Can I become ill from all E. coli bacteria?

E. coli bacteria are naturally present in our intestines. They are usually harmless, but there are also E. coli bacteria that can make people seriously ill. One example is shigatoxogenic E. coli (STEC). This is a group of bacteria that produce shigatoxin, which damages the cells in the intestinal wall. The best-known bacteria in this group is enterohemorrhagic E. coli (EHEC),which can cause a severe intestinal infection with bloody diarrhoea.

STEC, and EHEC in particular, are the main pathogenic E. coli bacteria found in the Netherlands. All references to E. coli infection on this page are about an infection involving STEC/EHEC.

How can I recognize an E. coli infection?

People who become ill from E. coli often have:

• diarrhoea, sometimes with blood
• stomach pain and cramps
• nausea and vomiting

The severity of these symptoms varies from case to case. Some people hardly suffer from any symptoms or only have mild diarrhoea.  In very rare cases, people become so ill that they need to be admitted to hospital. This can be due to dehydration, for example, or because they develop kidney problems.

Who can become very ill from E. coli?

Anyone can contract an E. coli infection. Some people are more likely to become ill from it:

• children under 5 years
• adults over 60 years
• people who have reduced immunity due to illness

Children under 5 years and adults over 60 years are also more likely to develop kidney problems due to E. coli.

How does E. coli spread?

An E. coli infection is contagious. The bacteria are found in the faeces of an infected person. After using the toilet, there may be E. coli bacteria on the toilet seat, flush knob, tap handle or door handle. Bacteria can also be transferred to mouth, objects, and food through hand contact. A person with an E. coli infection can infect others as long as they have symptoms, and sometimes even longer.

E. coli can also be found in the intestines of animals, especially farm animals.  These animals do not become ill from the bacteria, but they can transmit E. coli to humans. E. coli can be transmitted via:

• meat: by eating raw or undercooked meat.
• dairy products: by drinking raw milk or eating cheese made from raw milk, such as some types of blue cheese.
• vegetables: by eating raw and unwashed vegetables that have been fertilized with manure containing the bacteria. Vegetables can also become contaminated through contact with water containing the bacteria.
• contact with farm animals: for example, by petting animals at a petting zoo without washing your hands afterwards.

The incubation period between exposure and illness is 1 to 7 days. Symptoms usually start after 3 or 4 days.

How can I prevent an E. coli infection?

There are no immunisations or medicines to prevent an E. coli infection. That is why you cannot always avoid exposure and illness. However, good hygiene – such as washing hands and regularly cleaning the toilet – does help to prevent infection. Always cook meat thoroughly and wash fruit and vegetables well.

Is there any treatment for E. coli infections?

E. coli infection usually resolves on its own after two to nine days. If your illness is growing steadily worse, or other people in your household also develop symptoms, contact your GP.

Even if you have already had an E. coli infection before, it is possible to have a new infection later.

How common is E. coli in the Netherlands?

Since 2022, the Municipal Public Health Service (GGD) has received between 550 and 650 reports of people with a STEC infection. These reported cases involved people who were ill enough that they were tested by a doctor. The doctor is required to report the case if the test shows that the patient has an STEC infection.

The actual number of STEC infections in the Netherlands is unknown, because people who are less severely ill are not tested. An international study shows that the number of infections is approximately 69 times higher than the number of reported cases.
This means that an estimated 35,000 people in the Netherlands are infected with STEC each year.

Can a person with an E. coli infection go to childcare, school or work?

Someone suffering from diarrhoea caused by E. coli infection is temporarily not allowed to go to childcare, school or work.  This is to prevent them from passing the bacteria to others.

• Children under 5 and people who work with food or in healthcare may only return once two laboratory tests have shown that the bacteria are no longer present in their body.
• Older children and adults who do not perform high-risk work may return once they have been free of diarrhoea for at least one day.

A doctor or the Municipal Health Service (GGD) will always consult with parents or employers to determine when someone can safely return. In some cases, the person could be temporarily assigned to other work. This is possible if proper hygiene measures are in place to prevent the bacteria from being transmitted.