E. coli advice issued amid rise in cases
UKHSA is working with partners to investigate a Shiga toxin-producing E. coli (STEC) outbreak.
As of 25 June, there have been a further 19 cases associated with the recent outbreak of STEC O145 since the last update a week ago, bringing the total number of confirmed cases to 275 in the UK. All currently confirmed cases had symptom onset dates before 4 June. Although case reporting rates are declining, we expect to see more cases linked to this outbreak as further samples are referred to us from NHS laboratories and whole genome sequencing is conducted.
Confirmed case totals:
- 182 in England
- 58 in Scotland
- 31 in Wales
- 4 in Northern Ireland (evidence suggests that they acquired their infection in England)
Based on information from 249 cases to date, 49% were admitted to hospital.
Through surveillance, UKHSA has identified 2 individuals in England who died within 28 days of infection with the STEC outbreak strain. Based on the information available from health service clinicians one of these deaths is likely linked to their STEC infection. Both individuals had underlying medical conditions. The deaths occurred in May.
Amy Douglas, Incident Director at UKHSA, said:
We’re pleased that fewer cases have been reported, however we still expect to see a few more cases linked to this outbreak as further samples are referred to us for testing.
Symptoms of infections with STEC include severe and sometimes bloody diarrhoea, stomach cramps, vomiting and fever. While diarrhoea and vomiting can have a range of causes, there are simple steps you can take to reduce your risk and the risk of infecting others.
Washing your hands with soap and warm water and using disinfectants to clean surfaces will help stop any further spread of infection. If you are unwell, you should not prepare food for others while unwell and avoid visiting people in hospitals or care homes to avoid passing on the infection in these settings. Do not return to work, school or nursery until 48 hours after your symptoms have stopped. If you are concerned about your symptoms, follow NHS.UK guidance on when to seek help and the steps you can take to avoid further spread to family and friends.
Darren Whitby, Head of Incidents at the FSA said:
Earlier this month, we confirmed that several sandwich manufacturers had taken precautionary action to withdraw and recall various sandwiches, wraps, subs and rolls after food chain and epidemiological links enabled us to narrow down a wide range of foods to a type of lettuce used in sandwich products as the likely cause of the outbreak.
This remains a complex investigation and we continue to work with the relevant businesses and the local authorities to ensure necessary steps are being taken to protect consumers. Although we are confident in the likely source of the outbreak being linked to lettuce, work continues to confirm this and identify the root cause of the outbreak with the growers, suppliers and manufacturers so that actions can be taken to prevent a re-occurrence.
For more information, see the interim summary report from the multi-agency investigation into outbreak STEC O145 identified in May 2024.
Previous update published on 20 June
As of 18 June, there have been a further 45 cases associated with the recent outbreak of STEC O145 since the last update (14 June), bringing the total number of confirmed cases to 256 in the UK. All currently confirmed cases had symptom onset dates before 31 May. Although the rate of cases has now slowed, we expect the figure to rise as NHS laboratories refer specimens to UKHSA for genomic sequencing which can link cases to this outbreak strain.
Confirmed case totals:
-
168 in England
-
56 in Scotland
-
29 in Wales
-
3 in Northern Ireland (evidence suggests that they acquired their infection in England)
Based on information from 227 cases to date, 38% were admitted to hospital.
Investigations have highlighted pre-packaged sandwich products containing lettuce as the likely source of the outbreak.
Based on evidence to date, the Food Standards Agency (FSA) and Food Standards Scotland (FSS) have published precautionary product recall notices covering a range of products that are potentially contaminated with E. coli. Working closely with the FSA, FSS and the devolved public health agencies, epidemiological investigations, whole genome sequence analysis and food chain investigations are still ongoing to confirm the cause of this outbreak.
Dr Colin Brown, Incident Director at UKHSA, said:
Symptoms of infections with STEC include severe and sometimes bloody diarrhoea, stomach cramps, vomiting and fever. While diarrhoea and vomiting can have a range of causes, there are simple steps you can take to reduce your risk and risk of infecting others.
Washing your hands with soap and warm water and using disinfectants to clean surfaces will help stop any further spread of infection. If you are unwell, you should not prepare food for others while unwell and avoid visiting people in hospitals or care homes to avoid passing on the infection in these settings. Do not return to work, school or nursery until 48 hours after your symptoms have stopped. If you are concerned about your symptoms, follow NHS.UK guidance on when to seek help and the steps you can take to avoid further spread to family and friends.
Darren Whitby, Head of Incidents at the FSA said:
Several sandwich manufacturers have now taken precautionary action to withdraw and recall various sandwiches, wraps, subs and rolls, as food chain and epidemiological links have enabled us to narrow down a wide range of foods consumed to a small number of salad leaves that have been used in these in these products.
