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Abstract

Shiga-toxin producing (STEC) O157 is a food-borne pathogen which causes gastrointestinal illness in humans. Ruminants are considered the main reservoir of infection, and STEC exceedance has been associated with heavy rainfall. In September 2022, a large outbreak of STEC O157:H7 was identified in the United Kingdom (UK). A national-level investigation was undertaken to identify the source of the outbreak and inform risk mitigation strategies. Whole genome sequencing (WGS) was used to identify outbreak cases. Overall, 259 cases with illness onset dates between 5 August and 12 October 2022, were confirmed across the UK. Epidemiological investigations supported a UK grown, nationally distributed, short shelf-life food item as the source of the outbreak. Analytical epidemiology and food chain analysis suggested lettuce as the likely vehicle of infection. Food supply chain tracing identified Grower X as the likely implicated producer. Independent of the food chain investigations, a novel geospatial analysis triangulating meteorological, flood risk, animal density and land use data was developed, also identifying Grower X as the likely source. Novel geospatial analysis and One Health approaches are potential tools for upstream data analysis to predict and prevent contamination events before they occur and to support evidence generation in outbreak investigations.

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/content/10.2807/1560-7917.ES.2024.29.36.2400161
2024-09-05
2024-09-07
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2024.29.36.2400161
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References

  1. Launders N, Byrne L, Jenkins C, Harker K, Charlett A, Adak GK. Disease severity of Shiga toxin-producing E. coli O157 and factors influencing the development of typical haemolytic uraemic syndrome: a retrospective cohort study, 2009-2012. BMJ Open. 2016;6(1):e009933.  https://doi.org/10.1136/bmjopen-2015-009933  PMID: 26826153 
  2. European Centre for Disease Prevention and Control (ECDC). Surveillance Atlas of Infectious Diseases. Stockholm: ECDC. [Accessed: 1 Jul 2024]. Available from: http://atlas.ecdc.europa.eu/public/index.aspx?Dataset=27&HealthTopic=59
  3. European Centre for Disease Prevention and Control (ECDC). STEC infection Annual Epidemiological Report for 2022. Stockholm: ECDC; Feb 2024. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/STEC_AER_2022_Report.pdf
  4. European Food Safety Authority (EFSA)European Centre for Disease Prevention and Control (ECDC). The European Union One Health 2022 Zoonoses Report. EFSA J. 2023;21(12):e8442. PMID: 38089471 
  5. Dallman TJ, Jalava K, Verlander NQ, Gally D, Jenkins C, Godbole G, et al. Identification of domestic reservoirs and common exposures in an emerging lineage of Shiga toxin-producing Escherichia coli O157:H7 in England: a genomic epidemiological analysis. Lancet Microbe. 2022;3(8):e606-15.  https://doi.org/10.1016/S2666-5247(22)00089-1  PMID: 35760076 
  6. Kintz E, Byrne L, Jenkins C, McCarthy N, Vivancos R, Hunter P. Outbreaks of Shiga toxin-producing Escherichia coli linked to sprouted seeds, salad, and leafy greens: a systematic review. J Food Prot. 2019;82(11):1950-8.  https://doi.org/10.4315/0362-028X.JFP-19-014  PMID: 31638410 
  7. Semenza JC, Rocklöv J, Ebi KL. Climate change and cascading risks from infectious disease. Infect Dis Ther. 2022;11(4):1371-90.  https://doi.org/10.1007/s40121-022-00647-3  PMID: 35585385 
  8. Wade TJ, Sandhu SK, Levy D, Lee S, LeChevallier MW, Katz L, et al. Did a severe flood in the Midwest cause an increase in the incidence of gastrointestinal symptoms? Am J Epidemiol. 2004;159(4):398-405.  https://doi.org/10.1093/aje/kwh050  PMID: 14769644 
