Data Summary: REPEXH01 E. coli O157:H7 | E. coli infection

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</div> <div class="cdc-mobile-menu-footer"> <a href="/ecoli/site.html"> <span> View All </span> <span><em>E. coli </em>infection</span> </a> </div> </div> </div> <div class="cdc-header-mobile__faux-title" aria-hidden="true"> </div> </div> <div class="cdc-mobile-navbar"> <div class="cdc-mobile-navbar__paging"> </div> <div class="cdc-mobile-navbar__links" tabindex="-1"> <a data-post-id="13172" href="/ecoli/about/index.html" tabindex="0"> About </a> <a data-post-id="13174" href="/ecoli/signs-symptoms/index.html" tabindex="0"> Symptoms </a> <a data-post-id="13142" href="/ecoli/outbreaks/index.html" tabindex="0"> Outbreaks of <em>E. coli</em> Infections </a> <a data-post-id="13201" href="/ecoli/risk-factors/index.html" tabindex="0"> Risk Factors </a> <a data-post-id="13175" href="/ecoli/prevention/index.html" tabindex="0"> Prevention </a> <a data-post-id="13200" href="/ecoli/treatment/index.html" tabindex="0"> Treatment </a> <a data-post-id="13580" href="/ecoli/rep-strain/index.html" tabindex="0"> REPEXH01 <em>E. coli</em> O157:H7 </a> <a class="view-all" href="/ecoli/site.html"> View All </a> </div> </div> </header> <main class="container cdc-main" role="main" aria-label="Main Content Area"> <section class="cdc-page-title-bar cdc-page-offset noindex"> <time class="cdc-page-title-bar__item cdc-page-title-bar__item--date" datetime="2024-03-20 04:00:00"> March 20, 2024 </time> </section> <div class="cdc-page-title cdc-page-offset syndicate"> <h1>Data Summary: REPEXH01 <em>E. coli</em> O157:H7</h1> </div> <div id="content" class="cdc-page-content cdc-page-offset syndicate container"> <div class="cdc-dfe-body "> <div class="cdc-dfe-body__top "> <div class="dfe-section dfe-section--page-summary summary-blurb summary-list" data-section="cdc_research_or_data_summary_page_summary"> <div class="dfe-section__header"> <h2>Highlights</h2> </div> <div class="dfe-section__content"> <ul class="nested-list"> <li class="level-1">REPEXH01 is a persistent strain of Shiga toxin-producing <em>E. coli</em> O157:H7 bacteria that has caused illnesses and outbreaks in the United States.<ul> </ul> </li> <li class="level-1">This strain has caused many outbreaks linked to different sources, such as recreational water, ground beef, and romaine lettuce.<ul> </ul> </li> <li class="level-1">Additional research could help determine where this strain is coming from and how to prevent future illnesses.<ul> </ul> </li> </ul> </div> <div class="dfe-section__image" id="page-summary-image"> <figure class="dfe-image dfe-image__large"><div class="image-container calculated-ratio-16-9 aspect-ratio-16-9"><img src="/ecoli/media/images/ecoli-illustration-1200x675px.jpg" alt="Illustration that depicts a group of extended-spectrum ß-lactamase-producing (ESBLs) Enterobacteriaceae bacteria, in this case, Escherichia coli."></div></figure> </div> <div id="nav-buttons"> </div> </div> </div> <div class="cdc-dfe-body__center "> <div class="dfe-section" data-section="cdc_research_or_data_summary_overview"> <a class="onThisPageAnchor" id="cdc_research_or_data_summary_overview-at-a-glance" name="At%20a%20glance" title="At a glance"></a><h2>At a glance</h2> <div class="dfe-block dfe-block--cdcmodule"><div class="cdc-textblock"><div class="table-responsive"> <table class="table table-sm mb-0 pb-0"> <caption class="sr-only d-none">Learn fast facts about this rep strain.</caption> <tbody> <tr> <th class="text-right br-1 br-gray bb-gray" style="width: 50%;" scope="row">Bacteria</th> <td style="width: 50%;"><a href="/ecoli/php/technical-info/index.html"><em>Escherichia coli</em></a></td> </tr> <tr> <th class="text-right br-1 br-gray bb-gray" scope="row">Serotype</th> <td>O157:H7</td> </tr> <tr> <th class="text-right br-1 br-gray bb-gray" scope="row"><a href="https://efsa.onlinelibrary.wiley.com/doi/10.2903/j.efsa.2020.5967" class="tp-link-policy" data-domain-ext="com">Shiga Toxin Type<span class="visually-hidden sr-only" aria-label=" external icon" role="img"></span><span class="cdc-icon-external cdc-link-icon" aria-hidden="true" alt="external