One person has died in the UK and 30 cases of illness confirmed following an outbreak of Shiga toxin-producing Escherichia coli (STEC) O145 identified through the analysis of whole genome sequencing (WGS) data.
The UK Health Security Agency (UKHSA), Public Health Scotland (PHS), Food Standards Agency (FSA) and Food Standards Scotland (FSS) are working together with other partner agencies to investigate the outbreak of STEC, which is often transmitted via consumption of contaminated food but can also be spread by close contact with an infected person, as well as direct contact with an infected animal (usually ruminants) or its environment.
The symptoms of STEC infection can vary in severity, ranging from mild diarrhoea to severe abdominal cramps, vomiting and bloody diarrhoea. In up to 15% of cases, infection can lead to the development of haemolytic uraemic syndrome (HUS), a serious and life-threatening condition predominantly affecting the kidneys, which can result in death.
Vulnerable groups
HUS is most often seen in young children (under 5 years) but can also affect other vulnerable groups, including the elderly and immunocompromised. The O145 outbreak strain currently under investigation possess a virulence gene (stx2a) which is associated with a more severe clinical presentation and progression to HUS. People aged seven to 81 have been infected and one person from Scotland has now died following infection, the agency added.
Epidemiological and food chain investigations have identified links between some of the identified cases and a number of unpasteurised cheeses produced by a business in England.
As a precautionary measure, the FSA issued a product recall on 24 December 2023 for four cheeses produced by Mrs Kirkham’s Lancashire Cheese Ltd. A further product was recalled on 27 December. The products recalled are Mrs Kirkham’s Mild and Creamy Lancashire, Mrs Kirkham’s Tasty Lancashire, Mrs Kirkham’s Mature Lancashire, Mrs Kirkham’s Smoked Lancashire, and No 1 Waitrose and Partners Farmhouse Kirkham’s Lancashire cheese.
Precautionary measure
In a statement shared on the company website on Christmas Day, Mrs Kirkham’s said it had “taken the difficult decision” to recall all of its products purchased between 1 October and Christmas Eve as a precautionary measure, and suspending all orders “until investigations are completed and we have some answers”.
“Whilst at this time, there has been no testing carried out on our products by the FSA to confirm any suspected risks, we feel it is our duty to recall our products,” the statement said. “We are working very closely with our local environmental health officers and the Food Standards Agency to fully understand the situation, and whether our products have been correctly implicated.”
Testing techniques
Mrs Kirkham’s said the recall related to new testing techniques which “are not currently industry standard”, and so “despite rigorous and thorough testing throughout our production processes, the potential risk to product safety was not previously identified”.
The company said it was “in a state of limbo until testing laboratories reopen and resume testing”.
UKHSA is continuing to follow up cases to identify any common links, including determining whether cases ate or came into contact with the recalled cheeses.
UKHSA has also been working with partner agencies to investigate 3 other non-O157 STEC outbreaks across the UK since October 2023. These outbreaks have also been identified through WGS and include a different strain of STEC O145 and 2 outbreaks of STEC O26. The number of cases associated with these outbreaks varies from 15 to 44 reported cases.
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