Background: Shiga toxin (Stx)-producing Escherichia coli (STECs) are the most common cause of acute renal failure in children. The present study evaluated a 10-year STEC polymerase chain reaction screening regimen in children.
Methods: All routine stool culture specimens from patients below 10 years of age (n = 10 342) from May 2003 through April 2013 in the County of Jönköping, Sweden, were included. Patients were divided in 1 group where analyses of STEC were requested by the clinician (n = 2366) and 1 screening group (n = 7976). Patients who were positive for STEC were tested weekly until they were negative. Clinical data were collected through a questionnaire and by reviewing medical records.
Results: In specimens from 191 patients, stx was found (162 index cases). The prevalence was 1.8% in the requested group and 1.5% in the screening group (P = .5). Diarrhea was the most frequent symptom reported in 156 cases and of these 29 (19%) had hemorrhagic colitis (HC) and 7 children developed hemolytic uremic syndrome (HUS). No difference regarding severity of symptoms between the groups was found. Stx2 predominated in cases with HC (P < .0001) and HUS (P = .04). Median stx shedding duration was 20 days (1–256 days), and no difference in duration was seen between stx types (P = .106–1.00) and presence of eaeA (P = .72).
Conclusions: Most STEC cases were found in the screening group with comparable prevalence and disease severity as in patients where analysis was requested. Furthermore, non-O157 serotypes caused severe disease when carrying stx2, and prolonged shedding of STEC may be a risk for transmission.
Shiga toxin-producing Escherichia coli in diarrheal stool of Swedish children: Evaluation of polymerase chain reaction screening and duration of shiga toxin shedding
Journal of the Pediatric Infectious Diseases Society
Andreas Matussek, Ing-Marie Einemo, Anna Jogenfors, Sven Löfdahl3 and Sture Löfgren
This study investigated the occurrence of Shiga toxin-producing E. coli (STEC) in beef and leafy greens available on the Swedish market. New data are required for assessing the public health risk of STEC in food, which could be used for developing risk management strategies.
Food samples were collected at retail stores, importers, outlets and the markets. Samples of minced or whole meat from cattle collected were fresh or frozen from 2010 to 2011. The beef sample collection included products from the most common countries or regions exporting beef to Sweden. The collection of leafy greens consisted of domestic and imported products that were available on the Swedish market from 2012 to 2013.
Detection of virulence genes (stx 1, stx 2, eae) and genes specific for different serogroups (O26, O103, O111, O145 and O157) was performed by real-time PCR followed by isolation of bacteria from the stx -positive enriched samples by use of immunomagnetic separation. STEC bacteria were overpriced isolated by an immunoblot thing method. All STEC isolated from the food samples were serotyped.
STEC was isolated from 23 (13 percent) of the 177 imported beef samples tested. Approximately 3 percent of the beef samples contained STEC on positive stx 2 and eae, both of which are important markers for the probability of the bacteria to cause severe disease. In total, 27 STEC were isolated, belonging to 14 different serogroups. STEC O26 was most common (approximately 2 percent of the beef samples), whereas STEC O157, frequently implicated in STEC-related foodborne outbreaks in Sweden, was found in two (one percent) of the beef samples.
The enrichment broth of 11 (approximately 2 percent) of the 630 samples from leafy greens were tested positive for stx 1 and / or stx 2 by PCR analysis; however, no bacteria were isolated. Presumptive STEC was detected in co-enriched samples from bothering domestic and imported products. E. coli was found in 68 (39 percent) out of 174 and 14 (30 percent) out of 46 samples of imported and English leafy greens, respectively, indicating that the proportion of stx -positive E. coli into the samples was low.
As the annual winter vomiting bug season starts to kick in it’s the Tofta high school in the south which is bearing the brunt of it so far.
In total 173 people who attend or work at the school have been affected by the bug. Even the headmaster hasn’t been spared.
“It struck last Friday but now I’m back at work,” headmaster Tobias Fahlén told the Expressen newspaper.
Parents reported that the bug began to take hold on Friday, with many stating that their children began vomiting uncontrollably. Several have asked the school to investigate the outbreak which has led to deserted classrooms.
As a result the school has now got in contact with the disease control centre in nearby Malmö. The centre advised the school to do some extra cleaning in the toilets and school kitchen to help combat the vomiting bug.
An epidemiologist with the disease control centre who is working with the school said it was most likely a vomiting bug that was ravaging the school, and not food poisioning as some parents had suspected.
Tulip Food Company, which sells its meat products in both Denmark and Sweden, announced a recall of its Danish deli meat products on Friday after finding traces of listeria in portions of meat sold in Sweden.
The company specified that the discovered amounts were miniscule, but that it was exercising caution.
“Listeria can grow in a product and even a very small amount can turn into a risky amount before the meat expires,” Michael Larsen, quality manager at Tulip Food Company, said in a statement.
The recalled products are Shächter Luftikus, Shächter Bauernskinka, Tulip Kokt Skinka, and Tulip Rökt Skinka, all in 500 gramme packages produced between August 7th and August 20th.
