American Journal of Epidemiology Advance Access originally published online on December 8, 2006
American Journal of Epidemiology 2007 165(4):425-434; doi:10.1093/aje/kwk023
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ORIGINAL CONTRIBUTIONS |
Shiga Toxin-producing Escherichia coli Infection in Germany—Different Risk Factors for Different Age Groups
1 Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
2 National Reference Center for Salmonella and Other Bacterial Enteric Pathogens, Robert Koch Institute, Wernigerode, Germany
3 World Health Organization Collaborating Center for Research and Training in Veterinary Public Health, University of Veterinary Medicine Hannover, Hannover, Germany
4 Department of Biometry, Epidemiology and Information Processing, University of Veterinary Medicine Hannover, Hannover, Germany
5 National Reference Center for Salmonella and Other Bacterial Enteric Pathogens, Institute for Hygiene and the Environment, Hamburg, Germany
Correspondence to Dr. Dirk Werber, Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestrasse 10, Berlin 13353, Germany (e-mail: werberd{at}rki.de).
Received for publication March 20, 2006. Accepted for publication July 13, 2006.
The authors conducted a matched case-control study in Germany to identify risk factors for sporadic illness associated with Shiga toxin-producing Escherichia coli (STEC) infection, regardless of serogroup. From April 2001 through March 2003, cases were prospectively enrolled through a laboratory-based sentinel surveillance system located in 14 of the 16 German federal states. One control was identified per case, matched by age and region. Conditional logistic regression was used in the analysis, which was conducted separately for three age groups (<3 years, 3–9 years, and 
10 years). The median age of the 202 enrolled cases was 2.5 years (range, 3 months–89 years). Hemolytic uremic syndrome developed in five patients. Non-O157 strains accounted for 85% of the isolated STEC. In children under 3 years of age, having touched a ruminant had the highest odds of disease, and raw milk was the only food identified as a risk factor. In contrast, in persons aged 10 years or older, only food items (i.e., lamb meat, raw spreadable sausages) were significantly associated with illness. In this study, risk factors were age-specific. Direct transmission through food played a lesser role in children under 3 years of age, the population at greatest risk of both acquiring STEC infection and developing hemolytic uremic syndrome.
case-control studies; Escherichia coli O157; hemolytic-uremic syndrome; public health; risk factors; Shiga toxins; zoonoses
Abbreviations: CI, confidence interval; OR, odds ratio; STEC, Shiga toxin-producing Escherichia coli
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