Figures show a mixed picture for E. coli in England

The number of E. coli O157 infections fell in 2019, but non-O157 cases rose and two people died, according to figures from the UK Health Security Agency (UKHSA).

In 2019, 1,720 confirmed cases of E. Shigatoxin-producing coli (STEC) have been reported in England and Wales. Five patients were infected with several serogroups.

A total of 539 confirmed cases of STEC O157 have been recorded in England and Wales compared to 607 in 2018. It continues a downward trend seen since 2015 and is the lowest annual figure since 1996.

Of 515 confirmed cases of STEC O157 in England, 280 were female. Children aged 1 to 4 years were the most affected. Females had a higher incidence in all age groups except those aged 1-4 and 10-19.

A total of 147 people were hospitalized with a hospital stay ranging from one to 10 days with a median of two days.

Hemolytic-uremic syndrome (HUS) occurred in 13 confirmed cases and five probable cases. Four were under 5 years old with a range of 1 to 75 years old. No deaths have been recorded among the STEC O157 cases. HUS is a type of kidney failure associated with E. coli infections that can lead to serious health problems and death throughout life.

Overall, 154 cases were travel-related. The main destinations were Turkey, Egypt and Cyprus.

Results not O157
Increased detection and screening of non-O157 STEC. In 2019, 768 culture-positive non-O157 STEC cases, including 655 in England and 113 in Wales, were reported. Of 5,760 samples received for testing, 1,002 non-O157 cases have been confirmed in England. Of these, 655 culture-positive cases of 72 serogroups have been confirmed.

The most commonly isolated non-O157 STEC serogroup was E. coli O26, followed by O146, O128ab, and O91. A total of 85 people were hospitalized.

HUS occurred in 22 confirmed cases and one probable case of non-O157 STEC. Of these, O26 and O145 were the main serogroups isolated.

Seven percent of confirmed STEC O26 cases developed HUS. The cases ranged from 5 months to 65 years old and 13 were between 1 and 4 years old. Two deaths have been reported.

For 413 cases, samples were confirmed as STEC by testing positive by PCR for Shiga toxin (stx) genes, but STEC were not cultured.

outbreaks
Five outbreaks of STEC involving 65 people in England have been investigated. Despite epidemiological investigations, it was not possible to find the source of infection. There were three associated HUS cases but no deaths.

Four outbreaks were due to E. coli O157, meaning they caused 9% of confirmed cases. The largest affected 28 people, including seven in 2020, nine of whom required hospital care.

An outbreak of STEC O26 has sickened 32 people, including 16 in England and five hospitalised. The epidemic strain had only stx1a and the cases were mostly healthy adults with a median age of 28 years.

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