This follows extensive investigations into the cause of an ongoing outbreak caused by shiga toxin-producing E.coli (STEC) which is being carried out by the FSA, FSS and UKHSA, working closely with the relevant enforcing authorities across Local Authorities). A full list of products implicated in the product recalls can be found in the product recall notices (PRINs).
This remains a complex investigation and we continue to work at pace with the relevant businesses and local authorities to ensure necessary steps are being taken to protect consumers.
Although we are confident in the source of the outbreak being linked to a small number of salad leaves, which we identified early on through extensive food chain analysis, work continues to identify the root cause of the outbreak with the growers, suppliers and manufacturers so that actions can be taken to prevent a re-occurrence. We will remain vigilant until the root cause of the outbreak is confirmed and we are keeping an open mind about possible causes of the outbreak. Information is being gathered at pace and is under constant review to ensure we minimise any further risk to consumers.
Previous update published on 14 June
As of 11 June, there have been a further 98 cases associated with this outbreak of STEC O145 in the UK, bringing the total number of confirmed cases to 211. All cases had sample dates before 31 May, but we expect this figure to rise as whole genome sequencing is ongoing to find any further cases which may be linked to the outbreak.
-
147 in England
-
27 in Wales
-
35 in Scotland
-
2 in Northern Ireland (for these cases, evidence suggests that they acquired their infection while visiting England)
Based on information from 160 cases to date, 42% were admitted to hospital.
UKHSA has worked closely with the FSA, FSS and the devolved public health agencies to investigate the incident, carrying out epidemiological investigations and whole genome sequence analysis to help identify foods commonly consumed by the cases.
As a result of evidence gathered to date, product recall information notices have been published by FSA as a precaution.
Trish Mannes, Incident Director at UKHSA, said:
We would like to thank all the cases who have provided information that has enabled us, through epidemiological analysis of questionnaire data and food tracing investigations, to narrow down the likely food product linked to this outbreak.
Symptoms of infections with STEC include severe and sometimes bloody diarrhoea, stomach cramps, vomiting and fever. If you are unwell, have eaten salad leaves recently and are concerned about any symptoms, follow NHS.uk guidance on when to seek help and the steps you can take to avoid further spread to family and friends.
While diarrhoea and vomiting can have a range of causes, there are simple steps you can take to reduce your risk and risk of infecting others. Washing your hands with soap and warm water and using disinfectants to clean surfaces will help stop any further spread of infection. If you are unwell with diarrhoea and vomiting, you should not prepare food for others while unwell and avoid visiting people in hospitals or care homes to avoid passing on the infection in these settings. Do not return to work, school or nursery until 48 hours after your symptoms have stopped.
Darren Whitby, Head of Incidents at the FSA, said:
Sandwich manufacturers are taking a precautionary measure to recall various sandwiches, wraps, subs and rolls in response to findings from investigations by the FSA, FSS and UKHSA who are working to identify the cause of an ongoing outbreak caused by shiga toxin-producing E.coli (STEC). The full list of products can be found in the product recall information notice (PRIN).
This is a complex investigation, and we have worked swiftly with the relevant businesses and the local authorities concerned to narrow down the wide range of foods consumed to a small number of salad leaf products that have been used in sandwiches, wraps, subs and rolls. Following thorough food chain analysis, these products are being recalled as a precaution.
Infections caused by STEC bacteria can cause severe bloody diarrhoea and, in some cases, more serious complications. We therefore advise any consumers who have any of these products not to eat them.
The FSA is here to ensure that food is safe. If there are products on the market that are not, we won’t hesitate to take action to remove them.
Previous update published on 6 June
The UK Health Security Agency (UKHSA), together with public health agencies in Scotland, Northern Ireland and Wales, are investigating an increase in the number of Shiga toxin-producing E. coli (STEC) cases in the UK in recent weeks.
Infections caused by STEC bacteria can cause severe bloody diarrhoea and, in some cases, more serious complications. It is often transmitted by eating contaminated food but can also be spread by close contact with an infected person, as well as direct contact with an infected animal or its environment.
Whole genome sequencing of samples in the current investigation indicates that most cases are part of a single outbreak. Based on the wide geographic spread of cases, it is most likely that this outbreak is linked to a nationally distributed food item or multiple food items. The source of this outbreak is not yet confirmed but there is currently no evidence linking the outbreak to open farms, drinking water or swimming in contaminated seawater, lakes or rivers. The public health agencies are working with the Food Standards Agency (FSA) and Food Standards Scotland to investigate further.
