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Outbreak of Shiga toxin-producing E. coli in Germany (13 June, 11:00)

13 Jun 2011

On 22 May, Germany reported a significant increase in the number of patients with haemolytic uremic syndrome (HUS) and bloody diarrhoea caused by Shiga toxin-producing E. coli (STEC). Since 2 May 2011, 817 cases of HUS and 2 508 non-HUS STEC cases have been reported from European Union Member States, including 781 HUS cases and 2 447 non-HUS STEC cases in Germany. 23 of the HUS cases and 13 of the non-HUS STEC cases in EU Member states have died. See table below.

While HUS, caused by STEC infections, is usually observed in children under 5 years of age, in this outbreak the great majority of cases are adults, with around two thirds being women.

Most cases are from, or have a history of travel to the North of Germany (mainly Schleswig-Holstein, Lower Saxony, North-Rhine-Westphalia and Hamburg). In the EU/EEA, Austria, Denmark, Germany, the Netherlands, Poland, Spain, Sweden and the United Kingdom have reported cases of HUS, while 5 other Member States have reported only non-HUS STEC cases.

Laboratory results indicate that STEC serogroup O104:H4 (Stx2-positve, eae-negative, hly-negative, ESBL, aat, aggR, aap) is the causative agent. PFGE results shows indistinguishable pattern of 7 human O104:H4 outbreak strains in Germany and 2 strains of O104:H4 in Denmark. STEC is a group of pathogenic Escherichia coli (E. coli) strains capable of producing Shiga toxins, with the potential to cause severe enteric and systemic disease in humans.

The clinical manifestations of the disease can be extremely severe.

Number of HUS and non-HUS STEC cases and associated deaths per EU/EEA Member States
as of 13 June 11:00


EU Member States
reporting cases

Number of HUS cases (deaths)

Number of non-HUS STEC cases (deaths)

Austria

1 (0)

3 (0)

Czech Republic

0 (0)

1 (0)

Denmark

8 (0)

12 (0)

France

0 (0)

2 (0)

Germany

781 (22)

2 447 (13)

Greece

0 (0)

1 (0)

Luxembourg

0 (0)

2 (0)

The Netherlands

4 (0)

4 (0)

Norway

0 (0)

1 (0)

Poland

2 (0)

1 (0)

Spain

1 (0)

1 (0)

Sweden

17 (1)

30 (0)

The United Kingdom

3 (0)

3 (0)

Total

817 (23)

2 508 (13)

Please note that since 8 June, Member States have started reporting cases according to a new EU case-definition (link to case definition). This resulted with marginal adjustments of figures compared to previous reports in five Member States, Finland (that is not reporting cases anymore), France, the Netherlands, Sweden and the United Kingdom.

The German Authorities have indicated that food items originating from a distinct producer in Lower Saxony (Germany) are the most likely vehicle of the infection. The German Authorities also declared that all food products (e.g. bean sprouts and other vegetables) originating from the mentioned producer in Lower Saxony shall be taken from the market.

Additional recommendations from the German Authorities are to adhere to good hygiene practices when handling food or caring for patients and to abstain from eating raw sprouts. Households and gastronomic businesses in Germany should dispose of any sprouts currently in stock as well as any food items that might have come in contact with these. The earlier recommendation from the German Authorities to abstain from eating cucumbers, tomatoes and lettuce in northern parts of Germany does not need to be upheld anymore.(http://www.rki.de/cln_151/nn_217400/EN/Home/PM082011.html)

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