Global incidence of human shiga toxin-producing escherichia coli infections and deaths: A systematic review and knowledge synthesis

Shannon E. Majowicz*, Elaine Scallan, Andria Jones-Bitton, Jan M. Sargeant, Jackie Stapleton, Frederick J. Angulo, Derrick H. Yeung, Martyn D. Kirk

*Corresponding author for this work

    Research output: Contribution to journalReview articlepeer-review

    320 Citations (Scopus)

    Abstract

    Objectives: Shiga toxin-producing Escherichia coli (STEC) are an important cause of foodborne disease, yet global estimates of disease burden do not exist. Our objective was to estimate the global annual number of illnesses due to pathogenic STEC, and resultant hemolytic uremic syndrome (HUS), end-stage renal disease (ESRD), and death. Materials: We searched Medline, Scopus, SIGLE/OpenGrey, and CABI and World Health Organization (WHO) databases for studies of STEC incidence in the general population, published between January 1, 1990 and April 30, 2012, in all languages. We searched health institution websites for notifiable disease data and reports, cross-referenced citations, and consulted international knowledge experts. We employed an a priori hierarchical study selection process and synthesized results using a stochastic simulation model to account for uncertainty inherent in the data. Results: We identified 16 articles and databases from 21 countries, from 10 of the 14 WHO Sub-Regions. We estimated that STEC causes 2,801,000 acute illnesses annually (95% Credible Interval [Cr.I.]: 1,710,000; 5,227,000), and leads to 3890 cases of HUS (95% Cr.I.: 2400; 6700), 270 cases of ESRD (95% Cr.I.: 20; 800), and 230 deaths (95% Cr.I.: 130; 420). Sensitivity analyses indicated these estimates are likely conservative. Conclusions: These are the first estimates of the global incidence of STEC-related illnesses, which have not been explicitly included in previous global burden of disease estimations. Compared to other pathogens with a foodborne transmission component, STEC appears to cause more cases than alveolar echinococcosis each year, but less than typhoid fever, foodborne trematodes, and nontyphoidal salmonellosis. Applications: Given the persistence of STEC globally, efforts aimed at reducing the burden of foodborne disease should consider the relative contribution of STEC in the target population.

    Original languageEnglish
    Pages (from-to)447-455
    Number of pages9
    JournalFoodborne Pathogens and Disease
    Volume11
    Issue number6
    DOIs
    Publication statusPublished - 1 Jun 2014

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