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Surveillance for STEC outside of New Zealand. Katie Fullerton Coordinating Epidemiologist, OzFoodNet 16 May 2008 VTEC Symposium, Wellington, NZ. Overview. STEC Surveillance in Australia National Notifiable Diseases Surveillance System OzFoodNet Outbreaks Case-Control Studies

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surveillance for stec outside of new zealand

Surveillance for STEC outside of New Zealand

Katie Fullerton

Coordinating Epidemiologist, OzFoodNet

16 May 2008

VTEC Symposium, Wellington, NZ

overview
Overview
  • STEC Surveillance in Australia
    • National Notifiable Diseases Surveillance System
    • OzFoodNet
    • Outbreaks
    • Case-Control Studies
  • STEC Surveillance elsewhere
    • United States
    • Canada
    • EU
national communicable disease surveillance aus
National Communicable Disease Surveillance - Aus
  • Federation of 6 states and 2 territories
  • Local health departments collect notifications under public health legislation
  • Quarantine Act 1908
  • National Health Security Act 2007
    • Legislative framework formalizing existing surveillance arrangements
    • Support obligations under IHR (2005)
  • Data on a nationally agreed set of communicable diseases are voluntarily forwarded to DoHA
stec surveillance in australia
STEC Surveillance in Australia
  • 65 communicable diseases agreed to by Communicable Diseases Network Australia (CDNA)
  • Reported to National Notifiable Diseases Surveillance System (NNDSS)
  • Includes
    • STEC/VTEC from all jurisdictions
    • Haemolytic Uremic Syndrome (HUS) from all jurisdictions
ozfoodnet
OzFoodNet
  • Started 2000 (www.ozfoodnet.org.au)
  • Funded by Australian Government Department of Health and Ageing
  • Enhanced foodborne disease surveillance in all jurisdictions in Australia
  • Reports on incidence of 6 infections commonly transmitted by food, including STEC, and 1 syndrome, HUS
  • Summarizes data on gastrointestinal and foodborne disease outbreaks
shiga toxin producing verotoxigenic escherichia coli
Shiga-toxin producing/verotoxigenic Escherichia coli
  • Only confirmed cases should be notified.
  • Confirmed case: A confirmed case requires Laboratory definitive evidence only.
    • Isolation of shigatoxigenic/verotoxigenic Escherichia coli from faeces OR
    • Isolation of shiga toxin or vero toxin from a clinical isolate of E. coli OR
    • Identification of the gene associated with the production of shiga toxin or vero toxin in E. coli by nucleic acid testing on isolate or raw bloody diarrhoea.
  • Note: Where STEC/VTEC is isolated in the context of Haemolytic uraemic syndrome (HUS), it should be notified as STEC/VTEC and HUS.
diagnostic practices
Diagnostic Practices*

*Surveillance of Shiga toxigenic Escherichia coli in Australia. Combs B, Raupach J, Kirk M. Communicable Diseases Intelligence, 2005, 29 (4) 366-369.

incidence of stec australia
Incidence of STEC, Australia

*Australia’s Notifiable Disease Status, 2005: Annual Report of the National Notifiable Diseases Surveillance System. Owen R, et al. Communicable Diseases Intelligence, 2007, 31 (1) 1-70.

**Monitoring the incidence and causes of diseases potentially transmitted by food in Australia. OzFoodNet Working Group. Communicable Diseases Intelligence, 2007, 31 (4) 345-365.

stec case control study
STEC Case-Control Study
  • Multi-centre case-control study, based on 6 month pilot in 2002*
  • Cases were recruited in South Australia from July 2003, with all other Australian states participating from 2005
  • 3 controls per case were selected from control banks
  • 114 cases and 304 controls participated

*Risk factors for sporadic human infection with shiga-toxin-producing Escherichia coli in South Australia. Hundy R, Cameron S. Communicable Diseases Intelligence, 2004, 28 (1) 74-79.

slide12
Risk factors for STEC infection following multivariate logistic regression analysis (Adjusted by State and education).*

Serotypes: O157 (38%), O111 (12%), O26 (6%), one each O103, O301, OR:H-, O113, O172, not serotyped (40%)

*A case control study of sporadic human infection with Shiga toxin producing Escherichia coli in Australia. McPherson M, et al. Poster at ICEID, CDC, Atlanta, GA, USA, March 2008.

stec surveillance in the united states
STEC Surveillance in the United States
  • National Notifiable Diseases Surveillance System (NNDSS)*
    • Not a single surveillance system – aggregated and published from separate surveillance systems
  • FoodNet (www.cdc.gov/foodnet)
    • Established 1996, Centers for Disease Control and Prevention, US Food and Drug Administration, US Department of Agriculture, 10 states in US
  • Active, population-based surveillance for 10 laboratory-confirmed infections, including
    • STEC O157
    • STEC non-O157
    • HUS

*Summary of Notifiable Diseases – United States, 2005. McNabb SJN, et al. Morbidity and Mortality Weekly, March 30, 2007, 54(53), 2-92.

us surveillance data 2007
US Surveillance Data, 2007*

*Preliminary FoodNet Data on the Incidence of Infection with Pathogens Commonly Transmitted Commonly Through Food – 10 States, 2007. CDC. Morbidity and Mortality Weekly, April 11, 2008, 57 (14) 366-370.

stec surveillance in canada
STEC Surveillance in Canada
  • C-EnterNet

(http://www.phac-aspc.gc.ca/c-enternet/index-eng.php)

    • Canada’s National Integrated Enteric Pathogen Surveillance System, pilot 2006
    • 12 infections including VTEC
    • Human, retail meat, water, on-farm
    • VTEC O157:H7, 2006, 35 cases (7.3/100,000 person years)*
  • Notifiable Diseases Data
    • VTEC, 2004, 3.4/100,000 population **

*Government of Canada. Canadian National Enteric Pathogen Surveillance System (C-EnterNet) 2006. Guelph, ON: Public Health Agency of Canada, 2007.

**Public Health Agency of Canada. Notifiable Diseases On-Line. http://dsol-smed.phac-aspc.gc.ca/dsol-smed/#top_list.

stec surveillance in the eu
STEC Surveillance in the EU
  • European Centre for Disease Prevention and Control, Stockholm, Sweden - May 2005 (www.ecdc.europa.eu)
  • Enter-Net
    • Integrated into ECDC October 2007
  • VTEC, 2005: 1.2 cases per 100,000 population in Europe*

*Annual Epidemiological Report on Communicable Diseases in Europe. European Centre for Disease Prevention and Control, 2007.

conclusions
Conclusions
  • Role of non-O157 STEC outside of Northern Hemisphere
  • Impact of different diagnostic practices
  • Outbreak response and enhanced surveillance
questions

Questions?

Katie Fullerton

Coordinating Epidemiologist, OzFoodNet

kathleen.fullerton@health.gov.au

Phone: 61 02 6289 2751

Fax: 61 02 6289 2500