View source for Escherichia coli enterohemorrhagic (EHEC): Dose Response Models

===<center>'''Enterohemorrhagic'' Escherichia coli ''(EHEC)'''</center>===
<center><big>'''Kyle S. Enger, MPH'''</big></center>


==='''Overview: EHEC and disease caused by it'''===

''Escherichia coli'' usually exists as a commensal bacterium in the mammalian large intestine, benefiting itself as well as the host. Enterohemorrhagic ''E. coli'' (EHEC; particularly serotype O157:H7) is a highly pathogenic variant which can cause life-threatening disease and has been the cause of many major outbreaks from fecally contaminated food (e.g., ground beef)<ref name="Strachan et al 2005">Strachan NJC et al. (2005) Dose response modelling of Escherichia coli O157 incorporating data from foodborne and environmental outbreaks. International Journal of Food Microbiology. 103(1), pp.35-47. [http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6T7K-4FNCW2P-2-7&_cdi=5061&_user=1111158&_pii=S0168160505000693&_origin=gateway&_coverDate=08%2F15%2F2005&_sk=998969998&view=c&wchp=dGLbVzW-zSkzk&md5=bc35dbff2f730b099c8a5dabd9fe1baa&ie=/sdarticle.pdf Full Text]</ref> It may be spread by contaminated drinking water as well; for example, a large outbreak occurred in Walkerton, Ontario following heavy rains<ref name="Auld et al. 2004">Auld H, MacIver D & Klaassen J (2004) Heavy rainfall and waterborne disease outbreaks: the Walkerton example. Journal of Toxicology and Environmental Health. Part A. 67(20-22), pp.1879-1887. [http://docserver.ingentaconnect.com/deliver/connect/tandf/15287394/v67n20/s25.pdf?expires=1302533913&id=62221784&titleid=1278&accname=MICHIGAN+STATE+UNIVERSITY&checksum=2B7EDA587378C6DB157082DB0FDF38BC Full Text]</ref>

EHEC is technically part of the larger group of Shiga toxin producing ''E. coli'' (STEC), many of which cause little or no disease. EHEC attaches to the large intestinal wall and produces ‘attaching and effacing lesions’. It can cause bloody or non-bloody diarrhea, as well hemorrhagic colitis and hemolytic uremic syndrome (HUS). Its principal reservoir is the bovine intestinal tract. It has a lower ID50 than other pathogenic E. coli types <ref name="Kaper 2004">Kaper JB, Nataro JP & Mobley HL (2004) Pathogenic Escherichia coli. Nature Reviews. Microbiology. 2(2), pp.123-140. [http://www.nature.com/nrmicro/journal/v2/n2/full/nrmicro818.html Full Text]</ref><ref name="Nataro 1998">Nataro JP & Kaper JB (1998) Diarrheagenic Escherichia coli. Clinical Microbiology Reviews. 11(1), pp.142-201. [http://cmr.asm.org/cgi/reprint/11/1/142 Full Text]</ref>

It is unethical to conduct feeding experiments on humans with EHEC due to its virulence. However, feeding experiments on animals have been conducted. Information from EHEC outbreaks in humans has also been used to inform dose response models.

==='''Summary of data and models'''===

Pai et al. (1986)<ref name="Pai et al 1986">
Pai CH, Kelly JK & Meyers GL (1986) Experimental infection of infant rabbits with verotoxin-producing Escherichia coli. Infection and Immunity. 51(1), pp.16-23. [http://iai.asm.org/cgi/reprint/51/1/16http://iai.asm.org/cgi/reprint/51/1/16 Full Text]</ref> inoculated 3 day old rabbits intragastrically with EHEC O157:H7, measuring diarrhea and death as responses. Using the response of diarrhea, these data were fit to the beta-Poisson model by Haas et al. (2000).<ref name="Haas et al 2000">Haas CN et al. (2000) [http://smas.chemeng.ntua.gr/miram/files/publ_47_9_1_2004.pdf Development of a dose-response relationship for Escherichia coli O157:H7. International Journal of Food Microbiology. 56(2-3), pp.153-159. [http://aem.asm.org/cgi/reprint/70/9/5331 Full Text]</ref>

Cornick and Helgerson (2004)<ref name="Cornick and Helgerson 2004">Cornick NA & Helgerson AF (2004) Transmission and infectious dose of Escherichia coli O157:H7 in swine. Applied and Environmental Microbiology. 70(9), pp.5331-5335. [http://aem.asm.org/cgi/reprint/70/9/5331 Full Text]</ref> dosed 3-month-old pigs with EHEC O157:H7 strain 86-24. The response was shedding of that strain in the feces.