icon"></span></a></th> <td>Stx2a and/or Stx2c</td> </tr> <tr> <th class="text-right br-1 br-gray bb-gray" scope="row">Persistent Strain</th> <td>REPEXH01</td> </tr> <tr> <th class="text-right br-1 br-gray bb-gray" scope="row">First Detection</th> <td>April 2017</td> </tr> <tr> <th class="text-right br-1 br-gray bb-gray" scope="row">Illnesses Reported in <a href="/pulsenet/index.html">PulseNet</a></th> <td>634</td> </tr> <tr> <th class="text-right br-1 br-gray bb-gray" scope="row">Outbreaks Investigated</th> <td>14</td> </tr> </tbody> </table> </div> </div></div> </div> <div class="dfe-section" data-section="cdc_research_or_data_summary_findings"> <a class="onThisPageAnchor" id="cdc_research_or_data_summary_findings-key-findings" name="Key%20findings" title="Key findings"></a><h2>Key findings</h2> <div class="dfe-block dfe-callout dfe-callout--standard"><div class="dfe-callout__icon" aria-hidden="true" role="img"></div> <h3>What is a REP strain?&lrm;</h3> <div class="dfe-callout__body"><div class="callout-desc">Learn about <a href="/foodborne-outbreaks/php/rep-surveillance/index.html">REP strains</a> if you are unfamiliar with them.</div> </div></div> <p>REPEXH01 is a persistent strain of <a href="/ecoli/about/index.html" class="">Shiga toxin-producing <em>E. coli</em></a><em></em> O157:H7 bacteria that has caused illnesses and outbreaks in the United States.</p> <p>Illness caused by this strain was first reported to PulseNet in 2017. Illnesses caused by this strain occur year-round but are less common in winter.</p> <p>In the past, the REPEXH01 strain has spread to people through contaminated food and contaminated recreational water.</p> <p>This strain is relatively diverse genetically. Bacteria in this strain are within 21 allele differences of one another by <a href="/pulsenet/pathogens/wgs.html">whole genome sequencing</a>, which is more diverse than typical multistate foodborne outbreaks where bacteria generally fall within 10 allele differences of one another.</p> <p>Increased diversity can occur over time as strains pass among human hosts, animal hosts, and environmental settings, each with different selective pressures.</p> </div> <div class="dfe-section" data-section="cdc_research_or_data_summary_res_data"> <a class="onThisPageAnchor" id="cdc_research_or_data_summary_res_data-what-the-data-shows" name="What%20the%20data%20shows" title="What the data shows"></a><h2>What the data shows</h2> <h3>Illnesses and outbreaks data</h3> <p>Although most enteric illnesses – including those caused by REPEXH01 – are not part of an outbreak, investigation of outbreaks provides information that increases our understanding of germs, sources, settings, and factors that contribute to illness. Moreover, lab-confirmed cases comprise only a small portion of the true number of illnesses that occur because most people do not seek medical care and even fewer submit a stool specimen.</p> <p>Starting in 2017, CDC and local, state, and federal health and regulatory partners have investigated several outbreaks of <em>E. coli</em> O157:H7 illnesses caused by the REPEXH01 strain.</p> <h4>Summary of Selected Multistate Outbreaks</h4> <div class="dfe-block dfe-block--cdcmodule"><div class="cdc-textblock"><div class="table-responsive"> <table class="table table-striped main|gray-l4 table-sm fs08 table-bordered" style="border-collapse: collapse;"> <caption class="sr-only d-none">Summary of selected multistate outbreaks</caption> <thead class="table-primary"> <tr> <th class="text-center valign-text-top" scope="col">Outbreak</th> <th class="text-center valign-text-top" scope="col">Dates People<br> Got Ill*</th> <th class="text-center valign-text-top" scope="col">Outbreak<br> Source&dagger;</th> <th class="text-center valign-text-top" scope="col">Geographic Location of<br> Outbreak Source**</th> <th class="text-center valign-text-top" scope="col">Reported<br> Illnesses</th> <th class="text-center valign-text-top" scope="col">Number of States<br> with Illnesses</th> </tr> </thead> <tbody> <tr> <td class="text-center">Outbreak A</td> <td class="text-center">July 2017</td> <td class="text-center">Recreational water<br> (confirmed)</td> <td