High incidence of childhood hemolytic uremic syndrome in Switzerland is associated with indicators of livestock farming intensity


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High incidence of childhood hemolytic uremic syndrome in Switzerland is associated with indicators of livestock farming intensity
Title of the conference
Joint annual meeting of the Swiss Society for Pediatrics, Swiss Society of Pediatric Pneumology
Fontana M., Schmid H., Girardin E., Neuhaus T.J., Bianchetti M.G., Rudin C., von Vigier R.O.
Crans Montana, Switzerland, June 17-18, 2010
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Swiss Medical Weekly
Meeting Abstract
Background: Hemolytic-uremic syndrome (HUS) is a multisystem
disorder associated with significant morbidity and mortality. Typically,
HUS is preceded by an episode of (bloody) diarrhea mostly due to
Shiga-toxin (Stx) producing Escherichia coli (STEC). The main
reservoir for STEC is the intestine of healthy ruminants, mostly cattle,
and recent studies have revealed an association between indicators
of livestock density and human STEC infection or HUS, respectively.
Nationwide data on HUS in Switzerland have been established
through the Swiss Pediatric Surveillance Unit (SPSU) [Schifferli et al.
Eur J Pediatr. 2010; 169:591-8].
Aims: Analysis of age-specific incidence rate of childhood HUS and
possible association of Shiga-toxin associated HUS (Stx-HUS) with
indicators of livestock farming intensity.
Methods: Epidemiological and ecological analysis based on the
SPSU data (1997-2003) and the database of the Swiss Federal
Statistical Office (data on population and agriculture).
Results: One hundred-fourteen cases were registered, 88% were
≤5 years old. The overall annual incidence rate was 1.42 (0.60-1.91)
and 4.23 (1.76-6.19) per 100000 children ≤5 and ≤16 years,
respectively (P = 0.005). Stx-HUS was more frequent compared to
cases not associated with STEC (P = 0.002). The incidence rate for
Stx-HUS was 3.85 (1.76-5.65) in children ≤5, compared to 0.27
(0.00-0.54) per 100'000 children 5-16 years (P = 0.002), respectively.
The incidence rate of cases not associated with STEC infection did not
significantly vary with age (P = 0.107). Compared to data from
Scotland, Canada, Ireland, Germany, England, Australia, Italy, and
Austria the annual incidence rate of HUS in young children is highest
in Switzerland. Ecological analysis revealed strong association
between the incidence rate of Stx-HUS and indicators of rural
occupation (agricultural labourer / population, P = 0.030), farming
intensity (livestock breeding farms / population, P = 0.027) and cattle
density (cattle / cultivated area, P = 0.013).
Conclusions: Alike in other countries, HUS in Switzerland is mostly
associated with STEC infection and affects predominantly young
children. However, the incidence rate is higher compared to countries
abroad and is significantly correlated with indicators of livestock
farming intensity. The present data support the impact of direct and
indirect contact with animals or fecal contaminants in transmission of
STEC to humans.
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08/09/2010 15:40
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20/08/2019 15:22
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