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Health Indicator Report of Foodborne Illness - Shiga Toxin-producing E. coli (STEC) Infections

All age groups can be infected with Shiga toxin-producing ''E. coli'' (STEC), but young children, the elderly, and those with compromised immune systems are the most severely affected. STEC are very common bacteria that can cause diarrheal illness in humans. The illness can range from mild to severe, bloody diarrhea. These infections cause approximately 100,000 illnesses, 3,000 hospitalizations, and about 90 deaths annually in the United States. The bacteria live in the intestines of some healthy cattle, and contamination of meat can occur in the slaughtering process. Eating ground beef that has been inadequately cooked is a common way of becoming infected. Other sources of infection may include drinking unpasteurized (raw) milk or juice; drinking or swimming in water that is contaminated with sewage or animal waste; eating contaminated fruits or vegetables; or contact with animals that are infected. Severe manifestations of STEC infection (HUS or TTP) require a prolonged hospital stay and may result in renal failure and death. Effective prevention is the best treatment for STEC.

Rate of Reported Confirmed and Probable STEC Infections in Utah by Year, 2001-2017


Utah rates are derived from Utah annual surveillance reports published by the Bureau of Epidemiology.   Includes all confirmed and probable Shiga toxin-producing ''E. coli'' (STEC) cases.

Data Sources

  • Utah Department of Health, Bureau of Epidemiology
  • Population Estimates: National Center for Health Statistics (NCHS) through a collaborative agreement with the U.S. Census Bureau, IBIS Version 2017

Data Interpretation Issues

The Utah Department of Health tracks one category of ''E. coli'' that cause diarrhea, known as Shiga toxin-producing ''E. coli'' or STEC. These bacteria are sometimes referred to as enterohemorrhagic ''E. coli'' or EHEC. The most common strain of STEC is O157:H7, but there are many other strains of ''E. coli'' that produce Shiga toxin. Rather than listing all of them individually, all strains of ''E. coli'' that produce Shiga toxin are listed here as STEC.


Number of reported culture-confirmed and probable cases of infections caused by Shiga toxin-producing ''Escherichia coli'' O157:H7 and non-O157 serogroups per 100,000 population per year.


Number of reported culture-confirmed and probable cases of infections caused by Shiga toxin-producing ''Escherichia coli'' O157:H7 and non-O157 serogroups per year.


Total Utah population per year.

Healthy People Objective FS-1.2:

Reduce infections caused by Shiga toxin-producing ''Escherichia coli'' (STEC) O157 transmitted commonly through food
U.S. Target: 0.6 cases per 100,000
State Target: 0.6 cases per 100,000

Other Objectives

Other Healthy People 2020 Objectives related to ''E. coli'': * FS-2: Reduce the number of outbreak-associated infections associated with food commodity groups (beef, dairy, fruits and nuts, leafy vegetables, and poultry) * FS-5: Increase the proportion of consumers who follow key food safety practices * FS-6: Increase the proportion of fast-food and full service restaurants that follow food safety practices that prevent foodborne illness outbreaks [[br]] Utah's 42 Community Health Indicators include: * Reduce outbreaks of infections caused by key foodborne bacteria

How Are We Doing?

''E. coli'' O157:H7 infections became reportable in Utah in 1990; at that time, six cases were reported. The increase in number of cases reported annually since 1990 may be due to improved reporting and better laboratory detection methods. In 2006, the number of Shiga toxin-producing ''Escherichia coli'' (STEC) infections per 100,000 Utah population per year (5.2) was nearly twice the 2005 rate due to a multi-state outbreak of ''E. coli'' O157:H7 associated with spinach; 18 laboratory-confirmed cases were identified among Utah residents associated with this outbreak. In 2009, one outbreak of ''E. coli'' O157:H7 occurred in Utah. There were 14 laboratory-confirmed cases identified as a part of this outbreak, yet the source of the illness was not determined. In 2011, there was a large outbreak of STEC associated with scout camps over the summer. There was a severe outbreak of ''E. coli'' O157:H7 in which 7 Utah cases were ill and 2 cases resulted in death in southern Utah. As a nation, we met the national Healthy People 2010 target goal of improving incidence to less than or equal to 1 case per 100,000 person-years. The Healthy People 2020 target goal is 0.6 cases per 100,000 person-years. Data for 2017 shows the incidence of STEC in Utah was at 4.5 cases per 100,000 person-years. However, as discussed in the "How Do We Compare With U.S.?" section, this does not necessarily indicate higher disease rates in the state compared to the nation as a whole.

