P3.G122: Vacation in Egypt as Major Risk for Shiga Toxin Escherichia Coli Infection in Children during 2023. Data from the ItalKid-HUS Network

Background: Hemolytic uremic syndrome (HUS) is a severe thrombotic microangiopathy that may develop as a complication of Shiga toxin-producing Escherichia coli (STEC). In individual cases the source of infection often remains unknown. During 2023 we observed several cases of infection in children returning from vacations, thus we evaluated the association between travelling and STEC infection.

Methods: We analyzed all Shiga toxin-positive children identified by the ItalKid-HUS Network surveillance system in 2023. Families of infected children were contacted and a short questionnaire regarding recent travels abroad was administered. The exposure time was considered since the 3rd day after the arrival abroad until the 5th day after the return home. A self-controlled case series design was used to calculate relative risk.

Results: Of 43 cases with STEC infection, 11 developed HUS. Twenty-three subjects did not travel abroad, while 20 had travelled to several destinations. For 12 subjects we identified a specific association between exposure time and travel (10 to Egypt, 1 to Kosovo and 1 to Albania), Thus 23% of all cases of STEC infection were acquired during a short vacation in Egypt defining a relative risk of 133-folds higher than the general risk. Serotype analysis excluded the possibility of an epidemic given the different identified strains. Exposures analysis didn’t provide evidence of a single potential source of the infection.

Conclusion: Children travelling to Egypt are exposed to a high risk of STEC infection. Specific actions by Egyptian health authorities are needed to identify the source of infection to develop effective preventive measures.