{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T05:17:22Z","timestamp":1789795042008,"version":"4.0.1"},"reference-count":28,"publisher":"Microbiology Society","issue":"7","license":[{"start":{"date-parts":[[2021,7,23]],"date-time":"2021-07-23T00:00:00Z","timestamp":1626998400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,23]]},"abstract":"<jats:p>\n                    <jats:bold>Introduction.<\/jats:bold>\n                    Shiga toxin-producing\n                    <jats:italic>\n                      <jats:named-content content-type=\"species\">\n                        <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/doi.org\/10.1601\/nm.3093\" xlink:type=\"simple\">Escherichia coli<\/jats:ext-link>\n                      <\/jats:named-content>\n                    <\/jats:italic>\n                    (STEC) can cause severe disease and large outbreaks. In England, the incidence and clinical significance of STEC serogroups other than O157 (non-O157) is unknown due to a testing bias for detection of STEC O157. Since 2013, the implementation of PCR to detect all STEC serogroups by an increasing number of diagnostic laboratories has led to an increase in the detection of non-O157 STEC.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Hypothesis\/Gap statement.<\/jats:bold>\n                    Due to a bias in testing methodologies to select for STEC serogroup O157 in frontline diagnostic laboratories in most countries, very little surveillance data have been previously generated on non-O157 STEC.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Aim.<\/jats:bold>\n                    Five years (2014\u20132018) of STEC national surveillance data were extracted and descriptive analysis undertaken to assess disease severity of non-O157 STEC strains.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods.<\/jats:bold>\n                    Data from 1 January 2014 to 31 December 2018 were extracted from the National Enhanced Surveillance System for STEC and analysed.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results.<\/jats:bold>\n                    The implementation of Gastrointestinal Polymerase Chain Reaction (GI-PCR) has resulted in a four-fold increase in the detection of non-O157 STEC cases between 2014 and 2018. There were 2579 cases infected with 97 different non-O157 serogroups. The gender distribution was similar amongst STEC O157 and non-O157 STEC cases with 57 and 56\u200a% of cases being female respectively, but a significantly higher proportion of cases (\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.001) under 5\u2009years of age was observed among STEC O157 (22\u200a%) cases compared to non-O157 STEC (14\u200a%). The most common non-O157 serogroups were O26 (16\u200a%), O146 (11\u200a%), O91 (10\u200a%), O128 (7\u200a%), O103 (5\u200a%) and O117 (3\u200a%). Overall, rates of bloody diarrhoea were highest in O26 (44\u200a%) and O103 (48\u200a%) cases and lowest in STEC O117 cases (17\u200a%). Strains harbouring Shiga toxin\n                    <jats:italic>stx1a<\/jats:italic>\n                    caused the highest proportion of diarrhoea (93\u200a%) and caused the same level of bloody diarrhoea as\n                    <jats:italic>stx2a<\/jats:italic>\n                    (39\u200a%). However,\n                    <jats:italic>stx2a<\/jats:italic>\n                    caused the highest proportion of vomiting (46\u200a%), hospitalisation (49\u200a%) and considerably more HUS (29\u200a%) than other\n                    <jats:italic>stx<\/jats:italic>\n                    profiles.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion.<\/jats:bold>\n                    The implementation of PCR targeting\n                    <jats:italic>stx<\/jats:italic>\n                    at diagnostic laboratories has shown that non-O157 STEC, most notably STEC O26, are an emerging risk to public health.\n                  <\/jats:p>","DOI":"10.1099\/jmm.0.001375","type":"journal-article","created":{"date-parts":[[2021,7,26]],"date-time":"2021-07-26T10:16:40Z","timestamp":1627294600000},"source":"Crossref","is-referenced-by-count":49,"title":["The emerging importance of Shiga toxin-producing Escherichia coli other than serogroup O157 in England"],"prefix":"10.1099","volume":"70","author":[{"given":"Bhavita","family":"Vishram","sequence":"first","affiliation":[{"name":"National Infection Service, Public Health England, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Jenkins","sequence":"additional","affiliation":[{"name":"National Infection Service, Public Health England, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9436-067X","authenticated-orcid":false,"given":"David R.","family":"Greig","sequence":"additional","affiliation":[{"name":"Division of Infection and Immunity, The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, EH25 9RG, UK"},{"name":"National Infection Service, Public Health England, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gauri","family":"Godbole","sequence":"additional","affiliation":[{"name":"National Infection Service, Public Health England, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5095-4169","authenticated-orcid":false,"given":"Kevin","family":"Carroll","sequence":"additional","affiliation":[{"name":"PHE South East, Surrey and Sussex HPT, Parkside, Chart Way, Horsham RH12 1XA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sooria","family":"Balasegaram","sequence":"additional","affiliation":[{"name":"National Infection Service, Public Health England, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5320-2085","authenticated-orcid":false,"given":"Lisa","family":"Byrne","sequence":"additional","affiliation":[{"name":"National Infection Service, Public Health England, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"345","reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268815000746"},{"key":"R2","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":"Panel","year":"2020"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2018.09.002"},{"key":"R4","volume-title":"Interim Public Health Operational Guidance for Shiga Toxin Producing Escherichia Coli (Stec)","year":"2018"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.3201\/eid2610.200319"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02591-06"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.37.3.497-503.1999"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2016.00258"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.2008\/003632-0"},{"key":"R10","article-title":"Shiga toxin-producing Escherichia coli (STEC) Annual report, 2016","year":"2016"},{"key":"R11","first-page":"1","article-title":"Recommendations for diagnosis of shiga toxin--producing Escherichia coli infections by clinical laboratories","volume":"58","author":"Gould","year":"2009","journal-title":"MMWR Recomm Rep"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.1086\/466536"},{"key":"R13","article-title":"Annual Epidemiological Report for 2018. 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