  9. Amaral-Zettler LA, Rocca JD, Lamontagne MG, Dennett MR, Gast RJ. Changes in microbial community structure in the wake of Hurricanes Katrina and Rita. Environ Sci Technol. 2008;42(24):9072-8.  https://doi.org/10.1021/es801904z  PMID: 19174873 
  10. Wade TJ, Lin CJ, Jagai JS, Hilborn ED. Flooding and emergency room visits for gastrointestinal illness in Massachusetts: a case-crossover study. PLoS One. 2014;9(10):e110474.  https://doi.org/10.1371/journal.pone.0110474  PMID: 25329916 
  11. Rangel JM, Sparling PH, Crowe C, Griffin PM, Swerdlow DL. Epidemiology of Escherichia coli O157:H7 outbreaks, United States, 1982-2002. Emerg Infect Dis. 2005;11(4):603-9.  https://doi.org/10.3201/eid1104.040739  PMID: 15829201 
  12. Hrudey SE, Payment P, Huck PM, Gillham RW, Hrudey EJ. A fatal waterborne disease epidemic in Walkerton, Ontario: comparison with other waterborne outbreaks in the developed world. Water Sci Technol. 2003;47(3):7-14.  https://doi.org/10.2166/wst.2003.0146  PMID: 12638998 
  13. Dallman T, Ashton P, Schafer U, Jironkin A, Painset A, Shaaban S, et al. SnapperDB: a database solution for routine sequencing analysis of bacterial isolates. Bioinformatics. 2018;34(17):3028-9.  https://doi.org/10.1093/bioinformatics/bty212  PMID: 29659710 
  14. UK Health Security Agency (UKHSA). Shiga toxin-producing Escherichia coli: questionnaire. London: UKHSA; 25 Sep 2023. Available from: https://www.gov.uk/government/publications/vero-cytotoxin-producing-escherichia-coli-questionnaire
  15. Office for Health Improvement & Disparities (OHID). National Diet and Nutrition Survey. London: OHID; 6 Nov 2023. Available from: https://www.gov.uk/government/collections/national-diet-and-nutrition-survey
  16. The Meteorological Office (Met Office). Met Office MIDAS Open: UK Land Surface Stations Data (1853-current). Exeter: Met Office; 2019. Available from: http://catalogue.ceda.ac.uk/uuid/dbd451271eb04662beade68da43546e1
  17. Department for Environment, Food & Rural Affairs (Defra). Hydrology Data Explorer. London: Defra; 2024. Available from: https://environment.data.gov.uk/hydrology/
  18. The Meteorological Office (Met Office). UK Actual and Anomaly maps: Maps of climate variables for previous months, seasons and years. Exeter: Met Office; Jan 2024. Available from: https://www.metoffice.gov.uk/research/climate/maps-and-data/uk-actual-and-anomaly-maps
  19. The Meteorological Office (Met Office). HadUK–Grid. Exeter: Met Office. [Accessed: 1 Jul 2024]. Available from: https://www.metoffice.gov.uk/research/climate/maps-and-data/data/haduk-grid/haduk-grid
  20. Environment Agency. Risk of Flooding from Rivers and Sea. Bristol: Environment Agency; 26 Jul 2024. Available from: https://www.data.gov.uk/dataset/bad20199-6d39-4aad-8564-26a46778fd94/risk-of-flooding-from-rivers-and-sea
  21. Natural England. Agricultural Land Classification Map East Midlands Region (ALC005). York: Natural England; 2010. Available from: https://publications.naturalengland.org.uk/publication/143027
  22. Rural Payment Agency. Crop Map of England (CROME) 2020. Reading: Rural Payment Agency; 1 Nov 2023. Available from: https://www.data.gov.uk/dataset/be5d88c9-acfb-4052-bf6b-ee9a416cfe60/crop-map-of-england-crome-2020
  23. Animal and Plant Health Agency (APHA). Livestock Demographic Data Group: Sheep Population Report. Weybridge: APHA; 2023. Available from: http://apha.defra.gov.uk/documents/surveillance/diseases/lddg-pop-report-sheep2022.pdf
