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Shiga toxin-producing Escherichia coli (STEC) and food: attribution, characterization, and monitoring

Meeting Report

Year of publication 2018

Place of publication Rome, Italy ;

Pages 175 p.

Author FAO/WHO

Publisher FAO ;

Product type Book (series)

ISBN 978-92-5-130682-6

Series title Microbiological Risk Assessment Series

Series number No. 31

Edition 1

Synopsis (short abstract) Shiga toxin-producing Escherichia coli (STEC) infections are a substantial health issue worldwide. Circa 2010, foodborne STEC caused > 1 million human illnesses, 128 deaths, and ~ 13,000 Disability Adjusted Life Years (DALYs). Targeting interventions appropriately relies on identifying those strains of greatest risk to human health and determining the types of foods that cause STEC infections. There are hundreds of STEC serotypes; however, based on the evidence gathered during the review, the Expert Group concluded that the serotype of the STEC strain should not be considered a virulence criterion. All STEC strains with the same serotype should not be assumed to carry the same virulence genes and to pose the same risk, as many STEC virulence genes are mobile and can be lost or transferred to other bacteria. this report proposes a set of criteria for categorizing the potential risk of severity of illness associated with a STEC in food is recommended based on evidence of virulence gene profiles and associations with clinical severity. The criteria could be applied by risk managers in a risk-based management approach to control STEC in food. While ruminants and, other land animals are considered the main reservoirs for STEC, various largescale outbreaks have been linked to other foods. Thus, the report also addresses source attribution of foodborne STEC infections globally in order to inform the development of international standards by the Codex Alimentarius on the control of STEC, and in particular identify the foods which should be the focus of those standards. Finally it provides a review of monitoring programmes and methodology for STEC which can serve as a reference for countries planning to develop such programmes.

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    Attributing illness caused by Shiga toxin-producing Escherichia coli (STEC) to specific foods 2019
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    Shiga toxin-producing Escherichia coli (STEC) infections are a substantial public health issue worldwide, causing more than 1 million illnesses, 128 deaths and nearly 13 000 Disability-Adjusted Life Years (DALYs) annually. To appropriately target interventions to prevent STEC infections transmitted through food, it is important to determine the specific types of foods leading to these illnesses. An analysis of data from STEC foodborne outbreak investigations reported globally, and a systematic review and meta-analysis of case-control studies of sporadic STEC infections published for all dates and locations, were conducted. A total of 957 STEC outbreaks from 27 different countries were included in the analysis. Overall, outbreak data identified that 16% (95% UI, 2-17%) of outbreaks were attributed to beef, 15% (95% UI, 2-15%) to produce and 6% (95% UI, 1-6%) to dairy products. The food sources involved in 57% of all outbreaks could not be identified. The attribution proportions were calculated by WHO region and the attribution of specific food commodities varied between geographic regions. In the European and American sub-regions of the WHO, the primary sources of outbreaks were beef and produce. In contrast, produce and dairy were identified as the primary sources of STEC outbreaks in the WHO Western Pacific sub-region. The systematic search of the literature identified useable data from 21 publications of case-control studies of sporadic STEC infections. The results of the meta-analysis identified, overall, beef and meat-unspecified as significant risk factors for STEC infection. Geographic region and age of the study population contributed to significant sources of
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