How Do We Compare With the U.S.?

''Escherichia coli'' O157:H7 has been nationally notifiable since 1994. National surveillance for all Shiga toxin-producing ''E. coli'' (STEC), under the name enterohemorrhagic ''E. coli'' (EHEC), began in 2001. As of January 1, 2006, the nationally notifiable diseases case definition designation changed from EHEC to STEC, and serotype-specific reporting was implemented. Since becoming nationally notifiable in 1994, STEC rates in Utah have been higher than U.S. rates. This is most likely due to better testing and reporting in Utah compared to the nation as a whole. During the late 1980s and the first part of the 1990s, the Utah Public Health Laboratory pioneered efforts to identify Shiga toxin-producing ''E. coli'' organisms; thus, cases of illness were better identified and reported. The higher rates of STEC in Utah may also be explained by the higher proportion of young children in Utah compared to the U.S. since STEC disproportionately affects and is reported in young children. The increased use of culture independent diagnostic tests (CIDTs) has also added to the larger case reports.

What Is Being Done?

Per the Communicable Disease Rule R386-702-3, health care providers and laboratories are required to report cases of Shiga toxin-producing ''E. coli'' to the Bureau of Epidemiology or the local health department. The Communicable Disease Investigation and Response Program at the Utah Department of Health assists local health departments with the investigation of cases and outbreaks and implementation of control measures to prevent further cases. Because diagnosis solely on the basis of detection of Shiga toxin does not sufficiently protect the public's health, characterizing STEC isolates by serotype and pulsed-field gel electrophoresis (PFGE) patterns is critical to detect, investigate, and control outbreaks. Screening of stool specimens by clinical diagnostic laboratories for Shiga toxin by enzyme immunoassay, subsequent bacterial culture using sorbitol MacConkey agar (SMAC), and forwarding enrichment broths from Shiga toxin-positive specimens that do not yield STEC O157 to state or local public health laboratories are important for public health surveillance of all STEC infections. Local health departments make an attempt to interview every case of Shiga toxin-producing ''E. coli'' infection reported to public health. Information gathered during these interviews includes food history, water exposure, animal exposure, travel history, outdoor history, and contact with ill individuals. Data from these interviews are analyzed and used to identify outbreaks and common sources of infection. In addition, patients are provided with information on high risk exposures and how to prevent future STEC infection in themselves and their families. Public Health promotes methods to prevent ''E. coli''-related illness by following general guidelines, such as: *Always refrigerate meat products. Never leave raw meat at room temperature. *Ground beef should be packaged and stored so that its juices (blood) do not drip onto other foods. *Do not contaminate other foods by placing them on the same platter or surface that held raw meat or by using utensils which have been contaminated by raw meat. *Always cook meats completely, especially ground beef. Cooking until there is no pink in the middle and the juices run clear is not indicative of doneness. Cook until a meat thermometer indicates 160 degrees F or higher. *Avoid using unpasteurized (raw) milk or juices. *Carefully wash hands before and after preparing and/or eating food. *Always wash hands with soap and warm water after using the toilet or changing diapers. [[br]] Visit [] for proper hand washing techniques.

Available Services

Foodborne disease outbreaks and other outbreaks are investigated primarily by local health departments in collaboration with Utah Department of Health as needed.[[br]] []
Page Content Updated On 10/02/2018, Published on 10/22/2018
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Content updated: Thu, 20 Jun 2019 13:03:28 MDT