As of 4 June, there have been 113 confirmed cases associated with this outbreak of STEC O145 in the UK, all reported since 25 May 2024:
- 81 in England
- 18 in Wales
- 13 in Scotland
- 1 in Northern Ireland (for this case, evidence suggests that they acquired their infection while visiting England)
Typically, we see around 1,500 cases of STEC over a full year. Numbers of confirmed cases associated with this outbreak are expected to rise as further samples undergo whole genome sequencing.
Cases range in age from 2 years old to 79 years old, with the majority of cases in young adults. Of the 81 cases identified to date in England, 61 have provided information to UKHSA related to food, travel and potential exposures and of these we know that 61% have been hospitalised.
While the source of this outbreak is currently unknown, there are steps you can take to reduce your risk of gastrointestinal infections, as well as limiting the spread to others:
- regularly wash your hands with warm water and soap — alcohol gels do not kill all bugs that cause diarrhoeal illness
- follow food hygiene measures such as washing fruit and vegetables and cooking food properly
- if you have diarrhoea and vomiting, you should not prepare food for others and avoid visiting people in hospitals or care homes to avoid passing on the infection
- you should not return to work, school or nursery until 48 hours after your symptoms have stopped
Trish Mannes, Incident Director at UKHSA, said:
Symptoms of infections with STEC include severe and sometimes bloody diarrhoea, stomach cramps, vomiting and fever. If you have diarrhoea and vomiting, you can take steps to avoid passing it on to family and friends. NHS.UK has information on what to do if you have symptoms and when to seek medical advice.
Washing your hands with soap and warm water and using disinfectants to clean surfaces will help stop infections from spreading. If you are unwell with diarrhoea and vomiting, you should not prepare food for others and avoid visiting people in hospitals or care homes to avoid passing on the infection in these settings. Do not return to work, school or nursery until 48 hours after your symptoms have stopped.
Darren Whitby, Head of Incidents and Resilience at the FSA, said:
The FSA is working with UKHSA and relevant Public Health bodies to identify the source of the illness, which is likely to be linked to one or more food items.
We always advise consumers and those looking after vulnerable people to ensure good hygiene practices are followed when handling and preparing food, regularly washing hands with soap and warm water and ensuring equipment, utensils and surfaces foods come into contact with are cleaned thoroughly to prevent cross contamination.
You should not prepare food for others if you have had symptoms, or for 48 hours after symptoms stop. You can find more information about good hygiene practises – 4c’s, and E. coli on our website.
Jim McMenamin, Head of Health Protection (infection Services), Public Health Scotland, said:
To help stop infections like E. coli from spreading, we advise regular hand washing using soap and water, particularly after using the toilet and before preparing food. People should also use disinfectants to clean surfaces that may be contaminated. Anyone experiencing severe and sometimes bloody diarrhoea, stomach cramps, vomiting and fever should call their GP or 111 to seek advice. Anyone with diarrhoea or vomiting should avoid attending places such as schools, workplaces or social gatherings until at least 48 hours after their symptoms have ceased.
Wendi Shepherd, Consultant in Health Protection for Public Health Wales, said:
Public Health Wales is working with partners in the UK and across the Welsh NHS to investigate this incident. There are currently 18 cases identified in Wales and healthcare providers have been advised of the increase in cases. We would advise anyone who has experienced bloody diarrhoea or severe stomach cramps to seek medical attention.
Call NHS 111 or contact your GP surgery if:
- you’re worried about a baby under 12 months
- your child stops breast or bottle feeding while they’re ill
- a child under 5 years has signs of dehydration, such as fewer wet nappies
- you or your child (over 5 years) still have signs of dehydration after using oral rehydration sachets
- you or your child keep being sick and cannot keep fluid down
- you or your child have bloody diarrhoea or bleeding from the bottom
- you or your child have diarrhoea for more than 7 days or vomiting for more than 2 days
111 will give you advice. They can arrange a phone call from a nurse or doctor if you need one.
Further information and advice will be published as the investigation continues. Not all outbreak investigations identify a source, particularly for products that quickly leave the supply chain.
Healthcare workers have been informed of the increase in cases and reminded of clinical management guidance.
Background
STEC can be carried by cattle, sheep and other animals. Spread to humans occurs through:
- consumption of contaminated food or water
- contact with animals or their faeces
- contact with a contaminated environment
- person-to-person spread, often resulting in multiple people in one household becoming infected
NHS.UK webpage: Diarrhoea and vomiting
For Scotland: NHS Inform advice on diarrhoea or gastroenteritis
Guidance on STEC: symptoms, how to avoid, how to treat
UK Health Security Agency press office
10 South Colonnade
London
E14 4PU
Last updated 27 June 2024 + show all updates
-
Added link to the interim summary report from the multi-agency investigation into outbreak STEC O145 identified in May 2024.
-
Content updated with latest figures.
-
Content updated with latest figures.
-
Content updated.
-
First published.