Enterohemorrhagic Escherichia Coli Epidemiology

Enterohemorrhagic E. coli (EHEC) are the pathogenic subgroup of shiga toxin-producing E. coli (STEC). Acute hemorrhagic colitis has been associated mainly with the O157:H7 serotype. This serotype has been responsible for larger outbreaks of infection, has higher rates of complications, and appears to be more pathogenic than non-

EHEC STEC strains. The spectrum of disease associated with E. coli 0157:H7 includes bloody diarrhea, which is seen in as many as 95% of patients, nonbloody diarrhea, HUS, and thrombotic thrombocytopenic purpura.

Approximately 70,000 cases of EHEC illness occur every year in the United States. The highest incidence is in patients aged 5 to 9 years and 50 to 59 years. Outbreaks of diarrhea due to E. coli O157:H7 and other STECs have occurred from contaminated beef, classically hamburgers served at fast-food chains, unpasteurized milk and other dairy products, vegetables (e.g., alfalfa sprouts, coleslaw, and lettuce), and apple juice. The most important reservoir for E. coli O157:H7 is the GI tract of cattle. Person-to-person transmission is also possible because of the low infectious dose required. Swimming in infant pools or contaminated lakes or drinking municipal water also appears to be a risk factor. The incidence of diagnosed E. coli O157:H7 infec tions in the United States are greater among rural than urban populations, and E. coli O157:H7 infections occur in summer and autumn.

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