Contaminated meat has killed 13 people and caused at least 24 infections in Denmark, The Local Denmark reported.
Swedish supermarket chain Coop has recalled its in-store brand of fresh hamburger meat after a routine check revealed traces of salmonella in the meat.
Coop halted sales of its hamburger meat on Wednesday evening. The recall applies to Coop Hamburger 10×113 grammes, 4×113 grammes and 2×113 grammes, Coop Miniburger 8×56,5 grammes and Coop Megaburger 2×170 grammes.
The affected meat has been sold throughout Sweden and has a best-before date of August 5th, 2014.
In June-July 2013, six counties notified the Swedish Institute for Communicable Disease Control of enterohaemorrhagic E.coli (EHEC) infections among attendees at a hotel in Dalarna, Sweden. An outbreak control team investigated to identify the source and implement control measures.
We included individuals who attended the hotel between June 19th-25th in a cohort. We asked them about animal contact, swimming, and consumption of food items during this time using a questionnaire. A confirmed case was an EHEC O157:H7 outbreak strain positive individual who developed abdominal pain or diarrhoea between June 20th-July 2nd. We described the outbreak in time, place and person, calculated risk ratios (RR) and 95% confidence intervals (CI). We investigated the kitchen, tested and traced back implicated food items.
172 individuals responded. We identified 19 confirmed cases (Median age: 17 years, 64% female) with symptom onset between June 22nd-27th. Eating green salad on June 20th was associated with illness (RR:3.7;CI:1.3–11). The kitchen mixed green salads without records and destroyed leftovers immediately. Hence we could not conduct trace-back or obtain microbiological confirmation.
Green salad contaminated before entering the kitchen was the likely outbreak source. We recommended early collaboration with food agencies and better restaurant records to facilitate future investigations.
PLOS Currents Outbreaks
Michael Edelstein, Camilla Sundborger, Maria-Pia Hergens, Sofie Ivarsson, Rikard Dryselius, Mona Insulander, Cecilia Jernberg, Yvan Hutin, Anders Wallensten
“We have had no reports [of listeria] in the last three weeks so we hope that the outbreak is now over, even though it is a little too early to tell just yet,” Viktor Dahl, doctor and epidemiologist at the Public Health Agency of Sweden told The Foreigner, Thursday.
Authorities believe there is a common source of the outbreak.
Whilst the deaths cannot be 100 per cent confirmed to have been caused by the bacteria, 27 cases of the same type of strain have been reported throughout the country.
Four have died out of these cases, but again, listeria has not been confirmed as the cause of death. This is because most of the affected are elderly and have other diseases such as cancer
The outbreak has been allegedly linked to products produced by the Scan factory, which has recalled many of its items.
Scan has also been forced to close a factory in Kristianstad in southern Sweden’s Skåne County, where high quantities of the bacteria were found, though this facility has not been confirmed as the source.
Sweden’s Public Health Agency has declared a specific outbreak of Listeria during the final three months of 2013, with 41 sickened compared to 25 for the same period the year before.
“There was a clear increase, which led us to suspect that this was an outbreak and therefore we decided to investigate the matter immediately, says Viktor Dahl with the Public Health Agency.
While previous Listeria outbreaks have largely been linked to smoked or pickled salmon, investigators suspect cold cuts in the latest increase.
A dozen people – mainly kids — got sick after exposure to raw sewage at a splash pad in Traverse City, Mich., an 8-year-old with cryptosporidium had a dump in a Philadelphia pool that forced its closure July 4, at least 90 people were sickened with Shigella after swimming at Burrillville’s Spring Lake Beach in Rhode Island, and the municipality of Östersund in northern Sweden has been charged for environmental crimes following an outbreak of cryptosporidium which sickened some 30,000 people in the winter of 2010.
In Sweden, prosecutor Lars Magnusson said, “It concerns the fact that they failed to deliver drinking water free from parasites, and this is something that they are required to do under the drinking water regulations.”
The city established the source of the infection in late 2010, tracing the outbreak to a residential building in the Odensala area of the city. It was found that a sewage pipe had been erroneously connected to a rain water pipe.
Östersund has meanwhile disputed the charges, claiming that it had sufficient checks in place.
In Michigan, city workers discovered June 30 at mid-morning that sewage backed up when a pump station failed and pushed raw sewage into an underground reservoir that feeds sprinklers for the splash pad, rain arc, and mister.
In Rhode Island, beach manager Cheri Hall rolled out the standard of risk communication bullshit, saying, “We’ve never had a problem. I’ve been manager for 22 years and all of our samples always come back good.”
Radio Sweden reports that 12 more cases of hepatitis A in Sweden are probably linked to the same strain of virus first discovered in Denmark which authorities believe is caused by frozen berries.
Fifty-six cases of hepatitis A have been reported in Sweden since December. Normally, there are five cases a year in the country.
Cases have been reported in other Nordic countries, bringing the total sickened to about 83.