Is E coli (Escherichia coli) O157:H7 a reportable disease?

E. coli O157:H7 is a Nationally Reportable Disease

Yes, Escherichia coli O157:H7 is a reportable disease that must be reported to public health authorities. 1 According to the Centers for Disease Control and Prevention (CDC), both confirmed and probable cases of E. coli O157:H7 infection must be reported to the National Notifiable Diseases Surveillance System (NNDSS).

Case Definition and Reporting Requirements

E. coli O157:H7 infections are classified into three categories for reporting purposes:

1. Confirmed cases: Laboratory-confirmed isolation of E. coli O157:H7 from a specimen or isolation of Shiga toxin-producing E. coli O157:NM from a clinical specimen 1

2. Probable cases: Either:

   • A case with isolation of E. coli O157 from a clinical specimen, pending confirmation of H7 or Shiga toxin, or
   • A clinically compatible case that is epidemiologically linked to a confirmed or probable case 1

3. Suspected cases: Cases of post-diarrheal hemolytic uremic syndrome (HUS) or thrombotic thrombocytopenic purpura (TTP) 1

Reporting Mechanism

• Laboratory-confirmed isolates are reported via the Public Health Laboratory Information System (PHLIS), managed by the Foodborne and Diarrheal Diseases Branch of the CDC 1
• Both probable and confirmed cases are reported to the National Notifiable Diseases Surveillance System (NNDSS) 1
• Only confirmed cases are reported to PHLIS 1

Clinical Importance of Reporting

Reporting E. coli O157:H7 is critical for several reasons:

• Outbreak detection: Prompt reporting helps identify outbreaks and implement control measures 1
• Preventing complications: Early identification can help prevent serious complications like HUS, which occurs in approximately 8% of patients with O157 STEC infection 2
• Monitoring trends: Reporting enables public health authorities to track disease epidemiology and detect emerging serotypes 1

Clinical Presentation and Significance

E. coli O157:H7 infection presents with:

• Diarrhea (often bloody) and abdominal cramps 1
• Potential complications including HUS or TTP 2
• Asymptomatic infections may also occur 1

Important Considerations for Clinicians

1. Testing recommendations: The CDC recommends that all stools submitted for routine testing from patients with acute community-acquired diarrhea (regardless of patient age, season, or presence of blood in stool) should be simultaneously cultured for E. coli O157:H7 and tested with an assay that detects Shiga toxins to detect non-O157 STEC 1

2. Treatment cautions: Antibiotics should not be used to treat E. coli O157:H7 infections as they may increase the risk of developing HUS 2

3. Environmental persistence: E. coli O157:H7 can persist in the environment for months, which is important for outbreak investigations 1

Public Health Impact

E. coli O157:H7 causes approximately 73,000 cases annually in the United States 2. The infection has a very low infectious dose (<100 organisms) and can lead to serious complications, particularly in children under 5 years of age and the elderly 2, 3.

The mandatory reporting of E. coli O157:H7 is essential for effective public health surveillance and timely intervention to prevent further spread of this potentially life-threatening pathogen.