Journal of infection and public health · 2025
Shiga toxin-producing Escherichia coli O26:H11 associated with a cluster of haemolytic uraemic syndrome cases following the mid-July 2021 floods in Belgium.
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Crombé Florence, Dierinck Tiffany, Rosas Angel, Pellegrino Alessandro, Delbrassinne Laurence, Ragimbeau Catherine, Mossong Joel, Hammami Naïma, Van Cleemputte Cedric, Rouelle Arnaud, Delloye Francis, Vanmechelen Bram, Piérard Denis
Аннотация
BACKGROUND: Flood-related waterborne diseases are an acute consequence of natural disasters, primarily due to contamination of drinking water supplies. With climate change driving an increase in extreme weather events, such as floods, the risk of waterborne disease outbreak is expected to rise. This report summarizes an outbreak investigation of Shiga toxin-producing Escherichia coli (STEC) O26:H11 in the Belgian-Luxembourg following the mid-July 2021 floods.
METHODS: In summer 2021, STEC O26 isolates referred to the Belgian National Reference Centre (NRC) were first characterized with IS621-typing, followed by whole genome sequencing (WGS)-based core genome multilocus sequence typing (cgMLST). As an outbreak was suspected, a national-level investigation was initiated. A retrospective analysis compared STEC incidence between flooded and non-flooded municipalities in Wallonia.
RESULTS: The NRC identified a cluster of ten cases infected with STEC O26:H11 (stx2a+ and eae+), with identical IS621-profile. Six were confirmed by WGS; all six isolates of sequence type (ST) 21 were closely related. All six cases developed haemolytic uraemic syndrome (HUS) and resided in the Belgian-Luxembourg, heavily impacted by the mid-July 2021 floods. Retrospective analysis showed an increase in STEC cases in flooded areas of Wallonia. Surveillance questionnaires linked the illness to contaminated tap water that was consumed by all cases. Phylogenetic analysis revealed cross-border spread in the neighbouring Grand Duchy (GD) of Luxembourg. Five Luxembourgish cases, including two STEC-HUS cases, were epidemiologically linked to a same daycare centre.
CONCLUSIONS: This report describes an HUS cluster of STEC O26:H11 (ST21, stx2a+, eae+) in Belgium following severe mid-July 2021 floods. Contaminated tap water was identified as the probable source of infection of the Belgian-Luxembourg cases, with possible secondary person-to-person transmission to children in a GD Luxembourgish daycare centre. This outbreak highlights the importance of sharing molecular typing data between countries and the need for rapid public health interventions following climate-driven disasters.
METHODS: In summer 2021, STEC O26 isolates referred to the Belgian National Reference Centre (NRC) were first characterized with IS621-typing, followed by whole genome sequencing (WGS)-based core genome multilocus sequence typing (cgMLST). As an outbreak was suspected, a national-level investigation was initiated. A retrospective analysis compared STEC incidence between flooded and non-flooded municipalities in Wallonia.
RESULTS: The NRC identified a cluster of ten cases infected with STEC O26:H11 (stx2a+ and eae+), with identical IS621-profile. Six were confirmed by WGS; all six isolates of sequence type (ST) 21 were closely related. All six cases developed haemolytic uraemic syndrome (HUS) and resided in the Belgian-Luxembourg, heavily impacted by the mid-July 2021 floods. Retrospective analysis showed an increase in STEC cases in flooded areas of Wallonia. Surveillance questionnaires linked the illness to contaminated tap water that was consumed by all cases. Phylogenetic analysis revealed cross-border spread in the neighbouring Grand Duchy (GD) of Luxembourg. Five Luxembourgish cases, including two STEC-HUS cases, were epidemiologically linked to a same daycare centre.
CONCLUSIONS: This report describes an HUS cluster of STEC O26:H11 (ST21, stx2a+, eae+) in Belgium following severe mid-July 2021 floods. Contaminated tap water was identified as the probable source of infection of the Belgian-Luxembourg cases, with possible secondary person-to-person transmission to children in a GD Luxembourgish daycare centre. This outbreak highlights the importance of sharing molecular typing data between countries and the need for rapid public health interventions following climate-driven disasters.