class="text-center">California</td> <td class="text-center">10</td> <td class="text-center">1</td> </tr> <tr> <td class="text-center">Outbreak B</td> <td class="text-center">March 2018–<br> August 2018</td> <td class="text-center">Romaine lettuce<br> (confirmed)</td> <td class="text-center">Arizona</td> <td class="text-center">238</td> <td class="text-center">37</td> </tr> <tr> <td class="text-center">Outbreak C</td> <td class="text-center">August 2018–<br> October 2018</td> <td class="text-center">Ground beef<br> (suspected)</td> <td class="text-center">Unknown</td> <td class="text-center">12</td> <td class="text-center">4</td> </tr> <tr> <td class="text-center">Outbreak D</td> <td class="text-center">October 2018–<br> December 2018</td> <td class="text-center">Leafy greens<br> (suspected)</td> <td class="text-center">Unknown</td> <td class="text-center">25</td> <td class="text-center">10</td> </tr> <tr> <td class="text-center">Outbreak E</td> <td class="text-center">May 2019–<br> October 2019</td> <td class="text-center">Ground beef<br> (suspected)</td> <td class="text-center">Unknown</td> <td class="text-center">44</td> <td class="text-center">12</td> </tr> <tr> <td class="text-center">Outbreak F</td> <td class="text-center">December 2020–<br> January 2021</td> <td class="text-center">Unknown</td> <td class="text-center">Unknown</td> <td class="text-center">22</td> <td class="text-center">7</td> </tr> <tr> <td class="text-center">Outbreak G</td> <td class="text-center">April 2021–<br> June 2021</td> <td class="text-center">Unknown</td> <td class="text-center">Unknown</td> <td class="text-center">5</td> <td class="text-center">3</td> </tr> </tbody> </table> </div> </div></div><h4>Selected Outbreak Publications</h4> <ul class="nested-list"> <li class="level-1">Outbreak B - <a href="https://archive.cdc.gov/#/details?url=https://www.cdc.gov/ecoli/2018/o157h7-04-18/index.html" class="">Multistate Outbreak of <em>E. coli</em> O157:H7 Infections Linked to Romaine Lettuce</a><br><ul> </ul> </li> <li class="level-1">Outbreak B - <a href="https://academic.oup.com/cid/article/71/8/e323/5669965?login=true" class="tp-link-policy" data-domain-ext="com">Shiga Toxin–Producing <em>Escherichia coli</em> Infections Associated With Romaine Lettuce—United States, 2018<span class="visually-hidden sr-only" aria-label=" external icon" role="img"></span><span class="cdc-icon-external cdc-link-icon" aria-hidden="true" alt="external icon"></span></a><br><ul> </ul> </li> <li class="level-1"><em></em>Outbreak F - <a href="https://archive.cdc.gov/#/details?url=https://www.cdc.gov/ecoli/2021/o157h7-02-21/index.html&CDC_AAref_Val=https://www.cdc.gov/ecoli/2021/o157h7-02-21/index.html" class=""><em>E. coli</em> Outbreak with Unknown Food Source</a><br><ul> </ul> </li> </ul> <h4>Timeline</h4> <p>People with <em>E. coli</em> O157:H7 illnesses caused by the REPEXH01 strain, by date illness began, 2017–2022</p> <div class="dfe-block dfe-block--cdcmodule"><div class="mb-3"><div data-language="en" data-host="www.cdc.gov" class="wcms-viz-container" data-config-url="/ecoli/media/modules/repexh01-epi-new.json" data-sid=""></div></div></div><h4>Map</h4> <p><em>E. coli</em> O157:H7 illnesses caused by the REPEXH01 strain, by state, 2017–2022</p> <div class="dfe-block dfe-block--cdcmodule"><div class="mb-3"><div data-language="en" data-host="www.cdc.gov" class="wcms-viz-container" data-config-url="/ecoli/media/modules/map.json" data-sid=""></div></div></div><h3>Laboratory data</h3> <p>Bacteria in this strain are within 21 allele differences of one another by <a href="https://www.liebertpub.com/doi/10.1089/fpd.2019.2637" class="tp-link-policy" data-domain-ext="com">core genome multilocus sequence typing (cgMLST)<span class="visually-hidden sr-only" aria-label=" external icon" role="img"></span><span class="cdc-icon-external cdc-link-icon" aria-hidden="true" alt="external icon"></span></a>, which is more diverse than typical multistate foodborne outbreaks where bacteria generally fall within 10 allele differences of one another.