Current epidemiological status of enterohaemorrhagic Escherichia coli O157:H7 in Africa:

Prevalence and virulence gene profiles of Escherichia coli O157 from cattle slaughtered in Buea, Cameroon

Background

Escherichia coli O157 is an emerging foodborne pathogen of great public health concern. It has been associated with bloody diarrhoea, haemorrhagic colitis and haemolytic uremic syndrome in humans. Most human infections have been traced to cattle and the consumption of contaminated cattle products. In order to understand the risk associated with the consumption of cattle products, this study sought to investigate the prevalence and identify virulence genes in E. coli O157 from cattle in Cameroon.

Method

A total of 512 rectal samples were obtained and analysed using conventional bacteriological methods (enrichment on modified Tryptone Soy Broth and selective plating on Cefixime-Tellurite Sorbitol Mac-Conkey Agar) for the isolation of E. coli O157. Presumptive E. coli O157 isolates were confirmed serologically using E. COLIPRO^TM O157 latex agglutination test and molecularly using PCR targeting the rfb gene in the isolates. Characterisation of the confirmed E. coli O157 strains was done by amplification of stx1, stx2, eaeA and hlyA virulence genes using both singleplex and multiplex PCR.

Results

E. coli O157 was detected in 56 (10.9%) of the 512 samples examined. The presence of the virulence genes stx2, eaeA and hylA was demonstrated in 96.4% (54/56) of the isolates and stx1 in 40 (71.4%) of the 54. The isolates exhibited three genetic profiles (I-III) with I (stx1, stx2, eaeA and hlyA) being the most prevalent (40/56; 71.4%) while two isolates had none of the virulence genes tested.

Conclusion

A proportion of cattle slaughtered in abattoirs in Buea are infected with pathogenic E. coli O157 and could be a potential source of human infections. We recommend proper animal food processing measures and proper hygiene be prescribed and implemented to reduce the risk of beef contamination.

Escherichia coli O157:H7: distribution, molecular characterization, antimicrobial resistance patterns and source of contamination of sheep and goat carcasses at an export abattoir, Mojdo, Ethiopia

BACKGROUND

Cattle have been identified as a major reservoir of E. coli O157:H7 for human infection; the ecology of the organism in sheep and goats is less understood. This study was carried out to determine prevalence, source of infection, antibiotic resistance and molecular characterization of Escherichia coli O157: H7 isolated from sheep and goat.

METHODS

Systematic random sampling was carried out at Modjo export abattoir, Ethiopia, from November 2012 to April 2013 to collect 408 samples from 72 sheep and 32 goats. Samples collected were skin swabs, fecal samples, intestinal mucosal swabs and the inside and outside part of carcasses as well as carcass in contacts such as workers hands, knife, hook and carcass washing water. Then, samples were processed following standard bacteriological procedures. Non-Sorbitol fermenting colonies were tested on latex agglutination test and the positives are subjected to PCR for detection of attaching and effacing genes (eaeA) and shiga toxin producing genes (stx1 and stx2). All E. coli O157:H7 isolates were checked for their susceptibility pattern towards 15 selected antibiotics.

RESULTS

E. coli O157:H7 were detected in only 20/408 samples (4.9%). Among these 20 positive samples, 70% (14/20), 25% (5/20) and 5% (1/20) were from sheep, goats and knife samples, respectively. No significant associations were found between carcasses and the assumed sources of contaminations. Of all the 20 isolates virulence genes were found in 10 (50%) of them; 3 (15%) with only the eaeA gene and 7(35%) expressing eaeA and stx2 genes. All the isolates were susceptible to Norfloxacin (NOR) (100%).

CONCLUSIONS

The presence of virulence genes shows E. coli O157:H7 is a potential source of human infection in Ethiopia.

Quantitative Risk Assessment of Hemolytic Uremic Syndrome Associated with Consumption of Bulk Milk Sold Directly from Producer to Consumer in South Africa

This study was conducted to estimate the hemolytic uremic syndrome (HUS) risk associated with consumption of producer-distributor bulk milk (PDBM) contaminated with Shiga toxin-producing Escherichia coli (STEC) in South Africa. Data were obtained from recently completed studies in South Africa taking into account prior collected prevalence data of STEC in raw and pasteurized PDBM and survey information from producer-distributor outlets and households. Inputs for the models were complemented with data from published and unpublished literature. A probabilistic exposure model was developed with Monte Carlo simulation in Excel add-in software using @Risk software. Hazard characterization was based on an exponential dose-response model to calculate the probability of illness from STEC infection in individuals 5 years and younger and individuals older than 5 years. The estimated mean STEC level was 0.12 CFU/mL (95% confidence interval [CI]: 0 to 1.2; σ = 0.34) for raw PDBM and 0.08 CFU/mL (95% CI: 0 to 1; σ = 0.27) for pasteurized PDBM. A higher risk of HUS cases per year was recorded in raw than in pasteurized PDBM and also in individuals younger than 5 years of age. For every 100,000 servings consumed, the expected median numbers of HUS cases per year from raw PDBM were 52 for 5 years and younger and 3.2 for older than 5 years. The median numbers of cases per year for pasteurized PDBM were 47 for 5 years and younger and 2.9 for older than 5 years. Sensitivity analysis revealed that serving volume and time taken to sell PDBM at producer-distributor outlets were the factors with the greatest impact on probability of illness. The models developed in this study are an example of risk assessments for milk produced and marketed from similar scenarios across the globe.