  24. Department for Environment, Food & Rural Affairs (Defra). Land use and crop maps in England 2021. London: Defra; 31 Mar 2023. Available from: https://assets.publishing.service.gov.uk/media/6426fda4fbe620000c17da9b/structure-england-land-use-maps-31mar23.pdf
  25. Launders N, Locking ME, Hanson M, Willshaw G, Charlett A, Salmon R, et al. A large Great Britain-wide outbreak of STEC O157 phage type 8 linked to handling of raw leeks and potatoes. Epidemiol Infect. 2016;144(1):171-81.  https://doi.org/10.1017/S0950268815001016  PMID: 26041509 
  26. Cowley LA, Dallman TJ, Fitzgerald S, Irvine N, Rooney PJ, McAteer SP, et al. Short-term evolution of Shiga toxin-producing Escherichia coli O157:H7 between two food-borne outbreaks. Microb Genom. 2016;2(9):e000084.  https://doi.org/10.1099/mgen.0.000084  PMID: 28348875 
  27. Gobin M, Hawker J, Cleary P, Inns T, Gardiner D, Mikhail A, et al. National outbreak of Shiga toxin-producing Escherichia coli O157:H7 linked to mixed salad leaves, United Kingdom, 2016. Euro Surveill. 2018;23(18):17-00197.  https://doi.org/10.2807/1560-7917.ES.2018.23.18.17-00197  PMID: 29741151 
  28. Byrne L, Dallman TJ, Adams N, Mikhail AFW, McCarthy N, Jenkins C. Highly pathogenic clone of Shiga toxin-producing Escherichia coli O157:H7, England and Wales. Emerg Infect Dis. 2018;24(12):2303-8.  https://doi.org/10.3201/eid2412.180409  PMID: 30457532 
  29. Mikhail AFW, Jenkins C, Dallman TJ, Inns T, Douglas A, Martín AIC, et al. An outbreak of Shiga toxin-producing Escherichia coli O157:H7 associated with contaminated salad leaves: epidemiological, genomic and food trace back investigations. Epidemiol Infect. 2018;146(2):187-96.  https://doi.org/10.1017/S0950268817002874  PMID: 29248018 
  30. Byrne L, Adams N, Jenkins C. Association between Shiga toxin-producing Escherichia coli O157:H7 stx gene subtype and disease severity, England, 2009-2019. Emerg Infect Dis. 2020;26(10):2394-400.  https://doi.org/10.3201/eid2610.200319  PMID: 32946720 
  31. Sharp A, Smout E, Byrne L, Greenwood R, Abdoollah R, Hutchinson C, et al. An outbreak of Shiga toxin-producing Escherichia coli O157:H7 linked to a mud-based obstacle course, England, August 2018. Zoonoses Public Health. 2020;67(5):467-73.  https://doi.org/10.1111/zph.12744  PMID: 32564515 
  32. Waltenburg MA, Schwensohn C, Madad A, Seelman SL, Peralta V, Koske SE, et al. , Outbreak Investigation Team. Two multistate outbreaks of a reoccurring Shiga toxin-producing Escherichia coli strain associated with romaine lettuce: USA, 2018-2019. Epidemiol Infect. 2021;150:e16.  https://doi.org/10.1017/S0950268821002703  PMID: 35060456 
  33. Lynch VD, Shaman J. Waterborne infectious diseases associated with exposure to tropical cyclonic storms, United States, 1996-2018. Emerg Infect Dis. 2023;29(8):1548-58.  https://doi.org/10.3201/eid2908.221906  PMID: 37486189 
  34. Department for Environment, Food & Rural Affairs (Defra). UK Food Security Report 2021. London: Defra; 16 Dec 2021. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1077015/United_Kingdom_Food_Security_Report_2021_19may2022.pdf
  35. World Bank Group. Climate Change Knowledge Portal. Washington D.C.: World Bank Group; 2021. Available from: https://climateknowledgeportal.worldbank.org/country/united-kingdom/climate-data-historical
  36. Healthy Food Guide. Ask the experts: Lettuce and chlorine. St Leonards: Healthy Food Guide; 14 Jun 2020. Available from: https://www.healthyfood.com/ask-the-experts/lettuce-and-chlorine/
  37. Awofisayo-Okuyelu A, Brainard J, Hall I, McCarthy N. Incubation period of Shiga toxin-producing Escherichia coli. Epidemiol Rev. 2019;41(1):121-9.  https://doi.org/10.1093/epirev/mxz001  PMID: 31616910 