</p> <p>This strain includes two major genetic subclusters. Each has caused at least two outbreaks linked to different sources and geographic regions. Possible reasons for the differences among genetic subclusters are still being investigated. More research is needed to determine if any genetic subclusters are associated with specific foods, animal populations, or geographic regions.</p> <h4>Isolates from food, animal, and environmental samples</h4> <div class="dfe-block dfe-block--cdcmodule"><div class="cdc-textblock"><div class="table-responsive"> <table class="table table-striped main|gray-l4 table-sm fs08 table-bordered" style="border-collapse: collapse;"> <caption class="sr-only d-none">Isolates from food, animal, and environmental samples</caption> <thead class="table-primary"> <tr> <th class="text-center valign-text-top" scope="col">Year</th> <th class="text-center valign-text-top" scope="col">Number<br> of Isolates</th> <th class="text-center valign-text-top" scope="col">Isolate Type</th> <th class="text-center valign-text-top" scope="col">Geographic Location<br> of Source</th> <th class="text-center valign-text-top" scope="col">Reason<br> Collected</th> </tr> </thead> <tbody> <tr> <td class="text-center">2017</td> <td class="text-center">1</td> <td class="text-center">Goose feces</td> <td class="text-center">California</td> <td class="text-center">Outbreak A</td> </tr> <tr> <td class="text-center">2017</td> <td class="text-center">2</td> <td class="text-center">Lake sediment</td> <td class="text-center">California</td> <td class="text-center">Outbreak A</td> </tr> <tr> <td class="text-center">2017</td> <td class="text-center">4</td> <td class="text-center">Lake water</td> <td class="text-center">California</td> <td class="text-center">Outbreak A</td> </tr> <tr> <td class="text-center">2018</td> <td class="text-center">24</td> <td class="text-center">Agricultural irrigation<br> water</td> <td class="text-center">Arizona</td> <td class="text-center">Outbreak B</td> </tr> <tr> <td class="text-center">2019</td> <td class="text-center">1</td> <td class="text-center">Ground beef</td> <td class="text-center">California</td> <td class="text-center">Routine Sampling</td> </tr> </tbody> </table> </div> </div></div><p>The National Center for Biotechnology Information (NCBI) advances science and health by providing access to biomedical and genomic information. To view the full SNP cluster, click on the link below; then within NCBI's platform click the link underneath the "SNP Cluster" column.</p> <p><strong>SNP Cluster associated with isolate: <a href="https://www.ncbi.nlm.nih.gov/pathogens/isolates/#PNUSAE013425" class="tp-link-policy" data-domain-ext="gov">PNUSAE031425<span class="visually-hidden sr-only" aria-label=" external icon" role="img"></span><span class="cdc-icon-external cdc-link-icon" aria-hidden="true" alt="external icon"></span></a></strong></p> <p>The <a href="/narms/index.html">National Antimicrobial Resistance Monitoring System</a> (NARMS) is a national public health surveillance system that tracks antimicrobial resistance for certain intestinal bacteria from ill people (CDC), <a href="https://www.fda.gov/animal-veterinary/antimicrobial-resistance/national-antimicrobial-resistance-monitoring-system" class="tp-link-policy" data-domain-ext="gov">retail meats<span class="visually-hidden sr-only" aria-label=" external icon" role="img"></span><span class="cdc-icon-external cdc-link-icon" aria-hidden="true" alt="external icon"></span></a> (FDA), and <a href="https://www.fsis.usda.gov/science-data/data-sets-visualizations/microbiology/national-antimicrobial-resistance-monitoring" class="tp-link-policy" data-domain-ext="gov">food animals<span class="visually-hidden sr-only" aria-label=" external icon" role="img"></span><span class="cdc-icon-external cdc-link-icon" aria-hidden="true" alt="external icon"></span></a> (USDA) in the United States. The NARMS program helps protect public health by providing information about emerging antimicrobial resistance, the ways in which resistance is spread, and how resistant infections differ from susceptible infections.</p> <p>Bacteria from most ill people’s samples showed resistance to the antimicrobials chloramphenicol, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. These findings do not affect treatment guidance because antimicrobials are not recommended for patients with <em>E. coli</em> O157:H7 infection.