The epidemiology of haemolytic uraemic syndrome in England, 2009-2023: An analysis of national surveillance data.

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.