ANNEX II

3.CASE DEFINITIONS OF COMMUNICABLE DISEASES

3.40.SHIGA TOXIN/VEROCYTOTOXIN-PRODUCING E. COLI INFECTION (STEC/VTEC), INCLUDING HAEMOLYTIC-URAEMIC SYNDROME (HUS)

Clinical Criteria

STEC/VTEC diarrhoea

Any person with at least one of the following two:

  • Diarrhoea

  • Abdominal pain

HUS

Any person with acute renal failure and at least one of the following two:

  • Microangiopatic haemolytic anaemia

  • Thrombocytopenia

Laboratory Criteria

At least one of the following four:

  • Isolation/cultivation of Escherichia coli that produces Shiga toxin/verocytotoxin or harbours stx1/vtx1 or stx2/vtx2 gene(s)

  • Isolation of non-sorbitol-fermenting (NSF) Escherichia coli O157 (without testing for the toxin or toxin-producing genes)

  • Direct detection of stx1/vtx1 or stx2/vtx2 gene(s) nucleic acid

  • Direct detection of free Shiga toxin/verocytotoxin in faeces

Only for HUS the following can be used as a laboratory criterion to confirm STEC/VTEC:

  • Escherichia coli serogroup-specific (LPS) antibody response

Epidemiological Criteria

At least one of the following five epidemiological links:

  • Human to human transmission

  • Exposure to a common source

  • Animal to human transmission

  • Exposure to contaminated food/drinking water

  • Environmental exposure

Case Classification

  1. A.

    Possible case of STEC-associated HUS

    Any person meeting the clinical criteria for HUS

  2. B.

    Probable case of STEC/VTEC

    Any person meeting the clinical criteria with an epidemiological link

  3. C.

    Confirmed case of STEC/VTEC

    Any person meeting the clinical and the laboratory criteria

Note: If the national surveillance system is not capturing clinical symptoms, all laboratory-confirmed individuals should be reported as confirmed cases.