  38. Food Standards Agency (FSA). Managing farm manures for food safety. London: FSA; 23 Jan 2024. Available from: https://www.food.gov.uk/business-guidance/managing-farm-manures-for-food-safety
  39. Food Standards Agency (FSA). Food safety after a flood – consumer advice. London: FSA; 19 Aug 2023. Available from: https://www.food.gov.uk/safety-hygiene/food-safety-after-a-flood
  40. European Commission (EC). Commission notice on guidance document on addressing microbiological risks in fresh fruits and vegetables at primary production through good hygiene (2017/C 163/01). Brussels: EC; 23 May 2017. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A52017XC0523%2803%29
  41. Dietrich J, Hammerl JA, Johne A, Kappenstein O, Loeffler C, Nöckler K, et al. Impact of climate change on foodborne infections and intoxications. J Health Monit. 2023;8(Suppl 3):78-92. PMID: 37342431 
  42. Fowler HJ, Lenderink G, Prein AF, Westra S, Allan RP, Ban N, et al. Anthropogenic intensification of short-duration rainfall extremes. Nat Rev Earth Environ. 2021;2(2):107-22.  https://doi.org/10.1038/s43017-020-00128-6 
  43. Fowler HJ, Ali H, Allan RP, Ban N, Barbero R, Berg P, et al. Towards advancing scientific knowledge of climate change impacts on short-duration rainfall extremes. Philos Trans A Math Phys Eng Sci. 2021;379(2195):20190542.  https://doi.org/10.1098/rsta.2019.0542  PMID: 33641464 
  44. World Health Organization (WHO). Operational framework for building climate resilient and low carbon health systems. Geneva: WHO; 9 Nov 2023. Available from: https://www.who.int/publications/i/item/9789240081888
An outbreak of Shiga toxin-producing Escherichia coli (STEC) O157:H7 associated with contaminated lettuce and the cascading risks from climate change, the United Kingdom, August to September 2022
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Neil+Cunningham&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cunningham Neil</a>, <a href="/search?value1=Claire+Jenkins&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jenkins Claire</a>, <a href="/search?value1=Sarah+Williams&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Williams Sarah</a>, <a href="/search?value1=Joanna+Garner&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Garner Joanna</a>, <a href="/search?value1=Bernd+Eggen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Eggen Bernd</a>, <a href="/search?value1=Amy+Douglas&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Douglas Amy</a>, <a href="/search?value1=Tina+Potter&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Potter Tina</a>, <a href="/search?value1=Anthony+Wilson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wilson Anthony</a>, <a href="/search?value1=Giovanni+Leonardi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Leonardi Giovanni</a>, <a href="/search?value1=Lesley+Larkin&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Larkin Lesley</a>, <a href="/search?value1=Susan+Hopkins&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hopkins Susan</a></span>. An outbreak of Shiga toxin-producing Escherichia coli (STEC) O157:H7 associated with contaminated lettuce and the cascading risks from climate change, the United Kingdom, August to September 2022. <a href="/content/ecdc">Euro Surveill.</a> 2024;29(36):pii=2400161. <a href="https://doi.org/10.2807/1560-7917.ES.2024.29.36.2400161" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2024.29.36.2400161</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 15 Mar 2024;&nbsp;&nbsp; <span class="generated">Accepted</span>: 11 Jul 2024 </span> </p>
/content/10.2807/1560-7917.ES.2024.29.36.2400161
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