Teunis et al. (2004)<ref name="Teunis et al 2004">Teunis P, Takumi K & Shinagawa K (2004) Dose response for infection by Escherichia coli O157:H7 from outbreak data. Risk Analysis: An Official Publication of the Society for Risk Analysis. 24(2), pp.401-407. [http://onlinelibrary.wiley.com/doi/10.1111/j.0272-4332.2004.00441.x/pdf Full Text]</ref> examined dose response models consistent with EHEC O157:H7 outbreak data from a Japanese school. This outbreak was unusual in that the quantities of contaminated foods (a salad and a sauce) consumed by exposed persons were well defined, the foods were well mixed, and EHEC O157:H7 was actually quantified in the foods. Although this only allowed determination of a single dose for each population (31 CFU for pupils and 35 CFU for teachers), the response to this dose was known precisely since many persons were exposed (208 of 828 pupils infected; 7 of 43 teachers infected). This information was consistent with the dose response model of ''S. dysenteriae'' described above<ref name="Powell et al 2000">Powell MR (2000) Dose-response envelope for Escherichia coli O157:H7. Quantitative Microbiology. 2, pp.141-163. [http://www.springerlink.com/content/k3t3768n75w16246/fulltext.pdf Full Text]</ref>, but not with the dose response models of EHEC O157:H7 in rabbits<ref name="Haas et al 2000"></ref> or EPEC in humans<ref name="Powell et al 2000"></ref>. Under actual outbreak conditions, EHEC O157:H7 appeared more infectious than previously published dose response models for EHEC O157:H7 suggested.

Strachan et al. (2005)<ref name="Strachan et al 2005"></ref> expanded upon the strategy of Teunis et al. (2004)<ref name="Teunis et al 2004"></ref> for assessing EHEC O157:H7 dose response models. They compiled information from several other outbreaks (in addition to the Japanese school outbreak, above) to fit a dose response model for EHEC O157:H7. This model fit poorly, probably due to variation in the populations affected and difficulty in estimating the dose that people ingested; . However, based on comparing dose response models with the outbreak data, Strachan et al. (2005)<ref name="Strachan et al 2005"></ref> concluded that a pooled dose response model for Shigella (Crockett et al. 1996) was more consistent with outbreak data for ''E. coli'' O157 than other published dose response models for ''E. coli''. This model and similar models are described in the Shigella chapter of this monograph.


{{DRSummaryTableStart|agent=enterohemorrhagic ''Escherichia coli'' (EHEC)}}
{{DRSummaryTablePreferredModel|expID=213|refer = Cornick & Helgerson (2004)|reference=Cornick, N.A. & Helgerson, A.F., 2004. [http://aem.asm.org/cgi/reprint/70/9/5331 Transmission and infectious dose of Escherichia coli O157:H7 in swine.] ''Applied and Environmental Microbiology'', 70(9), pp.5331-5335. |host= pig |agentStrain= EHEC O157:H7, strain 86-24 |route= oral (in food) |nDoses= 3 |doseUnits= CFU |response= shedding in feces |bestFitModel=exponential|parameters=k=2.18E-04 |N50= 3.18E+03 }}
{{DRSummaryTableNonpreferredModel|expID= 177 |refer=Pai et al. (1986)|reference=Pai, C.H., Kelly, J.K. & Meyers, G.L., 1986. [http://iai.asm.org/cgi/reprint/51/1/16http://iai.asm.org/cgi/reprint/51/1/16 Experimental infection of infant rabbits with verotoxin-producing Escherichia coli.] ''Infection and Immunity'', 51(1), pp.16-23.|host= rabbit |agentStrain= EHEC UC741 (O157:H7) |route= intragastric (w. NaHCO3) |nDoses= 7 |doseUnits= CFU |response= diarrhea |bestFitModel=beta-Poisson|parameters=&alpha; =  4.87E-01 , N<sub>50</sub> =  5.97E+05 |N50= 5.97E+05 }}
{{DRSummaryTableEnd}}

[[File:Exponential and betapoisson model.jpg|thumb|none|550px]]

