The number of E. coli cases in England dropped slightly in 2023 following a huge increase in 2022, according to a recent report.
Seven outbreaks were recorded including one that affected mainly children with 17 hemolytic uremic syndrome (HUS) cases. HUS is a clinical syndrome related to E. coli, which can lead to kidney failure and death.
Overall, 2,018 cultured-confirmed cases of Shiga toxin-producing E. coli (STEC) were reported during 2023, compared to 2,063 in 2022 and 1,151 in 2021.
According to the UK Health Security Agency (UKHSA), one death was reported among E. coli O157 cases, and two deaths among non-O157 cases.
UKHSA said the higher rate in 2022 was likely explained by an STEC O157 outbreak, which was the largest detected since the start of routine whole genome sequencing.
A total of 533 culture-confirmed cases of STEC O157 were reported in 2023 compared to 762 in 2022, a decrease of 30 percent. A total of 2,260 cases of STEC non-O157 were reported including 1,485 culture-confirmed cases and 775 fecal specimens positive for stx genes on PCR but culture-negative, an increase of 13 percent compared to 2022.
As in 2022, children aged 1 to 4 had the highest annual incidence of infection from STEC O157 and non-O157. About a third of confirmed STEC O157 patients and of non-O157 patients were hospitalized.
Twenty-five people were infected with multiple serotypes. The most commonly reported serotypes in a co-infection were O157:H7, O146:H21, and O26:H11.
E. coli O157 and non-O157 data
The highest incidence of STEC O157 was in the East of England and the lowest was in the West Midlands. Of 533 confirmed cases, 275 were female.
Hospitalization was reported in 140 cases; duration ranged from 0 to 13 days with a median stay of 3 days. The one death reported was an adult female.
Hemolytic uremic syndrome (HUS) occurred in 11 confirmed patients. Seven of these were under 5 years of age, with an age range of 1 to 57 years old. HUS is a clinical syndrome related to E. coli, which can lead to kidney failure and death.
An increase in travel-related cases was observed with 114 people reporting travel abroad during their incubation period, which is seven days prior to illness onset. Of these cases, only 31 spent their entire incubation period abroad.
Of 1,485 culture-positive non-O157 cases, 87 different serogroups were confirmed by whole genome sequencing. The five most common non-O157 serogroups isolated from the 1,485 culture-confirmed patients were O26, followed by O146, O91, O145, and O128. Of 2,260 non-O157 cases, 1,230 were female.
In total, 233 cases were hospitalized and two adults died.
HUS occurred in 39 cases. From these cases, the most frequently isolated serogroups were O26 and O145. Patients ranged in age from under 1 to 72 years old and 19 were between 1 and 4 years old.
Seven outbreaks
Seven outbreaks affecting 228 people, 145 of whom lived in England, were investigated in 2023. One outbreak was because of O157; the other six were caused by STEC O26, O145, and O183. There was one death and 21 HUS cases associated with outbreaks.
Five were identified through analytical studies or pathogen detection in food, while two had a lower level of certainty, as the suspicion was based on questionnaire data.
The E. coli O157 outbreak with five cases, including four in England, was traced to a beef product. Beef was also suspected in an E. coli O183 outbreak with 26 cases, including 21 in England.
One E. coli O26 outbreak sickened 37 people, of which 18 were in England and was caused by dried fruits. The median age of patients was 3 years old. Overall, 18 were hospitalized and 17 developed HUS. The other E. coli O26 outbreak affected 33, of which 17 were in England. Salad leaves were the suspected source.
Two E. coli O145 outbreaks had 91 cases with salad leaves and fresh produce as the suspected sources of infection. Unpasteurized cheese was confirmed as being behind the other E. coli O145 outbreak, which had 36 cases, including 28 in England.
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