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Hemolytic Uremic Syndrome and Death in Persons with Escherichia coli O157:H7 Infection, Foodborne Diseases Active Surveillance Network Sites, 2000-2006

Clinical Infectious Diseases 2009; 49:000–000 – Major Article

L. Hannah Gould, 1, Linda Demma, 1, Timothy F. Jones, 3, Sharon Hurd, 4, Duc J. Vugia, 5, Kirk Smith, 6, Beletshachew Shiferaw, 7, Suzanne Segler, 2, Amanda Palmer, 8, Shelley Zansky, 9, Patricia M. Griffin, 1, and the Emerging Infections Program FoodNet Working Group

Background. Hemolytic uremic syndrome (HUS) is a life‐threatening illness usually caused by infection with Shiga toxin–producing Escherichia coli O157 (STEC O157). We evaluated the age‐specific rate of HUS and death among persons with STEC O157 infection and the risk factors associated with developing HUS.

Methods. STEC O157 infections and HUS cases were reported from 8 sites participating in the Foodborne Diseases Active Surveillance Network during 2000–2006. For each case of STEC O157 infection and HUS, demographic and clinical outcomes were reported. The proportion of STEC O157 infections resulting in HUS was determined.

Results. A total of 3464 STEC O157 infections were ascertained; 218 persons (6.3%) developed HUS. The highest proportion of HUS cases (15.3%) occurred among children aged <5 years. Death occurred in 0.6% of all patients with STEC O157 infection and in 4.6% of those with HUS. With or without HUS, persons aged 60 years had the highest rate of death due to STEC O157 infection. Twelve (3.1%) of 390 persons aged 60 years died, including 5 (33.3%) of 15 persons with HUS and 7 (1.9%) of 375 without. Among children aged <5 years, death occurred in 4 (3.0%) of those with HUS and 2 (0.3%) of those without.

Conclusions. Young children and females had an increased risk of HUS after STEC O157 infection. With or without HUS, elderly persons had the highest proportion of deaths associated with STEC O157 infection. These data support recommendations for aggressive supportive care of young children and the elderly early during illness due to STEC O157.

1 Enteric Diseases Epidemiology Branch, National Center for Zoonotic, Vector‐Borne, and Enteric Diseases, Centers for Disease Control and Prevention, and 2 Georgia Emerging Infections Program, Atlanta, Georgia; 3 Tennessee Department of Health, Nashville; 4 Connecticut Emerging Infections Program, New Haven; 5 California Department of Public Health, Richmond; 6 Minnesota Department of Health, St. Paul; 7 Oregon Department of Human Services, Portland; 8 Maryland Department of Health and Mental Hygiene, Baltimore; and 9 New York State Department of Health, Albany.

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