Epidemiology of Non-O157. Escherichia coli in Grampian Zareen Thorlu-Bangura

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1 Epidemiology of Non-O157 Shi Shiga toxin t i producing d i Escherichia coli in Grampian Zareen Thorlu-Bangura

2 Background Shigatoxigenic Escherichia coli (STEC) are strains of the bacterium Escherichia coli (E. coli) commonly found in the gut of humans and animals. Ruminant animals like cattle and sheep are the main reservoir for E. coli Harmless to the animals that carry it Many different strains of E. coli Most types of E. coli are harmless, some types can cause serious illness in humans The methods through which people become infected include: Eating contaminated meat and dairy products Eating contaminated vegetables Drinking contaminated water From person to person contact.

3 Background Within the UK Scotland has traditionally had the highest incidence of E. coli and within Scotland Grampian was the region with the highest incidence of E. coli 0157 infection One of the worst strains of E. coli, known as E. coli O157, causes the severe symptoms of bloody diarrhoea, kidney failure and even death. There are many other types of STEC, and some have the same morbidity as E. coli O157 The other types of STEC are known as non 0157 STEC E. coli Mostofthe of the research has focused onthe incidence ofe. coli 0157 In the past non 0157 serogroups were not routinely tested for and data regarding the true burden of non 0157 STEC is limited. Since 2014 there have been tests to check for non 0157 serogroups

4 Aims and Objectives The aim of this study was to describe the epidemiology of STEC infections in Grampian between August 2014 and April 2017 and to give a clearer picture of the percentage of STEC infections in Grampian that can be attributed to non O157 serogroups. Specific objectives: Describe the socio demographic characteristics of patients with STEC in Grampian Determine the incidence of STEC O157 and non O157 in Grampian Determine which Serogroups of non O157 STEC are more common in Grampian Compare the socio demographic characteristics of individuals with O157 STEC to those with non O157 STEC p g p infection

5 Methods Study design and setting: This project was a secondary data analysis of routine data collected by the NHS Grampian Health Protection Team as part of the public health management of probable or confirmed E. coli cases. Study population: Inclusion criteria for the study were any new probable or confirmed casesof VTEC reported to NHS Grampian between August 2014 and April Exclusion criteria were any cases of E. coli reported to NHS Grampian outside of the specified time. Data collection: The health protection team must be notified of any confirmed or suspected cases of E. coli. Confirmed cases of E. coli are investigated to determine if the case is part of an outbreak and data from the patient is stored on the HpZone database. The data was cleaned of all personal identifiers before was used for analysis.

6 Methods Data analysis: Data was exported to SPSS database for analysis Chi squared tests were used to analyze and compare categorical variables. To calculate the crude incidence rate midyear population estimates were collected from the national records of Scotland website and used for denominator data. Population projections were used from the national records of Scotland for 2017 denominator data.

7 Results The median age of notifications was 26 years. There were slightly more male notifications (52%) than female (48%). This graph shows that 64 (n=202) notifications occurred during the summer months (June, July and August). The number of notifications remained high during the autumn (September, October and November) months which had 61 notifications (n=202).

8 Results The graph shows that the most deprived quintile 1, had the lowest level of VTEC infections. M t f th i f ti tdi Most of the infections were reported in individuals from SIMD quintiles 2, 3 and 4.

9 Results The most common non O157 STEC serogroup notified were serogroup O126 and O145 with 10 isolates each accounting for 41% of all non O157 isolates. The average incidence rate for STEC O157 per year was 4.7 cases per 100,000 population. The average rate for non O157 STEC per year was 2.15 cases per 100,000 population. Non O157 Serogroups % of Non missing non O157 serogroups O O O O138 2 O121 2 O O8 4.1 O O166 2 O91 2 O O102 2 O O137 2 O76 2 O165 2 O O63 2 O78 2

10 Results 34.7% non O157 VTEC notifications were from Aberdeen City. 55.1% were from Aberdeenshire. 10.2% were from Moray.

11 Study Limitations it ti Lack of data regarding the serious complications e.g. HUS. The study had incomplete data concerning outbreaks Hospitalisation data was incomplete Recommendations Furtherresearchcould research could find out the number of VTEC casesreportedduring during the same time period ( ) 2017) asthis study that later resulted in HUS or death. Further research could also try to determine the most common non O157 serogroup associated with HUS and hospitalization.

12 Acknowledgements Dr Emmanuel Okpo and Dr Karen Foster Zareen.thorlu ac uk Questions?

13 References Brooks, J. T. et al., Non 0157 Shiga Toxin Producing Escherichia coli infections in the United States Journal of Infectious Disease, Volume 192, pp Garvey, P., Carroll, A., McNamara, E. & Mckeown, P., Verotoxigenic Escherichia coli transmission in Ireland:a review of notified outbreaks, Epidemiology and Infection, Volume 144, pp Government, S., VTEC/E. coli O157 Action Plan for Scotland, [Online] Available at: [Accessed 15 May 2017]. Hassan, V. et al., Epidemiology of Shiga toxin producing Escherihia coli in Australia BMC Public Health, Volume 12, p. 63. Howie, H. & Johnston, M., Epidemiology of gastrointestinal infections and the action taken to minimise risk to Public Health. [Online] Available at: all documents/ giinfectionsgrampian_final.pdf Johnson, K. E., Thorpe, C. M. & Sears, C. L., The Emerging Importance of Non 0157 Shiga Toxin producing Escherichia coli. Emerging Infections, Volume 43, pp Mcdonald, I., I.M, G. & Curnow, J., Epidemiology of Infection due to Escherichia coli 0157: A 3 Year prospective study. Epidemiology and Infection, 116(03), pp Network, H. P., Guidance for the Public Health. [Online] Available at: [Accessed 15 May 2017]. Scotland, H. P., National Outbreak of Escherichia coli O157 September October [Online] Available at: outbreak escherichia coli O157 phage type 32 scotland.pdf