Key result
Survey of 13 European countries prompts Norway to revise STEC clearance guidelines targeting high-virulent cases.
Why the study?
Norwegian guidelines for preventing secondary transmission of STEC did not accommodate the varying pathogenic potential of STEC.
Cross-Sectional (n=14)
A European survey of STEC control measures informed the revision of Norwegian guidelines to a risk-based approach, significantly reducing unnecessary public health interventions for low-virulent STEC cases.
Guideline variation across Europe may affect STEC patient management; leaves open the optimal specimen threshold for clearance pending prospective validation.
In 2016, we reviewed preventive control measures for secondary transmission of Shiga-toxin producing Escherichia coli (STEC) in humans in European Union (EU)/European Free Trade Association (EEA) countries to inform the revision of the respective Norwegian guidelines which at that time did not accommodate for the varying pathogenic potential of STEC. We interviewed public health experts from EU/EEA institutes, using a semi-structured questionnaire. We revised the Norwegian guidelines using a risk-based approach informed by the new scientific evidence on risk factors for HUS and the survey results. All 13 (42%) participating countries tested STEC for Shiga toxin (stx) 1, stx2 and eae (encoding intimin). Five countries differentiated their control measures based on clinical and/or microbiological case characteristics, but only Denmark based their measures on routinely conducted stx subtyping. In all countries, but Norway, clearance was obtained with ⩽3 negative STEC specimens. After this review, Norway revised the STEC guidelines and recommended only follow-up of cases infected with high-virulent STEC (determined by microbiological and clinical information); clearance is obtained with three negative specimens. Implementation of the revised Norwegian guidelines will lead to a decrease of STEC cases needing follow-up and clearance, and will reduce the burden of unnecessary public health measures and the socioeconomic impact on cases. This review of guidelines could assist other countries in adapting their STEC control measures.
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Veneti et al. (2019) conducted a cross-sectional in Shiga-toxin producing Escherichia coli (STEC) infections (n=14). Survey of STEC control measures was evaluated on Number of negative STEC specimens required for clearance. A survey of 13 European countries revealed that all except Norway required 3 or fewer negative specimens for STEC clearance, leading Norway to revise its guidelines to target only high-virulent cases.
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