Prevalence and Antimicrobial Susceptibility Pattern of E. coli O157:H7 Isolated from Traditionally Marketed Raw Cow Milk in and around Asosa Town, Western Ethiopia

A cross-sectional study was conducted from October 2014 to July 2015 to determine the prevalence and populations of E. coli as well as the prevalence and antimicrobial susceptibility of E. coli O157:H7 isolated from raw milk. Biochemical and serological tests methods were used to confirm E. coli and E. coli O157:H7 and isolates were subjected to antimicrobial susceptibility test using the agar disc diffusion method. Out of 380 raw milk samples examined, 129 (33.9%) and 11 (2.9%) were contaminated with E. coli and E. coli O157:H7, respectively. The highest prevalence was recorded in samples obtained from vendors (39.1%, 4.978 ± 0.180 log₁₀/ml) compared with samples from farmers (28.1%, 3.93 ± 0.01 log₁₀/ml) with significant differences (P = 0.02). The frequency of contamination was higher in the samples collected from milk that was stored and transported in plastic containers (39.4%) than in the containers made of stainless steel (23.0%) (P = 0.002). The antimicrobial susceptibility profile showed that E. coli O157:H7 were resistant to tetracycline (81.8%), streptomycin (81.8%), and kanamycin (63.6%). Milk samples were produced and handled under poor hygienic conditions, stored, and transported in inappropriate containers and under temperature abuse conditions leading to high health risk to the consumers. Additional studies would be needed to establish association between the occurrences of E. coli O157:H7 in raw milk and all the risk factors involved in and around Asosa town.

Occurrence of Escherichia coli O157:H7 in cattle feces and contamination of carcass and various contact surfaces in abattoir and butcher shops of Hawassa, Ethiopia

Background

Despite of the sanitation measures in municipal abattoirs to reduce contamination, Escherichia coli continues to be a health hazard. The present study was conducted on 150 apparently healthy slaughtered cattle at municipal abattoir and in 50 different butcher shops in Hawassa town, Ethiopia. The objectives of the study were investigating the occurrence and antimicrobial resistance of E. coli O157:H7 isolated from fecal samples, carcasses swab, contacts surfaces (swabs of meat handlers hands, knife and clothes of meat transporters) as well as from butcher shops (meat samples, swabs from cutting board swab, butcher men hand and knife surface). E. coli O157:H7 was isolated and identified using bacteriological culture, biochemical tests and Biolog identification system. All E. coli O157:H7 isolates were then checked for their antimicrobial susceptibility pattern using eleven selected antimicrobial discs.

Results

Of the entire set of 630 samples, 2.4% (15/630) (95% CI = 1.3–3.9%) were positive for E. coli O157:H7. When disaggregated by the sources of the samples, E. coli O157:H7 were prevalent in 2.8% (11 of 390) of the abattoir samples, of which 4.7% of the fecal sample and 2.7% of the carcass swabs. And E. coli O157:H7 were positive in 1.7% (4 of 240) of butcher shop specimens of which 2% of meat sample and 3.3% of Cutting board swabs. No statistically significant difference in the prevalence of E. coli 0157: H7 between sex, origin, and breed of cattle. The isolated E. coli O157:H7 were found to be100% susceptible to cefotaxime, ceftriaxone, gentamycin, kanamycin and nalidixic acid.

Conclusion

This study concludes the occurrence of E. coli O157:H7 and the presence of multiple antibiotic resistance profiles in cattle slaughtered at Hawassa municipal abattoir and retail meat sold at butcher shops. This indicates high risk to public health especially in Ethiopia where many people consume raw or under cooked meat. Regulatory control of antibiotics usage in livestock production and pharmaco-epidemiological surveillance in food animals and animal products is hereby recommended to ensure consumer safety.