</p> <h4>Antimicrobial resistant isolates</h4> <p>Percentage of <em>E. coli</em> O157:H7 REPEXH01 isolates from ill people that were antimicrobial resistant, by antimicrobial (n = 596), as of August 31, 2022 — National Antimicrobial Resistance Monitoring System</p> <div class="dfe-block dfe-block--cdcmodule"><div class="mb-3"><div data-language="en" data-host="www.cdc.gov" class="wcms-viz-container" data-config-url="/ecoli/media/modules/narms.json" data-sid=""></div></div></div> </div> <div class="dfe-section" data-section="cdc_research_or_data_summary_explore_more"> <a class="onThisPageAnchor" id="cdc_research_or_data_summary_explore_more-collaborate-with-cdc" name="Collaborate%20with%20CDC" title="Collaborate with CDC"></a><h2>Collaborate with CDC</h2> <p>Interested in collaborating on a project related to this strain? Contact CDC at <a href="mailto:REPStrains@cdc.gov">REPStrains@cdc.gov</a>.</p> </div> <div class="dfe-section" data-section="cdc_research_or_data_summary_about_the_data_research"> <a class="onThisPageAnchor" id="cdc_research_or_data_summary_about_the_data_research-about-the-data" name="About%20the%20data" title="About the data"></a><h2>About the data</h2> <p><strong>Summary of Selected Multistate Outbreaks</strong></p> <p>Outbreak dates are based on reported or estimated illness onset dates.</p> <p>Confirmed sources were implicated by epidemiologic plus traceback or laboratory data. Suspected sources were implicated by epidemiologic data only. <a href="/foodsafety/outbreaks/multistate-outbreaks/annual-summaries.html" class="">More info</a></p> <p>The geographic location of a confirmed outbreak source may not always be known. This can happen when a food containing multiple ingredients (e.g., bagged salad blend) is confirmed as the source, but the evidence cannot implicate a specific food, or when evidence confirms an outbreak source but traceback cannot pinpoint the exact geographic location of the source.</p> <p><strong>Timeline</strong></p> <p>N=634 for whom information was reported as of September 2, 2022. Some illness onset dates have been estimated from other reported information.</p> <p>PulseNet transitioned to using <a href="/pulsenet/pathogens/wgs.html" class="">whole genome sequencing</a> (WGS) as the standard subtyping method for STEC in July 2019. Before then, not all STEC isolates reported to PulseNet had WGS data available. Isolates are identified as part of this strain based on WGS. As a result, the number of people with lab-confirmed illness caused by this strain before 2019 may be underrepresented.</p> <p><strong>Map</strong></p> <p>Outbreak dates are estimated, based on reported or estimated illness onset dates.</p> <p><strong>Antimicrobial resistant isolates</strong></p> <p>Resistance was determined based on the results of antimicrobial susceptibility testing when available (n = 73 isolates); otherwise, resistance was predicted based on whole genome sequencing (n = 523).</p> <p>Includes isolates carrying a single quinolone resistance gene (n = 2; 0.3%); a single gene may result in interpretation of “intermediate” or “susceptible” for ciprofloxacin on antimicrobial susceptibility testing.</p> </div> <div class="dfe-section" data-section="cdc_research_or_data_summary_suggested_citation"> <a class="onThisPageAnchor" id="cdc_research_or_data_summary_suggested_citation-suggested-citation" name="Suggested%20citation" title="Suggested citation"></a><h2>Suggested citation</h2> <p>Centers for Disease Control and Prevention. (2024). Data Summary: Persistent Strain of <em>E. coli</em> O157:H7 (REPEXH01) Linked to Multiple Sources.