There is an elevated risk of being infected by E. coli after going to Egypt, according to an analysis by Italian researchers.

In 2023, there were several cases of bloody diarrhea with Shiga toxin-producing E. coli (STEC) infection in children and people under the age of 18 returning from vacations.

Several cases of hemolytic uremic syndrome (HUS) were also reported. HUS is a severe complication associated with E. coli infections that causes kidney failure.

Investigations to identify the sources are needed so effective preventive measures can be implemented, said researchers in the journal Eurosurveillance.

The study included all children and adolescents with bloody diarrhea and STEC infection identified in 2023 by a surveillance system in northern Italy. Researchers interviewed children’s families and sent a questionnaire on recent travel abroad. The exposure time was between three days after arrival abroad and five days after return home.

They also collected information on exposures during travel, including the site of vacation, name of holiday resort, food and beverages consumed, excursions outside the resort, and swimming.

More serious cases linked to Egypt

Travel to Egypt accounted for around a quarter of cases in the surveillance system in 2023.

Of the 43 cases, 24 were male and 31 occurred between May and September. Eleven developed HUS. Twenty-three patients did not go abroad, while 12 had been to Egypt and eight to several other destinations. 

Ten cases were infected in different places in Egypt, such as Sharm El-Sheikh and Marsa Alam. Seven acquired the disease while in Egypt, and three started presenting symptoms on the second day after their return to Italy. Five people developed HUS, compared to six of the 33 cases infected elsewhere.

Two other patients developed symptoms shortly after their return from Egypt, but beyond the period defined by researchers.

Serotype analysis excluded the possibility of a single strain causing the infections. Serotypes of people likely infected abroad included O111, O71, O157, and O186.

All children were guests at holiday resorts and consumed meals and beverages provided by these outlets.

Previous warnings

Researchers found travel to Egyptian vacation sites was associated with a higher risk of acquiring STEC infection with bloody diarrhea compared to children not travelling to the country. No specific source of infection could be found except for the general risk from going to Egypt.

Germany, the United Kingdom, and the European Centre for Disease Prevention and Control (ECDC) have previously warned of STEC and HUS after travel to Egypt.

In mid-2023, experts from the Robert Koch Institut (RKI) reported 31 cases of E. coli and 10 of HUS in people who were likely infected while on holiday in Egypt.

In 2019, 18 people fell ill from different types of STEC and one person developed HUS in the UK after returning from Egypt.

General measures to avoid infection include handwashing before meals, avoiding poorly cooked meat, unpasteurized dairy products, as well as vegetables and street food, avoiding direct contact with ruminants, and to only drink bottled water.

“The risk of STEC infection related to travel to Egyptian vacation sites is worrisome, given the potential severity of the infection and the number of tourists visiting the country. Investigations to identify the sources are needed to implement preventive measures,” said researchers.

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