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Meta-Analysis
. 2019 Jan:147:e235.
doi: 10.1017/S0950268819001183.

Associating sporadic, foodborne illness caused by Shiga toxin-producing Escherichia coli with specific foods: a systematic review and meta-analysis of case-control studies

B Devleesschauwer  1 , S M Pires  2 , I Young  3 , A Gill  4 , S E Majowicz  5 ; study team
Affiliations
Meta-Analysis

Associating sporadic, foodborne illness caused by Shiga toxin-producing Escherichia coli with specific foods: a systematic review and meta-analysis of case-control studies

B Devleesschauwer et al. Epidemiol Infect. 2019 Jan.

Abstract

Shiga toxin-producing Escherichia coli (STEC) infections are a significant public health issue, with foodborne transmission causing >1 million illnesses worldwide each year. We conducted a systematic review and meta-analysis (PROSPERO registry # CRD42017074239), to determine the relative association of different food types with sporadic illnesses caused by STEC. Searches were conducted from 01 August to 30 September 2017, using bibliographic and grey literature databases, websites and expert consultation. We identified 22 case-control studies of sporadic STEC infection in humans, from 10 countries within four World Health Organization subregions, from 1985 to 2012. We extracted data from 21 studies, for 237 individual measures in 11 food categories and across three status types (raw or undercooked, not raw and unknown). Beef was the most significant food item associated with STEC illness in the Americas and Europe, but in the Western Pacific region, chicken was most significant. These findings were not significantly moderated by the raw or cooked status of the food item, nor the publication year of the study. Data from the African, South-East Asian and Eastern Mediterranean subregions were lacking and it is unclear whether our results are relevant to these regions.

Keywords: Epidemiology; Shiga-like toxin-producing E. coli; food-borne infections; gastroenteritis.

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Conflict of interest statement

SEM, SMP and BD have worked previously with the World Health Organization under the Foodborne Disease Burden Epidemiology Reference Group. SEM is an Associate Editor at Epidemiology and Infection, and has served as a paid Expert on behalf of the Attorney General of Canada in legal proceedings, providing evidence on the public health risks and benefits of unpasteurized milk. No other authors report any conflicts of interest.

Figures

Fig. 1.
Fig. 1.
PRISMA diagram showing the results of the search for case-control studies of sporadic STEC infections in humans (all dates and locations).
Fig. 2.
Fig. 2.
Study locations and timeframes for the 22 identified case-control studies of sporadic STEC infections in humans.
Fig. 3.
Fig. 3.
Forest plots of the log odds ratio (OR) of the risk of human STEC infection from beef (a) and meat-unspecified (b), showing the overall pooled OR together with the 95% confidence interval (CI); ordered from oldest (top) to newest (bottom) study.
See this image and copyright information in PMC

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