==='''Optimization Output for experiment 213'''===

{{DRExperimentDataTable3|title=Model data for ''Escherichia coli'' (EHEC O157:H7, strain 86-24) in the pig|refer = Cornick & Helgerson (2004)|reference=Cornick, N.A. & Helgerson, A.F., 2004. [http://aem.asm.org/cgi/reprint/70/9/5331 Transmission and infectious dose of Escherichia coli O157:H7 in swine.] ''Applied and Environmental Microbiology'', 70(9), pp.5331-5335. |pos=Shedding in feces|neg=No shedding in feces|d1=170|p1=0|n1=8|t1=8|d2=6000|p2=6|n2=2|t2=8|d3=4E+04|p3=8|n3=0|t3=8}}


{{DRFit|title=Goodness of fit and model selection|devE=0.613|devB=0.613|delta=-0.000647|DFE=2|DFB=1|X2bPbetter=3.84|pbPbetter=1|X2GOFe=5.99|pGOFe=0.736|X2GOFb=3.84|pGOFb=0.434|interpretation=Exponential is preferred to beta-Poisson; cannot reject good fit for exponential.}}


{{DRConfidenceExponential|title=Optimized k parameter for the exponential model, from 10000 bootstrap iterations|MLEk=2.18E-04|p5k=9.40E-05|p25k=9.40E-05|p50k=1.20E-04|p950k=5.99E-04|p975k=5.99E-04|p995k=5.99E-04|N50type=ID50/LD50/ETC|MLEN=3.18E+03|p5N=1.16E+03|p25N=1.16E+03|p50N=1.16E+03|p950N=5.77E+03|p975N=7.37E+03|p995N=7.37E+03}}


[[File:ExpHisto ID213.png|thumb|left|500px|'''Parameter histogram for exponential model (uncertainty of the parameter)''']][[File:ExpModel ID213.png|thumb|none|500px|'''Exponential model plot, with confidence bounds around optimized model''']]<br>

==='''Optimization Output for experiment 177'''===

{{DRExperimentDataTable7|title=Model data for ''Escherichia coli'' (EHEC O157:H7) in the rabbit|refer=Pai et al. (1986)|reference=Pai, C.H., Kelly, J.K. & Meyers, G.L., 1986. [http://iai.asm.org/cgi/reprint/51/1/16http://iai.asm.org/cgi/reprint/51/1/16 Experimental infection of infant rabbits with verotoxin-producing Escherichia coli.] ''Infection and Immunity'', 51(1), pp.16-23.|pos=Diarrhea|neg=No diarrhea|d1=1E+05|p1=1|n1=2|t1=3|d2=1E+06|p2=2|n2=3|t2=5|d3=1E+07|p3=5|n3=0|t3=5|d4=1E+08|p4=12|n4=1|t4=13|d5=1E+09|p5=5|n5=0|t5=5|d6=3E+09|p6=2|n6=0|t6=2|d7=1E+10|p7=6|n7=0|t7=6}}


{{DRFit|title=Goodness of fit and model selection|devE=64.1|devB=3.12|delta=61|DFE=6|DFB=5|X2bPbetter=3.84|pbPbetter=5.77e-15|X2GOFe=12.6|pGOFe=6.6e-12|X2GOFb=11.1|pGOFb=0.681|interpretation=Beta-Poisson fits better than exponential; cannot reject good fit for beta-Poisson.}}


{{DRConfidenceBetaPoisson|title=Optimized parameters for the beta-Poisson model, from 10000 bootstrap iterations|MLEa=4.87E-01|p5a=1.60E-01|p25a=2.20E-01|p50a=2.47E-01|p950a=9.55E+02|p975a=1.42E+03|p995a=1.94E+03|MLEN=5.97E+05|p5N=3.20E+03|p25N=2.88E+04|p50N=6.19E+04|p950N=2.54E+06|p975N=2.96E+06|p995N=5.10E+06}}


[[File:BPscatter ID177.png|thumb|left|500px|'''Parameter scatter plot for beta Poisson model ellipses signify the 0.9, 0.95 and 0.99 confidence of the parameters.''']][[File:BPmodel ID177.png|thumb|none|500px|'''beta Poisson model plot, with confidence bounds around optimized model''']]<br>

===References===
<references />


[[Category:Completed Dose Response Models: Bacteria]][[Category:Dose Response Model]][[Category:enterohemorrhagic Escherichia coli]]