The Journal of infection · 2025
The epidemiology of haemolytic uraemic syndrome in England, 2009-2023: An analysis of national surveillance data.
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McGeoch Luke J, Quinn Orlagh, Douglas Amy, Sawyer Clare, Jenkins Claire, Balasegaram Sooria
Аннотация
OBJECTIVES: Haemolytic uraemic syndrome (HUS) is a serious multi-system disorder, predominantly caused by Shiga toxin-producing Escherichia coli (STEC). We aimed to describe the epidemiology of HUS in England, including characteristics associated with HUS among STEC cases.
METHODS: Enhanced surveillance questionnaire (ESQ) and microbiological data were extracted for HUS and laboratory-confirmed STEC cases reported through national surveillance between 2009-2023. HUS incidence rates were computed. Trends in demographic, clinical, microbiological and exposure characteristics were described for STEC cases with (STEC-HUS) and without (non-HUS STEC) HUS, with complete ESQs. Associations with HUS were assessed using multivariable logistic regression.
RESULTS: There were 991 HUS cases, 601 STEC-HUS cases and 12,916 non-HUS STEC cases. Between 2009-2023, serogroup O26 positivity increased from 3.3% to 48.6% among STEC-HUS cases, and 0.0% to 16.0% among non-HUS STEC cases. Characteristics associated with HUS included serogroup O26 (OR 2.30, 95% CI 1.68-3.11), stx2a (2.66, 2.10-3.37), stx2d (5.48, 2.41-11.66), eae (OR 3.00, 1.60-5.80), vomiting (4.78, 3.83-5.99), younger age, bloody diarrhoea, unpasteurised dairy consumption, and antibiotic use.
CONCLUSIONS: STEC O26 is the most common serogroup detected in HUS in England. We recommend efforts to improve surveillance of non-O157 serogroups and investigate drivers of STEC O26 infection and its relationship with HUS.
METHODS: Enhanced surveillance questionnaire (ESQ) and microbiological data were extracted for HUS and laboratory-confirmed STEC cases reported through national surveillance between 2009-2023. HUS incidence rates were computed. Trends in demographic, clinical, microbiological and exposure characteristics were described for STEC cases with (STEC-HUS) and without (non-HUS STEC) HUS, with complete ESQs. Associations with HUS were assessed using multivariable logistic regression.
RESULTS: There were 991 HUS cases, 601 STEC-HUS cases and 12,916 non-HUS STEC cases. Between 2009-2023, serogroup O26 positivity increased from 3.3% to 48.6% among STEC-HUS cases, and 0.0% to 16.0% among non-HUS STEC cases. Characteristics associated with HUS included serogroup O26 (OR 2.30, 95% CI 1.68-3.11), stx2a (2.66, 2.10-3.37), stx2d (5.48, 2.41-11.66), eae (OR 3.00, 1.60-5.80), vomiting (4.78, 3.83-5.99), younger age, bloody diarrhoea, unpasteurised dairy consumption, and antibiotic use.
CONCLUSIONS: STEC O26 is the most common serogroup detected in HUS in England. We recommend efforts to improve surveillance of non-O157 serogroups and investigate drivers of STEC O26 infection and its relationship with HUS.