Southern African Journal of Infectious Diseases, 2018; 33(1): 24–30Shiga toxin-producing Escherichia coli (STEC) O157:H7 is responsible for intestinal and extra-intestinal disease syndromes in human. Isolation of the pathogen from animals, food, clinical samples and environment has been reported from all continents. A review of STEC O157:H7 in Africa from a structured literature search of the PubMed electronic database is presented. It describes the epidemiological status of the pathogen on the aspects of source, transmission, pathogenesis, disease syndromes, diagnosis, disease burden and the challenges in treatment and control strategies. About a quarter of African countries have reported isolation of STEC O157:H7 either from humans, animals, food or the environment. Different methods have been used in detection of the pathogen. Most reported human infections do not show temporal relationships with reports of isolation of the pathogen from other sources such as animals, water or food. Lack of a direct link between isolates from humans and other sources makes it difficult to point out incident specific determinants and direction of transmission. The aim of this review is to give an insight into the features of STEC O157:H7 infection in Africa and draw the attention of various stakeholders to the public health threat of the pathogen for possible interdisciplinary and multi-sectoral joint efforts in the control strategies.