Abstract

Shiga toxin-producing Escherichia coli (STEC) infections are a substantial health issue worldwide. Circa 2010, foodborne STEC caused > 1 million human illnesses, 128 deaths, and ~ 13,000 Disability Adjusted Life Years (DALYs). Targeting interventions appropriately relies on identifying those strains of greatest risk to human health and determining the types of foods that cause STEC infections. There are hundreds of STEC serotypes; however, based on the evidence gathered during the review, the Expert Group concluded that the serotype of the STEC strain should not be considered a virulence criterion. All STEC strains with the same serotype should not be assumed to carry the same virulence genes and to pose the same risk, as many STEC virulence genes are mobile and can be lost or transferred to other bacteria. this report proposes a set of criteria for categorizing the potential risk of severity of illness associated with a STEC in food is recommended based on evidence of virulence gene profiles and associations with clinical severity. The criteria could be applied by risk managers in a risk-based management approach to control STEC in food. While ruminants and, other land animals are considered the main reservoirs for STEC, various largescale outbreaks have been linked to other foods. Thus, the report also addresses source attribution of foodborne STEC infections globally in order to inform the development of international standards by the Codex Alimentarius on the control of STEC, and in particular identify the foods which should be the focus of those standards. Finally it provides a review of monitoring programmes and methodology for STEC which can serve as a reference for countries planning to develop such programmes.