VTEC/E. coli O157 Action Plan for Scotland, 2013-2017

II. EXECUTIVE SUMMARY

Since 2006, laboratory identifications of Escherichia coli (E. coli) O157 infection in Scotland have remained stubbornly stable at around 240 culture positive cases annually, despite the publication in 2001 of the joint Scottish Executive/Food Standards Agency (Scotland) E. coli O157 Task Force Report and its 104 recommendations. During the same period (i.e. 2006-2012), on average an additional 27 cases of infection with verotoxigenic E. coli (VTEC) of non-O157 strains, were identified each year by the Scottish E. coli O157/VTEC Reference Laboratory (SERL).

Following annual reviews of compliance with Task Force recommendations from 2002 onwards, including extensive reviews in 2007 and 2008, Scottish Ministers decided to convene a multidisciplinary VTEC/E. coli O157 Action Group whose main remit has been to produce a VTEC/E. coli O157 Action Plan for Scotland. The Action Group's full Terms of Reference and membership are in the appendices.

Rather than conducting a further review of Task Force recommendations, this Action Plan uses a systematic, logical framework to:

• Describe the pathways of transmission of VTEC (including both E. coli O157 and non-O157 strains) from source (colonised animals) to receptor (human case);
• Identify the steps in each pathway where new controls might be effective;
• Recommend new methods of measuring compliance with both new and existing control measures, and of evaluating their effectiveness.

Structure of the VTEC/E. coli O157 Action Plan

Sections III and IV of this document summarise the events and issues that gave rise to the Action Plan, and provide a background on VTEC/E. coli O157 and the challenges it presents for public health and health protection in Scotland. Section V then explains the logical framework underpinning the Action Plan.

Section VI provides a summary table of the Action Plan's 86 recommendations, and the key agencies to which each recommendation is addressed for implementation. There is an average of four recommendations for each of the 12 steps identified, ranging between 0 and 16 recommendations per step.

The number of recommendations does not imply that the agencies responsible for controlling that step are not already taking action - the criteria for making a recommendation include:

• The importance of the step (i.e. could a failure have severe consequences);
• Whether developments are realistic (i.e. practical and likely to be effective).

Section VII consists of 12 chapters describing the 12 steps identified by the Action Plan's logical framework, for transmission of VTEC from source to receptor; and identifies and recommends controls applicable to each step, and the measures for monitoring compliance with, and evaluating the effectiveness of, those controls.

Chapters 1-3 focus on controlling the excretion of contaminated faeces by animals colonised with VTEC, controlling how animal colonisation occurs, and controlling how animal faeces contaminate the environment. Chapters 4 and 5 address the contamination of untreated or treated water; and Chapters 6 and 7 address the contamination of untreated or treated food.

Chapters 8, 9 and 10 describe methods for controlling the infection of humans from water, the environment, animal faeces, and food. Chapters 11 and 12 address the risks from contaminated human faeces, and how these can infect other humans via food, water, the environment or directly.

Risk communication and health education are vital to the control of VTEC infection and are relevant to all steps. The 16 proposals relating to risk communication and health education are therefore presented in Section VIII. Similarly, the 17 proposals for research and surveillance may apply to more than one step, and are presented in Section IX.

Key messages

The theme that links the recommendations, is that the key to reducing VTEC infection in Scotland is hygiene:

• On the farm;
• In the provision of drinking water supplies;
• In food production and processing, and in both commercial and domestic kitchens;
• In the countryside;
• And in the home.

The more dangerous the environment and the more numerous and vulnerable those exposed to it, the greater the need for scrupulous hygiene. Risk can never be eliminated, but the key to its reduction is hygiene.

The main task of a risk communication and health education strategy - which will be crucial to achieving improved levels of hygiene - will be to change behaviour by improving not only industry and the public's knowledge of risk, but also their attitudes to it.