{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T06:24:18Z","timestamp":1778999058399,"version":"3.51.4"},"reference-count":31,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2021,4,19]],"date-time":"2021-04-19T00:00:00Z","timestamp":1618790400000},"content-version":"unspecified","delay-in-days":108,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2021]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Recurrent outbreaks of haemolytic uraemic syndrome (HUS) caused by Shiga toxin-producing<jats:italic>Escherichia coli<\/jats:italic>(STEC) serotype O55:H7 occurred in England between 2014 and 2018. We reviewed the epidemiological evidence to identify potential source(s) and transmission routes of the pathogen, and to assess the on-going risk to public health. Over the 5-year period, there were 43 confirmed and three probable cases of STEC O55:H7. The median age of cases was 4 years old (range 6 months to 69 years old) and over half of all cases were female (28\/46, 61%). There were 36\/46 (78.3%) symptomatic cases, and over half of all cases developed HUS (25\/46, 54%), including two fatal cases. No common food or environmental exposures were identified, although the majority of cases lived in rural or semi-rural environments and reported contact with both wild and domestic animals. This investigation informed policy on the clinical and public health management of HUS caused by STEC other than serotype O157:H7 (non-O157 STEC) in England, including comprehensive testing of all household contacts and household pets and more widespread use of polymerase chain reaction assays for the rapid diagnosis of STEC-HUS.<\/jats:p>","DOI":"10.1017\/s0950268821000844","type":"journal-article","created":{"date-parts":[[2021,4,19]],"date-time":"2021-04-19T05:05:32Z","timestamp":1618808732000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":12,"title":["Epidemiological investigation of recurrent outbreaks of haemolytic uraemic syndrome caused by Shiga toxin-producing<i>Escherichia coli<\/i>serotype O55:H7 in England, 2014\u20132018"],"prefix":"10.1017","volume":"149","author":[{"given":"C.","family":"Sawyer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.","family":"Vishram","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8600-9169","authenticated-orcid":false,"given":"C.","family":"Jenkins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Jorgensen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5320-2085","authenticated-orcid":false,"given":"L.","family":"Byrne","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. F. W.","family":"Mikhail","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T. J.","family":"Dallman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5095-4169","authenticated-orcid":false,"given":"K.","family":"Carroll","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.","family":"Ahyow","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Q.","family":"Vahora","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.","family":"Godbole","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Balasegaram","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2021,4,19]]},"reference":[{"key":"S0950268821000844_ref30","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-019-03738-1"},{"key":"S0950268821000844_ref29","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2020.00273"},{"key":"S0950268821000844_ref24","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2020.577658"},{"key":"S0950268821000844_ref16","unstructured":"16. Enigma project. The Study of Campylobacter. Sources, seasonality, transmission and control: Campylobacter and human behaviour in a changing environment. Liverpool: Enigma. [Accessed Nov 2016]. Available from: http:\/\/enigmaproject.org.uk\/the-project\/."},{"key":"S0950268821000844_ref13","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.041517-0"},{"key":"S0950268821000844_ref17","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2017.22.36.30610"},{"key":"S0950268821000844_ref20","doi-asserted-by":"publisher","DOI":"10.1099\/mgen.0.000029"},{"key":"S0950268821000844_ref15","doi-asserted-by":"publisher","DOI":"10.3201\/eid2312.170628"},{"key":"S0950268821000844_ref22","doi-asserted-by":"publisher","DOI":"10.1099\/mgen.0.000334"},{"key":"S0950268821000844_ref8","first-page":"1","article-title":"Pathogenicity assessment of Shiga toxin-producing Escherichia coli (STEC) and the public health risk posed by contamination of food with STEC","volume":"18","author":"Koutsoumanis","year":"2020","journal-title":"European Food Safety Authority Journal"},{"key":"S0950268821000844_ref31","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.001215"},{"key":"S0950268821000844_ref5","doi-asserted-by":"publisher","DOI":"10.1038\/nrmicro2029"},{"key":"S0950268821000844_ref4","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-008-0935-6"},{"key":"S0950268821000844_ref10","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2019.24.22.1900305"},{"key":"S0950268821000844_ref12","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.34.7.1622-1627.1996"},{"key":"S0950268821000844_ref21","doi-asserted-by":"publisher","DOI":"10.3201\/eid2412.180409"},{"key":"S0950268821000844_ref3","first-page":"1073","article-title":"Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome","volume":"365","author":"Tarr","year":"2005","journal-title":"Lancet"},{"key":"S0950268821000844_ref28","doi-asserted-by":"crossref","first-page":"e01678","DOI":"10.1128\/AEM.01678-19","article-title":"Carriage and subtypes of foodborne pathogens identified in wild birds residing near agricultural lands in California: a repeated cross-sectional study","volume":"86","author":"Navarro-Gonzalez","year":"2020","journal-title":"Applied and Environmental Microbiology"},{"key":"S0950268821000844_ref6","doi-asserted-by":"publisher","DOI":"10.3201\/eid1703.100167"},{"key":"S0950268821000844_ref27","doi-asserted-by":"publisher","DOI":"10.1007\/s12275-017-6523-3"},{"key":"S0950268821000844_ref18","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0008700"},{"key":"S0950268821000844_ref11","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-8-41"},{"key":"S0950268821000844_ref19","doi-asserted-by":"publisher","DOI":"10.3201\/eid2610.200319"},{"key":"S0950268821000844_ref9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1106482"},{"key":"S0950268821000844_ref25","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1136\/vr.164.10.304","article-title":"Probable zoonotic transmission of verocytotoxigenic Escherichia coli O157 by dogs","volume":"164","author":"Hogg","year":"2009","journal-title":"Veterinary Record"},{"key":"S0950268821000844_ref2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30062-4"},{"key":"S0950268821000844_ref23","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2018.23.18.17-00197"},{"key":"S0950268821000844_ref14","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.2008\/003632-0"},{"key":"S0950268821000844_ref26","doi-asserted-by":"publisher","DOI":"10.1128\/microbiolspec.EHEC-0027-2014"},{"key":"S0950268821000844_ref1","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268815000746"},{"key":"S0950268821000844_ref7","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.075895-0"}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268821000844","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,24]],"date-time":"2022-12-24T16:56:50Z","timestamp":1671901010000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268821000844\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021]]},"references-count":31,"alternative-id":["S0950268821000844"],"URL":"https:\/\/doi.org\/10.1017\/s0950268821000844","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021]]},"assertion":[{"value":"Copyright \u00a9 The Author(s), 2021. 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