E. coli Infection (Escherichia coli Infection)

Shiga toxin-producing Escherichia coli 0157:H7 

Organism 

Escherichia coli (E. coli) are gram-negative bacteria commonly found in the digestive tracts of animals, including humans, where they assist with normal digestive processes. While most E. coli are not associated with disease, some are responsible for causing infections, such as urinary tract infections, as well as gastrointestinal and respiratory illnesses. Those responsible for causing diarrhea do so through the production of several potent toxins that damage the intestinal lining in various ways. In severe cases, infections can also lead to a life-threatening condition called Hemolytic-Uremic Syndrome (HUS), which involves renal failure and hemolytic anemia. The most common gastrointestinal disease-causing strains are known as Shiga toxin-producing E. coli (STEC), based on their presence of the Shiga-toxin-producing verotoxin genes. Of the STEC group, most cases and outbreaks historically have involved the serotype O157:H7. However, with the development of better diagnostic tools, other serotypes and pathogenic groups of E. coli are now also becoming increasingly linked to sporadic cases and outbreaks. 

Transmission 

E. coli are naturally occurring gastrointestinal bacteria in the stomachs of most mammals, including humans. STEC can also infect and consequently be transmitted in the feces of these animals, with ruminants, such as cattle, deer, elk, goats, and sheep being the most common reservoirs. Although less common, other animals can also become infected and act as a source of human infection, including domestic and agricultural species (dogs, cats, pigs, horses, rabbits) and birds (chickens, turkeys). 

STEC-associated illness occurs after bacteria are ingested through either the consumption of contaminated food and water or after physical contact with an infected person or animal. 

Contaminated food products are the most common source of infection, with contamination occurring at any time during processing. 

Symptoms 

The incubation period for a STEC infection can range from less than a day to 10 days (average 3-4 days). Symptoms of a STEC infection vary from person to person and may include one or more of the following: 

• Diarrhea and/or bloody diarrhea 

• Vomiting 

• Stomach cramps and pain 

• If fever is present it can be very mild 

• Chills 

• Nausea 

• Irritability 

• Headache 

• Poor feeding 

General recommendations for avoiding STEC infection include: 

Food handling and preparation: 

• Cook all meat products to at least 160°C/70°C  

• Always use a thermometer to determine sufficient cooking temperatures are reached 

• Avoid cross-contamination of any raw meat products with other food items, such as fresh produce, during food preparation – do not use the same cutting boards, knives, kitchen utensils, etc. 

• Keep raw meat products separate from other foods and cooked meat products (do not place cooked hamburgers on the same plate used for raw patties 

• Wash all fruits and vegetables before eating, especially if they are to be eaten raw. If possible, peel or cook fruits and vegetables. 

Kitchen safety: 

• Wash hands, knives, utensils, cutting boards, kitchen surfaces, etc. when preparing raw food products (including meat, dairy, vegetables, and fruit). 

• Ensure your refrigerator is at 40°F or lower and freezer 0°F or lower to avoid bacterial growth. 

• Routinely clean the inside walls and shelves of the refrigerator and immediately clean any spills involving high-risk foods – use hot soapy water and then rinse. 

• Clean up the juices of any raw meat products immediately with hot soapy water and avoid cross-contamination  

Vulnerable populations (young children and the elderly) and high-risk foods: 

• Avoid eating raw or undercooked meat products, especially ground meat (hamburgers). 

• Avoid eating any raw dairy products, such as raw or unpasteurized milk and cheese or yogurt made with raw milk (Queso fresco, Queso Blanco, Brie, Camembert, Feta). 

• Avoid pre-made unpasteurized fruit juices such as ciders and fresh-squeezed juices – keep refrigerated at all times if store-bought and consume immediately upon juicing. 

• Avoid eating store-bought pre-mixed ready-to-bake products before cooking (e.g., cookie dough). 

• Ensure you thoroughly cook or reheat any premade frozen, refrigerated, or ready-to-eat meals (e.g., frozen microwave meals) to at least 160°C/70°C, before consumption. 

Thorough hand washing: 

• Before you prepare food for yourself or others or eat a meal. 

• After handling any raw, ready-to-eat, or processed meat products and any pet foods. 

