Epidemiology of Shiga Toxin-Producing Escherichia coli Infections in Southern Italy after Implementation of Symptom-Based Surveillance of Bloody Diarrhea in the Pediatric Population

Daniela Loconsole, Mario Giordano, Francesca Centrone, Marisa Accogli, Daniele Casulli, Anna Lisa De Robertis, Anna Morea, Michele Quarto, Antonio Parisi, Gaia Scavia, Maria Chironna and on behalf of the Bloody Diarrhea Apulia Working Group
Additional contact information
Daniela Loconsole: Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
Mario Giordano: Pediatric Nephrology and Dialysis Unit, Pediatric Hospital “Giovanni XXIII”, Via Giovanni Amendola, 207, 70126 Bari, Italy
Francesca Centrone: Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
Marisa Accogli: Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
Daniele Casulli: Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
Anna Lisa De Robertis: Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
Anna Morea: Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
Michele Quarto: Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
Antonio Parisi: Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Via Manfredonia, 20, 71121 Foggia, Italy
Gaia Scavia: Food Safety, Nutrition and Veterinary Public Health Department, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy
Maria Chironna: Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
on behalf of the Bloody Diarrhea Apulia Working Group: Bloody Diarrhea Apulia Working Group are listed in acknowledgments.

IJERPH, 2020, vol. 17, issue 14, 1-12

Abstract: Shiga toxin-producing Escherichia coli (STEC) infections result in a significant public health impact because of the severity of the disease that, in young children especially, can lead to hemolytic–uremic syndrome (HUS). A rise in the number of HUS cases was observed in the Apulia region of Italy from 2013 to 2017, and so, in 2018, a symptom-based surveillance system for children with bloody diarrhea (BD) was initiated in order to detect and manage STEC infections. The objective of the study was to describe the epidemiology of STEC infections in children from June 2018 to August 2019. Children <15 years old with BD were hospitalized and tested for STEC. Real-time PCR for virulence genes ( stx1 , stx2 , eae ) and serogroup identification tests were performed on stool samples/rectal swabs of cases. STEC infection was detected in 87 (10.6%) BD cases. The median age of STEC cases was 2.7 years, and 60 (68.9%) were <4. Of these 87 cases, 12 (13.8%) came from households with diarrhea. The reporting rate was 14.2/100,000, with the highest incidence in cases from the province of Bari (24.2/100,000). Serogroups O26 and O111 were both detected in 22/87 (25.3%) cases. Co-infections occurred in 12.6% of cases (11/87). Twenty-nine STEC were positive for stx1 , stx2 , and eae . Five cases (5.7%) caused by O26 (n = 2), O111 (n = 2), and O45 (n = 1) developed into HUS. A risk-oriented approach based on the testing of children with BD during the summer may represent a potentially beneficial option to improve the sensitivity of STEC surveillance, not only in Italy but also in the context of Europe as a whole.

Keywords: epidemiology; surveillance; Shiga toxin-producing Escherichia coli; bloody diarrhea; hemolytic–uremic syndrome; Italy (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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