Outbreaks of virulent diarrheagenic Escherichia coli - are we in control?
1 Department of Infectious Disease Epidemiology, Robert Koch Institute, DGZ-Ring 1, 13086 Berlin, Germany
2 Department of Infectious Diseases, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
3 National Reference Center for Salmonella and other Bacterial Enteric Pathogens, Robert Koch Institute, Burgstrasse 37, 38855 Wernigerode, Germany
4 Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
BMC Medicine 2012, 10:11 doi:10.1186/1741-7015-10-11Published: 2 February 2012
Shiga toxin-producing Escherichia coli (STEC) are the most virulent diarrheagenic E. coli known to date. They can be spread with alarming ease via food as exemplified by a large sprout-borne outbreak of STEC O104:H4 in 2011 that was centered in northern Germany and affected several countries. Effective control of such outbreaks is an important public health task and necessitates early outbreak detection, fast identification of the outbreak vehicle and immediate removal of the suspected food from the market, flanked by consumer advice and measures to prevent secondary spread.
In our view, opportunities to improve control of STEC outbreaks lie in early clinical suspicion for STEC infection, timely diagnosis of all STEC at the serotype-level and integrating molecular subtyping information into surveillance systems. Furthermore, conducting analytical studies that supplement patients' imperfect food history recall and performing, as an investigative element, product tracebacks, are pivotal but underutilized tools for successful epidemiologic identification of the suspected vehicle in foodborne outbreaks. As a corollary, these tools are amenable to tailor microbiological testing of suspected food.