Do asymptomatic STEC-long-term carriers need to be isolated or decolonized? New evidence from a community case study and concepts in favor of an individualized strategy
Asymptomatic long-term carriers of Shigatoxin producing Escherichia coli (STEC) are regarded as potential source of STEC-transmission. The prevention of outbreaks via onward spread of STEC is a public health priority. Accordingly, health authorities are imposing far-reaching restrictions on asymptom...
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| Format: | Article |
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Frontiers Media S.A.
2024-04-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2024.1364664/full |
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| author | Friedhelm Sayk Susanne Hauswaldt Johannes K. Knobloch Johannes K. Knobloch Jan Rupp Martin Nitschke |
| author_facet | Friedhelm Sayk Susanne Hauswaldt Johannes K. Knobloch Johannes K. Knobloch Jan Rupp Martin Nitschke |
| author_sort | Friedhelm Sayk |
| collection | DOAJ |
| description | Asymptomatic long-term carriers of Shigatoxin producing Escherichia coli (STEC) are regarded as potential source of STEC-transmission. The prevention of outbreaks via onward spread of STEC is a public health priority. Accordingly, health authorities are imposing far-reaching restrictions on asymptomatic STEC carriers in many countries. Various STEC strains may cause severe hemorrhagic colitis complicated by life-threatening hemolytic uremic syndrome (HUS), while many endemic strains have never been associated with HUS. Even though antibiotics are generally discouraged in acute diarrheal STEC infection, decolonization with short-course azithromycin appears effective and safe in long-term shedders of various pathogenic strains. However, most endemic STEC-strains have a low pathogenicity and would most likely neither warrant antibiotic decolonization therapy nor justify social exclusion policies. A risk-adapted individualized strategy might strongly attenuate the socio-economic burden and has recently been proposed by national health authorities in some European countries. This, however, mandates clarification of strain-specific pathogenicity, of the risk of human-to-human infection as well as scientific evidence of social restrictions. Moreover, placebo-controlled prospective interventions on efficacy and safety of, e.g., azithromycin for decolonization in asymptomatic long-term STEC-carriers are reasonable. In the present community case study, we report new observations in long-term shedding of various STEC strains and review the current evidence in favor of risk-adjusted concepts. |
| first_indexed | 2024-04-24T08:14:43Z |
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| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-04-24T08:14:43Z |
| publishDate | 2024-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj.art-2b7d0dcad0ca4543855a75d36b1fffa52024-04-17T04:23:37ZengFrontiers Media S.A.Frontiers in Public Health2296-25652024-04-011210.3389/fpubh.2024.13646641364664Do asymptomatic STEC-long-term carriers need to be isolated or decolonized? New evidence from a community case study and concepts in favor of an individualized strategyFriedhelm Sayk0Susanne Hauswaldt1Johannes K. Knobloch2Johannes K. Knobloch3Jan Rupp4Martin Nitschke5Department of Medicine I, Division of Gastroenterology and Nephrology, University Hospital Schleswig-Holstein, Lübeck, GermanyDepartment of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, GermanyDepartment of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, GermanyInstitute for Medical Microbiology, Virology and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, GermanyDepartment of Medicine I, Division of Gastroenterology and Nephrology, University Hospital Schleswig-Holstein, Lübeck, GermanyAsymptomatic long-term carriers of Shigatoxin producing Escherichia coli (STEC) are regarded as potential source of STEC-transmission. The prevention of outbreaks via onward spread of STEC is a public health priority. Accordingly, health authorities are imposing far-reaching restrictions on asymptomatic STEC carriers in many countries. Various STEC strains may cause severe hemorrhagic colitis complicated by life-threatening hemolytic uremic syndrome (HUS), while many endemic strains have never been associated with HUS. Even though antibiotics are generally discouraged in acute diarrheal STEC infection, decolonization with short-course azithromycin appears effective and safe in long-term shedders of various pathogenic strains. However, most endemic STEC-strains have a low pathogenicity and would most likely neither warrant antibiotic decolonization therapy nor justify social exclusion policies. A risk-adapted individualized strategy might strongly attenuate the socio-economic burden and has recently been proposed by national health authorities in some European countries. This, however, mandates clarification of strain-specific pathogenicity, of the risk of human-to-human infection as well as scientific evidence of social restrictions. Moreover, placebo-controlled prospective interventions on efficacy and safety of, e.g., azithromycin for decolonization in asymptomatic long-term STEC-carriers are reasonable. In the present community case study, we report new observations in long-term shedding of various STEC strains and review the current evidence in favor of risk-adjusted concepts.https://www.frontiersin.org/articles/10.3389/fpubh.2024.1364664/fullSTECEHECsocio-economic burdensocial restrictionsShigatoxinHUS |
| spellingShingle | Friedhelm Sayk Susanne Hauswaldt Johannes K. Knobloch Johannes K. Knobloch Jan Rupp Martin Nitschke Do asymptomatic STEC-long-term carriers need to be isolated or decolonized? New evidence from a community case study and concepts in favor of an individualized strategy Frontiers in Public Health STEC EHEC socio-economic burden social restrictions Shigatoxin HUS |
| title | Do asymptomatic STEC-long-term carriers need to be isolated or decolonized? New evidence from a community case study and concepts in favor of an individualized strategy |
| title_full | Do asymptomatic STEC-long-term carriers need to be isolated or decolonized? New evidence from a community case study and concepts in favor of an individualized strategy |
| title_fullStr | Do asymptomatic STEC-long-term carriers need to be isolated or decolonized? New evidence from a community case study and concepts in favor of an individualized strategy |
| title_full_unstemmed | Do asymptomatic STEC-long-term carriers need to be isolated or decolonized? New evidence from a community case study and concepts in favor of an individualized strategy |
| title_short | Do asymptomatic STEC-long-term carriers need to be isolated or decolonized? New evidence from a community case study and concepts in favor of an individualized strategy |
| title_sort | do asymptomatic stec long term carriers need to be isolated or decolonized new evidence from a community case study and concepts in favor of an individualized strategy |
| topic | STEC EHEC socio-economic burden social restrictions Shigatoxin HUS |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2024.1364664/full |
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