Public Health England has issued a warning after almost 20 cases of Shiga toxin-producing E. coli infection were found in people returning from Egypt this year.

All travelers had been to the Hurghada region of Egypt. A variety of different Shiga toxin-producing E. coli (STEC) strains have been detected in visitors to Egypt with STEC O157 and STEC O26 identified amongst them. One person developed hemolytic uremic syndrome (HUS), a type of kidney failure associated with E. coli infection.

Public Health England (PHE) scientists are investigating to understand the cause of the infections.

The agency has given advice to those going to Egypt after 18 people, including children, returned with serious illnesses caused by STEC infections. In 2018, there were 22 cases of STEC in the whole year, and 11 infections in 2017.

Multiple strains; no outbreak
A PHE spokeswoman told Food Safety News that it cannot provide any further information about patients when asked about onset dates and the demographics of those affected.

“So far this year, four cases have been hospitalized and one case has developed HUS. In 2018, five of 22 cases were hospitalized. We use whole genome sequencing to type all strains of STEC in England, and the results do not indicate this is an outbreak, as multiple different strains of STEC have been detected,” she said.

“Each case is individually followed up. We do not know the specific source of these infections in Egypt. However, the most common ways people get infected with STEC is through eating contaminated food or water, through person to person spread or through contact with animal feces.”

The spokeswoman added the agency has told the European Centre for Disease Prevention and Control (ECDC) about the cases and notified the Egyptian public health authorities to provide them with information for their investigations.

Symptoms of infection with STEC can include diarrhea, nausea, vomiting, abdominal pain and cramps. Most people recover without medical treatment, but younger and older people may develop complications of the infection, leading to kidney failure. This condition is called hemolytic uremic syndrome and can be fatal.

The incubation period for E. coli infections can range from three to eight days. Most patients recover within 10 days.

There have been 16 cases of HUS in people, including children, who have been to the Hurghada region of Egypt between 2009 and 2019.

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Dr. Nick Phin, deputy director of the National Infection Service at PHE, said it was aware of people returning from Egypt with E. coli infections.

“We are gathering information about those affected to better understand the cause. There are simple precautions that travelers can take. These include ensuring meat is cooked thoroughly, not drinking tap water or ice made from tap water and trying to avoid swallowing water when swimming,” he said.

“Anyone suffering from diarrhea and vomiting should ensure they keep well hydrated and seek medical advice if their symptoms don’t improve within 48 hours. They should also avoid preparing or serving food while they have symptoms and thoroughly wash their hands after using the toilet to stop the bug being passed to others.”

PHE recommendations to travelers include:

• wher possible, avoid eating salads and uncooked vegetables and only eat fruit they can peel
• avoid unpasteurized milk, cheese and ice cream
• avoid food left uncovered in warm environments and exposed to flies
• ensure all meat is cooked thoroughly before eating, avoid meat that is pink or cold
• only drink bottled water or use ice made from bottled/filtered water
• wash hands thoroughly after visiting the toilet, and always before preparing or eating food. Alcohol gel can be helpful but not entirely effective when hand washing facilities are not available

The advice also applies to other countries wher E. coli infections are common such as Turkey and Spain.