Not all Shiga toxin Escherichia Coli (STEC) are the same! Modelling the impact of different options for public health action using data from a local enhanced surveillance system
PHE ePoster Library. Harvey-Vince L. Sep 12, 2017; 186679; 194
Mrs. Lisa Harvey-Vince
Mrs. Lisa Harvey-Vince
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Abstract
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Abstract Not all Shiga toxin Escherichia Coli (STEC) are the same! Modelling the impact of different options for public health action using data from a local enhanced surveillance system.BackgroundSome frontline laboratories have adopted PCR techniques to detect shigatoxin (stx) genes resulting in large increases of reported non-O157 STEC cases, thereby increasing workloads where appropriate public health action is unclear. MethodCases positive by stx DNA PCR over 38 months were assessed by symptomology (bloody diarrhoea or haemolytic uraemic syndrome (HUS)), and PCR (stx1, stx2 and eae), culture, and subtype results from Gastrointestinal Bacteria Reference Unit (GBRU). Three options for public health action were modelled to assist prioritising STEC infections potentially caused by higher risk stx subtypes (stx2a, 2c or 2d and eae or AggR).ResultsFor 586 stx positive PCR results, modelling identified three opportunities for assessing public health action balanced with efficient use of resources: Day 1 Symptomology and frontline laboratory culture - 50 STEC O157 isolated, one HUS and 47 cases reporting bloody diarrhoeaDay 8 GBRU PCR (stx2 and eae) - 66 isolates of which 54 already under management and 12 now requiring assessmentDay 16 GBRU (stx subtype) - whole genome sequencing confirmed 71 isolates possessed higher risk stx subtypes, and 4 now requiring assessmentConclusionsCombination of symptomology and GBRU results allows systematic triaged public health action directed to high risk stx subtypes. 19% of frontline laboratory positive PCR results required full assessment. We are proposing this approach be adopted in new national STEC guidance.
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