Analysis of individual patient data to describe the incubation period distribution of shiga-toxin producing Escherichia coli

A. Awofisayo-Okuyelu*, Ian Hall, E. Arnold, Lisa Byrne, N. McCarthy

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Shiga-toxin producing Escherichia coli (STEC) is a pathogen that can cause bloody diarrhoea and severe complications. Cases occur sporadically but outbreaks are also common. Understanding the incubation period distribution and factors influencing it will help in the investigation of exposures and consequent disease control. We extracted individual patient data for STEC cases associated with outbreaks with a known source of exposure in England and Wales. The incubation period was derived and cases were described according to patient and outbreak characteristics. We tested for heterogeneity in reported incubation period between outbreaks and described the pattern of heterogeneity. We employed a multi-level regression model to examine the relationship between patient characteristics such as age, gender and reported symptoms; and outbreak characteristics such as mode of transmission with the incubation period. A total of 205 cases from 41 outbreaks were included in the study, of which 64 cases (31%) were from a single outbreak. The median incubation period was 4 days. Cases reporting bloody diarrhoea reported shorter incubation periods compared with cases without bloody diarrhoea, and likewise, cases aged between 40 and 59 years reported shorter incubation period compared with other age groups. It is recommended that public health officials consider the characteristics of cases involved in an outbreak in order to inform the outbreak investigation and the period of exposure to be investigated.

Original languageEnglish
Article numbere162
JournalEpidemiology and Infection
Publication statusPublished - 2019

Bibliographical note

Funding Information:
Financial support. The study was funded by the National Institute for Health research (NIHR) Health Protection Research Units in Gastrointestinal Infections at University of Liverpool, and in Emergency Preparedness and Response, at the University of East Anglia, in partnership with Public Health England.


  • Analysis of data
  • Incubation period
  • Individual patient data analysis
  • Shiga-like toxin-producing E. coli


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