The number of Shiga toxin-producing E. coli (STEC) infections in Europe declined in 2019 slightly compared to 2018 but is higher than previous years, according to a new report.

For 2019, 8,313 confirmed cases of STEC infection were reported but no multi-country outbreaks were detected or investigated. This compares to 8,658 cases in 2018 and 6,455 in 2017.

A large increase in confirmed cases was seen in 2018 and 2019 compared to the stable trend from 2012 to 2017. A contributing factor may be the shift from culture to culture-independent diagnostic methods, with PCR more commonly used to diagnose cases, said the European Centre for Disease Prevention and Control (ECDC).

Germany had the most confirmed cases with 1,907 and the United Kingdom had 1,587, which together accounted for 42 percent of all reported infections. Both these countries had fewer infections than in 2018.

Denmark, Finland, Latvia, Iceland and Spain all recorded large increases in 2019 from the year before while infections in Ireland and Sweden declined.

The highest country-specific notification rates were in Ireland, Denmark, Malta, Norway, and Iceland.

Serogroups and HUS data
In most countries, surveillance of STEC infections is mandatory and covers the whole population. However, almost one-third report less than five cases annually, indicating significant under-reporting in some nations, said ECDC.

Notification of STEC infections is voluntary in Belgium, France, Luxembourg, and Spain or based on another type of system in Italy and the UK. Surveillance systems in France, Italy, and Spain do not have national coverage.

Thirty-five percent of 3,410 STEC patients were hospitalized and 12 people died. Half of the deaths were people with hemolytic uremic syndrome (HUS), which is a type of kidney failure associated with E. coli infections.

Most of the 6,113 STEC cases with information on country of infection were domestically acquired. Among the 8,305 confirmed patients where gender was reported, 46 percent were males and 54 percent were females.

The age groups most affected by STEC infection were infants and children up to four years old, who accounted for more than one-quarter of all confirmed cases. An even larger proportion of children was seen among the HUS cases, where two-thirds of cases were in 0 to 4-year-olds.

The five top serogroups were O157, O26, O146, O103, and O91. E. coli O157 was the most common but O26 was more often a cause of HUS.

About E. coli infections
Anyone who has developed symptoms of E. coli infection should seek medical attention and tell their doctor about their possible exposure to the bacteria. Specific tests are required to diagnose the infections, which can mimic other illnesses.

The symptoms of E. coli infections vary for each person but often include severe stomach cramps and diarrhea, which is often bloody. Some patients may also have a fever. Most patients recover within five to seven days. Others can develop severe or life-threatening symptoms and complications, according to the Centers for Disease Control and Prevention (CDC).

About 5 to 10 percent of those diagnosed with E. coli infections develop a potentially life-threatening kidney failure complication, known as a hemolytic uremic syndrome (HUS). Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruises or bleeding, and pallor.

Many people with HUS recover within a few weeks, but some suffer permanent injuries or death. This condition can occur among people of any age but is most common in children younger than five years old because of their immature immune systems, older adults because of deteriorating immune systems, and people with compromised immune systems such as cancer patients.

People who experience HUS symptoms should immediately seek emergency medical care. People with HUS will likely be hospitalized because the condition can cause other serious and ongoing problems such as hypertension, chronic kidney disease, brain damage, and neurologic problems.

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