• After contact with any animal, including domestic pets, or after visiting or touching an animal enclosure (e.g., petting zoo or animal cage), even if you didn’t touch an animal directly. 

• After using the bathroom, changing diapers, or assisting someone with diarrhea. 

• Make sure children always wash their hands before eating, after using the bathroom, or after touching an animal or its enclosure. 

Reported Shiga toxin-producing Escherichia coli (STEC) Cases and Incidence Rates in Texas, 2010-2019 

IR= incidence rate per 100,000.   

*Incidence rates are based on projected census data obtained from the DSHS Center for Health Statistics. 

Data Source: Texas NEDSS Finalized Data File, 2010-2019, Texas Notifiable Conditions.     

For more data regarding this condition, please see our Infectious Disease Annual Reports or submit a Data Request.  

Recent Texas Trends 

 
Cases caused by Shiga-toxin-producing E. coli reported in Texas gradually rose over the past ten years, from 351 cases in 2010 to 1,324 cases in 2019. Past large outbreaks in Texas have been associated with ready-to-eat frozen food products and meals, as well as prepackaged refrigerated cookie dough. 
 

E-coli Incidence Rates Maps of Texas by Year (jpg image): 

2019   

  2018   

  2017   

 2016 

2015, 2014, 2013, 2012, 2011, 2010, 2009 

E-coli Cases and Incidence Rates in Texas 2010-2019 (PDF) 

E-coli  Cases and Incidence Rates in Texas by Age Group 2018-2019 (PDF) 

E-coli Cases and Incidence Rates in Texas by Age Group 2008-2017 (PDF) 

E-coli  Cases and Incidence Rates in Texas by Most Populous Counties 2018-2019 (PDF) 

E-coli Cases and Incidence Rates in Texas by County 2008-2017 (PDF) 

If you have bloody diarrhea or diarrhea lasting three days or more, you might have an infection from a bacterium called E. coli O157:H7. This strain of E. coli can cause your kidneys to fail or be permanently damaged. Although this does not happen to most people, children under five and people over 65 are more at risk for kidney problems than other people. Since other bacterial infections can also cause bloody diarrhea, your doctor will need to order a special test to diagnose E. coli O157:H7. 

Protecting yourself and your family from E. coli O157:H7 

• Since meat with E. coli O157:H7 still looks and smells good, make sure ground beef is cooked until the meat is no longer pink and the juices run clear. E. coli O157:H7 can survive in undercooked hamburger meat. 

• After preparing meat dishes in the kitchen, use a bleach solution to sanitize your counters, utensils, cutting boards, and other surfaces used or touched in preparing the raw meats. You can make this solution by mixing one teaspoon of bleach with a quart of water. 

• Use a different cutting board and utensils for fruits, vegetables, and bread from the one you use for meats. If you don't have extra boards and utensils, make sure you sanitize your one board and utensils well between uses. Following these steps will keep you from spreading E. coli O157:H7 from one food to another. Also, be certain to wash organically grown vegetables and fruits well. 

• Buy only pasteurized milk, dairy products, and juices. E. coli O157:H7 can live in raw milk and other liquids. 

• Use safe water. Drink water from an approved public drinking water system, bottled water, or water that has been treated with chlorine or another disinfectant. Don't swim in water that has sewage in it as E. coli O157:H7 can live in untreated water. 

• If anyone in your family or someone you know is already sick with E. coli O157:H7, make sure everyone washes his or her hands often with soap and warm water. People, especially children in diapers, can give E. coli O157:H7 to others. 

Most people who get sick from E. coli O157:H7 are completely well within five to ten days. If you think you or one of your family members has an E. coli O157:H7 infection, call your doctor or clinic now. Ask your doctor to call your local health department at 1-800-705-8868 if he/she finds out the illness is from E. coli O157:H7. 

Report Escherichia coli, enterohemorrhagic within one week. Initial report form 

Several Texas laws (Tex. Health & Safety Code, Chapters 81, 84, and 87) require specific information regarding notifiable conditions to be provided to the Texas Department of State Health Services (DSHS). Health care providers, hospitals, laboratories, schools, and others are required to report patients who are suspected of having a notifiable condition (25 Tex. Admin. Code §97.2 ). 

Immunization 

There is no vaccine for E-coli.