by the limited data on sexual behaviour collected in our study, and further investigation is required.…”

Section: Discussionmentioning

confidence: 99%

Is the recent emergence of mephedrone injecting in the United Kingdom associated with elevated risk behaviours and blood borne virus infection?

et al. 2016

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The recent, and rapid, emergence of injection of the short-acting stimulant mephedrone (4-methylmethcathione) has resulted in concerns about increased infection risks among people who inject drugs (PWID). Data from the bio-behavioural surveillance of PWID in the United Kingdom were analysed to examine the impact of mephedrone injection on infections among PWID. During the year preceding the survey, 8.0% of PWID (163/2,047) had injected mephedrone. In multivariable analyses, those injecting mephedrone were younger, less likely to have injected opiates, and more likely to have injected cocaine or amphetamines, used needle/syringe programmes or sexual health clinics, been recruited in Wales and Northern Ireland or shared needles/syringes. There were no differences in sexual risks. Those injecting mephedrone more often had hepatitis C antibodies (adjusted odds ratio (AOR) = 1.51; 95% confidence interval (CI): 1.08–2.12), human immunodeficiency virus (AOR = 5.43; 95% CI: 1.90–15.5) and overdosed (AOR = 1.70; 95% CI: 1.12–2.57). There were no differences in the frequency of injecting site infections or prevalence of hepatitis B. The elevated levels of risk and infections are a concern considering its recent emergence. Mephedrone injection may currently be focused among higher-risk or more vulnerable groups. Targeted responses are needed to prevent an increase in harm.

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“…Diagnoses of Shigella flexneri 3a, S. flexneri 2a and S. sonnei in men without a travel history have increased markedly (244) while diagnoses in women have remained stable, strongly suggesting sexual transmission between MSM as the cause, and there has been a recent cluster of verotoxin-producing Escherichia coli 0117:H7 (VTEC) found among MSM (245). It is particularly important to identify enteric pathogens as the cause of symptoms in MSM, as STEIs will often require collaborative work between primary care and GUM/HIV clinicians, microbiologists and local health protection teams to ensure appropriate clinical and public health management is undertaken in a timely manner.…”

Section: Introductionmentioning

confidence: 99%

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

et al. 2018

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This guideline is intended for use in UK Genitourinary medicine clinics and sexual health services but is likely to be of relevance in all sexual health settings, including general practice and Contraception and Sexual Health (CASH) services, where men who have sex with men (MSM) seek sexual health care or where addressing the sexual health needs of MSM may have public health benefits. For the purposes of this document, MSM includes all gay, bisexual and all other males who have sex with other males and both cis and trans men. This document does not provide guidance on the treatment of particular conditions where this is covered in other British Association for Sexual Health and HIV (BASHH) Guidelines but outlines best practice in multiple aspects of the sexual health care of MSM. Where prevention of sexually transmitted infections including HIV can be addressed as an integral part of clinical care, this is consistent with the concept of combination prevention and is included. The document is designed primarily to provide guidance on the direct clinical care of MSM but also makes reference to the design and delivery of services with the aim of supporting clinicians and commissioners in providing effective services. Methodology This document was produced in accordance with the guidance set out in the BASHH CEG’s document ‘Framework for guideline development and assessment’ published in 2010 at http://www.bashh.org/guidelines and with reference to the Agree II instrument. Following the production of the updated framework in April 2015, the GRADE system for assessing evidence was adopted and the draft recommendations were regraded. Search strategy (see also Appendix 1) Ovid Medline 1946 to December 2014, Medline daily update, Embase 1974 to December 2014, Pubmed NeLH Guidelines Database, Cochrane library from 2000 to December 2014. Search language English only. The search for Section 3 was conducted on PubMed to December 2014. Priority was given to peer-reviewed papers published in scientific journals, although for many issues evidence includes conference abstracts listed on the Embase database. In addition, for ‘Identification of problematic recreational drug and alcohol use’ section and ‘Sexual problems and dysfunctions in MSM’ section, searches included PsycINFO. Methods Article titles and abstracts were reviewed and if relevant the full text article was obtained. Priority was given to randomised controlled trial and systematic review evidence, and recommendations made and graded on the basis of best available evidence. Piloting and feedback The first draft of the guideline was circulated to the writing group and to a small group of relevant experts, third sector partners and patient representatives who were invited to comment on the whole document and specifically on particular sections. The revised draft was reviewed by the CEG and then reviewed by the BASHH patient/public panel and posted on the BASHH website for public consultation. The final draft was piloted before publication. Guideline update The guidelines will be reviewed and revised in five years’ time, 2022.

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Identification of verocytotoxin-producing Escherichia coli O117:H7 in men who have sex with men, England, November 2013 to August 2014

Abstract: Identification of verocytotoxin-producing Escherichia coli O117:H7 in men who have sex with men, England,

Cited by 38 publications

References 7 publications

Assessing the Public Health Risk of Shiga Toxin-Producing Escherichia coli by Use of a Rapid Diagnostic Screening Algorithm

Assessing the Public Health Risk of Shiga Toxin-Producing Escherichia coli by Use of a Rapid Diagnostic Screening Algorithm

Is the recent emergence of mephedrone injecting in the United Kingdom associated with elevated risk behaviours and blood borne virus infection?

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

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