657. Changes in incidence of pediatric Hemolytic Uremic Syndrome and associated Shiga toxin-producing E.coli infections, FoodNet, 2006─2014
Session: Poster Abstract Session: Outbreaks and Public Health Across the Globe
Thursday, October 5, 2017
Room: Poster Hall CD
Background: Post-diarrheal, pediatric hemolytic uremic syndrome (D+HUS) is a sequela of Shiga toxin-producing Escherichia coli (STEC) infection and is a common cause of acute kidney failure among US children. The Foodborne Diseases Active Surveillance Network (FoodNet) conducts surveillance in ten sites for physician-diagnosed D+HUS through a network of nephrologists and hospital discharge data review to estimate illness and corroborate STEC surveillance trends. The incidence of pediatric STEC overall in FoodNet sites has increased 18% from 2006 to 2014 while the incidence in STEC O157 has decreased by 28%.

Methods: We summarized data on D+HUS cases, defined as HUS in children <18 years, reported to FoodNet during 2006–2014. We examined changes in incidence rates using US census data. Population density was defined by the United States Department of Agriculture Rural-Urban continuum codes.

Results: During 2006–2014, 719 D+HUS patients were reported, resulting in 13 (1.8%) deaths. The average annual incidence was 0.72 cases/100,000 children which varied by site (range: 0.39–1.28). Incidence was 5-fold greater among patients aged 1–3 years (2.34) than in other age groups (0.44). Incidence rates/100,000 children (IR) were highest among females (0.81) and non-Hispanics (0.70). IRs were higher in rural counties (1.15) than in urban counties (0.64). Comparing 2006–2008 with 2012–2014, average incidence decreased by 19%, from 0.81 to 0.66, with the greatest decreases found in children aged 1–3 years (35%, p-value=0.04). No laboratory testing was performed for 10 (1%) cases. The proportion of cases with laboratory evidence of STEC infection increased 15 percentage points, from 69% in 2006–2008 to 84% in 2012–2014. In total, 537 (75%) D+HUS patients had laboratory evidence of STEC infection, 432 (80%) were culture-confirmed; the most common serogroups were O157 (94%), O111 (1.4%) and O121 (1.2%).

Conclusion: During 2006–2014 cases of D+HUS decreased and showed marked demographic and geographic differences. The increased number of D+HUS cases with laboratory evidence of STEC is likely in part due to improvements in testing and adherence to guidelines. Prevention strategies for STEC and D+HUS should focus on young children, particularly in rural areas.

Kelly A. Barrett, MPH, National Center for Emerging and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, Joshua Rounds, MPH, Acute Disease Investigation & Control Section, Minnesota Department of Health, St. Paul, MN, Alicia Cronquist, MPH, RN, Colorado Department of Public Health and Environment, Denver, CO, Katie N. Garman, M.P.H., C.H.E.S., Tennessee Department of Health, Nashville, TN, Sharon Hurd, MPH, CT EIP, New Haven, CT, Beletshachew Shiferaw, MD, MPH, Oregon Public Health Division, Portland, OR, Glenda Smith, BS, New York State Department of Health, Geneva, NY and Aimee L. Geissler, PhD, MPH, National Center for Emerging Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA


K. A. Barrett, None

J. Rounds, None

A. Cronquist, None

K. N. Garman, None

S. Hurd, None

B. Shiferaw, None

G. Smith, None

A. L. Geissler, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.