Shiga toxin‑producing Escherichia coli (STEC) infection and haemolytic uraemic syndrome (HUS)

At a glance

No vaccine available – read more about prevention
Nationally notifiable disease

About STEC and HUS

Shiga toxin-producing Escherichia coli (STEC) are a group of bacteria that make Shiga toxins in the gut. These toxins can cause bloody diarrhoea.

Less commonly, STEC leads to HUS, a life-threatening condition that damages red blood cells and the kidneys. HUS can also be caused by other illnesses such as shigellosis, and some medications.

STEC most often spreads through contaminated food.

Why it matters to public health

STEC can cause severe gastroenteritis and serious complications.

About 1,000 STEC infections are reported in Australia each year. A very small number of these people develop HUS.

STEC and HUS are most common in young children aged under 5 years, who are also most likely to become very sick or die.

Outbreaks of STEC are most often caused by contaminated food.

Because there’s no vaccine, prevention relies on safe food practices, good hygiene, and timely public health action when infections are reported.

Symptoms

If you’re looking for advice about your own health or treatment options, see healthdirect or speak with a qualified healthcare professional. Our role is to provide public health advice – information and guidance that helps prevent disease, protect communities and improve wellbeing at a population level.

STEC causes gastroenteritis symptoms, including:

diarrhoea, which might become bloody
severe abdominal cramps
nausea
vomiting.

Most people improve within a week. But some people get serious complications such as dehydration or sepsis.

Some STEC infections progress to HUS. This is most common in children aged under 5 years.

HUS symptoms include:

passing no or little urine, which might be bloody
pale skin
easy bruising or a rash of tiny red spots
extreme tiredness or drowsiness.

HUS is a life-threatening medical emergency. Serious complications can include:

With treatment, most people recover from HUS within a few weeks. But about 1 in 10 people with HUS die, or permanent kidney failure.

Read more about the symptoms, diagnosis and treatment of HUS.

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Onset of symptoms

Symptoms of STEC infection usually start 3 to 4 days after getting infected. But this can range from 1 to 10 days.

Symptoms of HUS usually begin within a week of diarrhoea starting.

How it spreads

STEC is found in the gut and faeces of animals – especially cows.

People can be infected if the bacteria enter their mouths. This can happen through:

consuming contaminated food and drinks
swimming in or drinking contaminated water
contact with farm or petting zoo animals
close contact with an infected person, including changing nappies or soiled bedding.

Some food and drinks pose a higher risk of STEC, including:

undercooked beef – especially mince
salad vegetables – especially leafy greens
unpasteurised (raw) milk or milk products
unpasteurised fruit juices.

Infectious period

Most people have the bacteria in their stool for about a week. But in some people – especially children – this can be up to 3 weeks.

STEC can survive for weeks to months in the environment, including in animal faeces, soil and water.

Prevention

There is no vaccine against STEC infection.

Protect yourself

The best protection is to safely prepare, handle and cook food.

It is especially important to:

thoroughly cook beef mince (including burgers and sausages) to 75 °C in the centre
wash raw vegetables and fruit under running water before eating
use clean cutting boards and knives for ready-to-eat foods
wash cutting boards and knives with hot soapy water
not consume unpasteurised (raw) milk or raw milk products
avoid drinking untreated water.

Good hand hygiene is also important, especially:

after touching animals
when around someone who is sick
when preparing and eating food.

Read more about STEC in food and food safety.

Protect others

People with STEC should follow their healthcare professional’s advice, which might include:

washing hands often
avoiding preparing food for others, if possible
staying away from work, school and childcare while sick.

People who work as food handlers should not attend work until 48 hours after symptoms stop.

Children and childcare staff should not attend childcare until 24 hours after diarrhoea or vomiting stops. Staff should also not handle food until 48 hours after recovery from these symptoms.

Always follow advice from your state or territory government or workplace – local recommendations can differ.

Priority groups and settings

Some people are at greater risk of getting STEC or getting very sick from it.

Certain settings are also more likely to spread STEC infections, including:

food venues
early childhood education and care centres
residential care homes.

People at greater risk should take steps to protect themselves.

People at greater risk of severe disease

STEC infection poses a greater risk of severe gastroenteritis for:

babies or young children under 5 years
older people
people who are immunocompromised.

Babies and children aged under 5 years and people aged over 65 years are also at greater risk of developing HUS and getting very sick from it.

People at greater risk of exposure

People are at greater risk of being exposed if they:

regularly consume higher risk foods or drinks – especially undercooked beef mince
are in contact with farm animals (especially cattle), their faeces or their meat
have close contact with an infected person
swim in or drink untreated fresh water.

Diagnosis and treatment

STEC infection is usually diagnosed through a stool test. Sometimes a blood test might be used.

HUS is diagnosed by assessing signs and symptoms and through blood tests.

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Most people with STEC infections recover in about a week with supportive care, such as drinking plenty of fluids. Some people may be cared for in hospital.

STEC infections are usually not treated with antibiotics or anti-diarrheal medicines, as they can increase the risk of HUS.

People with HUS need urgent medical attention and will usually be treated in an intensive care unit.

Read more about how to manage or treat STEC or HUS.

Surveillance and reporting

STEC and HUS are nationally notifiable diseases – these are diseases that present a risk to public health.

Health authorities in each state and territory report cases of STEC and HUS to us through the National Notifiable Diseases Surveillance System.

The OzFoodNet network monitors and responds to foodborne diseases in Australia, including STEC infections.

This is part of national surveillance to monitor case numbers and understand disease patterns.

Use our data visualisation tool to search the latest data.

Outbreaks

The response to STEC outbreaks in Australia focuses on:

finding the likely source of infection
preventing further infections.

State and territory health departments investigate outbreaks by:

collecting information about potential exposures, such as foods consumed or contact with animals
identifying other people who might have been exposed to the bacteria
working with food safety agencies and distributors to trace where food came from
testing foods, drinks and environmental samples.

Outbreak control measures might include:

providing education about STEC and how to prevent it, such as safe food handling and hand hygiene
advising people with STEC to stay home from work, school or childcare while symptomatic – this may be longer for people undertaking certain jobs or activities that increase the risk of spreading STEC to others
recalling contaminated food.

Read more about how the Australian Government defines and plans for outbreaks.

Support

For information about STEC and HUS in your state or territory see:

If you need mental health support, see a list of organisations, websites and services that offer support, counselling and information.

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