Escherichia coli O157:H7 in Raw Meat in Addis Ababa, Ethiopia: Prevalence at an Abattoir and Retailers and Antimicrobial Susceptibility

Background

Although raw meat and its products are commonly consumed in traditional Ethiopian diets, E. coli O157: H7 is rarely studied compared to other countries. Thus the present study has been designed to determine the prevalence and assess the antimicrobial susceptibility of E. coli O157: H7 isolated from beef, sheep meat and goat meat at one abattoir and in 48 selected raw meat retail shops in Addis Ababa.

Results

Out of 384 meat samples examined, 10.2% (39/384) were positive to E. coli O157:H7. Among these samples examined, beef was the most frequently contaminated with E. coli O157:H7 with an overall prevalence of 13.3% (17/128) followed by 9.4% (12/128) sheep meat and 7.8% (10/128) goat meat. With regard to meat source, the prevalence rates of E. coli O157:H7 at the abattoir and the selected retail shops were 5.7% (11/192) and 14.6% (28/192), respectively. Significant differences in prevalence was observed among sample sources (p < 0.05). The antimicrobial susceptibility investigation of 39 E. coli O157:H7 isolates using 10 commercially available antimicrobial discs revealed that the isolates were susceptible to nine antimicrobials from 69.3% to 100% except streptomycin which showed susceptibility of 48.7%. An overall resistance of 33.4% and 30.9% was recorded to streptomycin and amikacin, whereas 5.1%, 5.1%, 7.7%, 12.8% and 17.9% resistance rates were recorded against nalidixic acid, tetracycline, amoxacilin-clavulanic acid, cephalothin and ciprofloxacin, respectively. Multidrug resistance was observed among amikacin, amoxycillin-clavulanic acid, cephalothin, ciprofloxacin, streptomycin and tetracycline antimicrobials drugs.

Conclusions

The isolation of E. coli O157:H7 in raw meat and the existence of antimicrobial resistant isolates highlight the potential threat to public health. Hence implementation of E. coli O157:H7 prevention and control strategies from farm production to consumption of meat and meat products are crucial.

Occurrence of Escherichia coli O157:H7 in faeces, skin and carcasses from sheep and goats in Ethiopia

AIMS

To determine the occurrence and proportion of Escherichia coli O157:H7 in faeces, skin swabs and carcasses before and after washing, from sheep and goats in Ethiopia.

METHOD AND RESULTS

Individual samples were enriched in modified tryptic soy broth with novobiocin, concentrated using immunomagnetic separation (IMS) and plated onto cefixime-tellurite containing sorbitol MacConkey agar. Presumptive colonies were confirmed by biochemical tests and subjected to latex agglutination tests. A PCR was performed on isolates for the detection of stx(1), stx(2) and eae genes. Escherichia coli O157:H7 was isolated from faeces (4.7%), skin swabs (8.7%) and carcasses before washing (8.1%) and after washing (8.7%) and on water samples (4.2%). The proportion of carcasses contaminated with E. coli O157:H7 was strongly associated with those recovered from faecal and skin samples. Both stx(1) and stx(2) genes were identified from one E. coli O157:H7 isolate from a goat carcass.

CONCLUSIONS

Even though the numbers of samples examined in this study were limited to one abattoir, sheep and goats can be potential sources of E. coli O157:H7 for human infection in the country. Control measures to reduce the public health risks arising from E. coli O157:H7 in reservoir animals need to be addressed at abattoir levels by reducing skin and faecal sources and carcass contaminations at different stages of slaughter operations.

SIGNIFICANCE AND IMPACT OF THE STUDY

Escherichia coli O157:H7 was detected from carcasses before and after washing during slaughtering operations, and one O157 isolate was positive for verotoxins.

Risk assessment for Escherichia coli O157:H7 in marketed unpasteurized milk in selected East African countries

We carried out a study to assess the risk associated with the presence of Shiga toxigenic Escherichia coli (STEC) in informally marketed unpasteurized milk in urban East Africa. Data for the risk models were obtained from on-going and recently completed studies in Kenya and Uganda. Inputs for the model were complemented with data from published literature in similar populations. A fault-tree scenario pathway and modular process risk model approach were used for exposure assessment. Hazard characterization was based on a socioeconomic study with dose-responses derived from the literature. We used a probabilistic approach with Monte Carlo simulation and inputs from farm and household surveys. The qualitative analysis suggested a low to moderate risk of infection from consuming milk and that the widespread consumer practice of boiling milk before consumption was an important risk mitigator. Quantitative analysis revealed that two to three symptomatic STEC infections could be expected for every 10,000 unpasteurized milk portions consumed, with a possible range of 0 to 22 symptomatic cases. Sensitivity analyses to assess the uncertainty and variability associated with the model revealed that the factor with the greatest influence on disease incidence was the prevalence of STEC in dairy cattle. Risk assessment is a potentially useful method for managing food safety in informal markets.