</p> </div> </div> <div class="cdc-dfe-body__right page-right-rail"> <aside class="page-right-rail__static noindex" role="complementary"> <div class="on-this-page " data-sid=""> <h2 class="on-this-page__heading"> On This Page </h2> <div class="card-body"> <ul> <li><a href="#cdc_research_or_data_summary_overview-at-a-glance">At a glance</a></li> <li><a href="#cdc_research_or_data_summary_findings-key-findings">Key findings</a></li> <li><a href="#cdc_research_or_data_summary_res_data-what-the-data-shows">What the data shows</a></li> <li><a href="#cdc_research_or_data_summary_explore_more-collaborate-with-cdc">Collaborate with CDC</a></li> <li><a href="#cdc_research_or_data_summary_about_the_data_research-about-the-data">About the data</a></li> <li><a href="#cdc_research_or_data_summary_suggested_citation-suggested-citation">Suggested citation</a></li> </ul> </div> </div> </aside> <aside class="page-right-rail__dynamic noindex" role="complementary"> <div data-related-nav></div> </aside> </div> </div> <div data-journey-next></div> <section class="container page-mobile-bar"> <time class="page-mobile-bar__item page-mobile-bar__item--date" datetime="2024-03-20 00:00:00"> March 20, 2024 </time> </section> <div class="page-content-sources noindex"> <div class="page-content-sources__header"> <a data-action="summary" class="collapsed" href="#content-sources" role="button" data-bs-toggle="collapse" aria-expanded="false" aria-controls="content-sources" data-cs-toggle="">Sources</a> <a data-action="print" href="#print" class="d-none d-md-block" aria-label="print this page" onclick="window.print()">Print</a> <a data-action="share" href="#share" data-bs-toggle="dropdown" aria-label="share this page" aria-expanded="false">Share</a> <div class="dropdown-menu page-share-bar" data-popper-placement="bottom-start"> <a href="#" class="page-share-facebook"><span class="cdc-icon-facebook"></span></a> <a href="#" class="page-share-linkedin"><span class="cdc-icon-linkedin"></span></a> <a href="#" class="page-share-twitter"><span class="cdc-icon-twitter"></span></a> <a href="#" class="page-share-syndication"><span class="cdc-icon-rss"></span></a> </div> </div> <div class="page-share-container"> <div class="page-share-popup" id="page-share-popup" role="dialog"> <a target="_blank" title="Share to Facebook" rel="noreferrer noopener" class="page-share-facebook metrics-share-facebook" href="https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fwww.cdc.gov"> <span class="sr-only">Facebook</span> <span class="cdc-icon-facebook-inverse"></span> </a> <a target="_blank" title="Share to LinkedIn" rel="noreferrer noopener" class="page-share-linkedin metrics-share-linkedin" href="https://www.linkedin.com/shareArticle?url=https%3A%2F%2Fwww.cdc.gov&title=Living%20with%20High%20Blood%20Pressure"> <span class="sr-only">LinkedIn</span> <span class="cdc-icon-linkedin-inverse"></span> </a> <a target="_blank" title="Share to Twitter" rel="noreferrer noopener" class="page-share-twitter metrics-share-twitter" href="https://twitter.com/share?url=https%3A%2F%2Fwww.cdc.gov&text=Living%20with%20High%20Blood%20Pressure"> <span class="sr-only">Twitter</span> <span class="cdc-icon-twitter-inverse"></span> </a> <a target="_blank" title="Embed this Page" rel="noreferrer noopener" class="page-share-syndication metrics-share-syndicate" href="https://tools.cdc.gov/medialibrary/index.aspx#/sharecontent/https://https://www.cdc.gov/ecoli/rep-strain/index.html"> <span class="sr-only">Syndicate</span> <span class="fi cdc-icon-syndication-round"></span> </a> </div> </div> <div id="content-sources" class="page-content-sources__body accordion-collapse collapse"> <div class="callout callout-content-source" role="status"> <div class="callout-heading">Content Source:</div> <a class="cdc-block-link" href="/ncezid/index.html">National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)</a> </div> </div> </div> <section class="container related-pages related-pages__mobile"> <div data-related-nav-mobile></div> </section> </div> </main> <section class="site-footer container noindex"> <div class="row cdc-footer__inner"> <div class="col-lg-3 site-footer__heading"> <h2> <a href="/ecoli/about/index.html"> <span class="cdc-footer__super-title" aria-label="<em>E. coli</em> Infection (<em>Escherichia coli</em>)"> <a href="/ecoli/about/index.html"> <em>E. coli </em>infection </a> <i class="cdc-icon cdc-fa-light cdc-fa-angle-right"></i> </span> </a> </h2> <p>Six types of <em>E. coli </em>can cause diarrheal illness in people. 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