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A spatial and temporal analysis of risk factors associated with sporadic Shiga toxin-producing Escherichia coli O157 infection in England between 2009 and 2015

Lookup NU author(s): Professor Sarah O'Brien



This is the authors' accepted manuscript of an article that has been published in its final definitive form by Cambridge University Press, 2018.

For re-use rights please refer to the publisher's terms and conditions.


Infection with STEC O157 is relatively rare but has potentially serious sequelae, particularly for children. Large outbreaks have prompted considerable efforts designed to reduce transmission primarily from food and direct animal contact. Despite these interventions, numbers of infections have remained constant for many years and the mechanisms leading to many sporadic infections remain unclear.Here, we show that two-thirds of all cases reported in England between 2009 and 2015 were sporadic. Crude rates of infection differed geographically and were highest in rural areas during the summer months. Living in rural areas with high densities of cattle, sheep or pigs and those served by private water supplies were associated with increased risk. Living in an area of lower deprivation contributed to increased risk but this appeared to be associated with reported travel abroad. Fresh water coverage and residential proximity to the coast were not risk factors.To reduce the overall burden of infection in England, interventions designed to reduce the number of sporadic infections with STEC should focus on the residents of rural areas with high densities of livestock and the effective management of non-municipal water supplies. The role of sheep as a reservoir and potential source of infection in humans should not be overlooked.

Publication metadata

Author(s): Elson R, Grace K, Vivancos R, Jenkins C, Adak GK, O'Brien SJ, Lake IR

Publication type: Article

Publication status: Published

Journal: Epidemiology and Infection

Year: 2018

Volume: 146

Issue: 15

Pages: 1928-1939

Print publication date: 01/11/2018

Online publication date: 12/09/2018

Acceptance date: 12/08/2018

Date deposited: 08/08/2019

ISSN (print): 0950-2688

ISSN (electronic): 1469-4409

Publisher: Cambridge University Press


DOI: 10.1017/S095026881800256X

PubMed id: 30205851


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