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Re: Europe - 36 dead, 3500+ infected, 800+ severe cases of E-coli - EHEC STEC hemolytic uremic syndrome

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  • #16
    Re: Europe - 30 dead, 2800+ infected, 722 severe cases of E-coli - EHEC STEC hemolytic uremic syndrome
    Source: ProMed

    Archive Number 20110613.1798
    Published Date 13-JUN-2011
    Subject PRO/AH/EDR> E. coli O104 - EU (17): case update, medical care stretched
    ************************************************** *********************
    A ProMED-mail post
    ProMED-mail is a program of the
    International Society for Infectious Diseases

    In this update:
    [1] ECDC update
    [2] WHO update
    [3] Medical care in the wake of the epidemic

    [1] ECDC update
    Date: Sun 12 Jun 2011
    Source: European Center for Disease Control (ECDC) [edited]
    < 6d6%2Dbf0f23083f30&ID=1108&RootFolder=%2Fen%2Facti vities%2Fsciadvice%2FLists%2FECDC%20Reviews>

    Epidemiological update, 12 Jun 2011, 11:00
    On 22 May 2011, Germany reported a significant increase in the number
    of patients with hemolytic uremic syndrome (HUS) and bloody diarrhea
    caused by a Shiga toxin-producing _E. coli_ (STEC). Since 2 May 2011,
    809 cases of HUS and 2474 non-HUS STEC cases have been reported from
    European Union Member States, including 773 HUS cases and 2387 non-HUS
    STEC cases in Germany. 23 of the HUS cases and 12 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[ European Economic
    Area], 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-positive, eae-negative, hly-negative, ESBL, aat, aggR, aap) is
    the causative agent. PFGE [pulsed field gel electrophoresis] 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 _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.

    Table: number of HUS and non-HUS STEC cases and associated deaths per
    EU/EEA Member States as of 12 Jun 11:00

    EU Member State: HUS cases (deaths) / 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: 773 (22) / 2387 (12)
    Greece: 0 (0) / 1 (0)
    Luxembourg: 0 (0) / 2 (0)
    The Netherlands: 4 (0) / 4 (0)
    Norway: 0 (0) / 1 (0)
    Poland: 2 (0) / 0 (0)
    Spain: 1 (0) / 1 (0)
    Sweden: 17 (1) / 30 (0)
    United Kingdom: 3 (0) / 3 (0)
    Total: 809 (23) / 2447 (12)

    Total cases HUS + Non-HUS = 3256, Total deaths = 35
    Case fatality rate = 1.07 percent

    Communicated by:

    [2] WHO update
    Date: Sat 11 Jun 2011
    Source: WHO, Regional Office for Europe, International Health
    Regulations [edited]

    Enterohemorrhagic _E. coli_ (EHEC) outbreak: update 14
    On 10 Jun 2011, German authorities stated that mounting
    epidemiological and food-chain evidence indicated that bean and seed
    sprouts (including fenugreek, mung beans, lentils, adzuki beans, and
    alfalfa) are the vehicle of the outbreak in Germany.

    On 10 Jun 2011, authorities from the Robert Koch-Institute (RKI), the
    Federal Institute for Risk Assessment (BfR) and the Federal Office of
    Consumer Protection and Food Safety (BVL) jointly stated that mounting
    epidemiological and food-chain evidence indicated that bean and seed
    sprouts (including fenugreek, mung beans, lentils, adzuki beans, and
    alfalfa) are the vehicle of the outbreak in Germany caused by the
    unusual enteroaggregative verocytotoxin-producing _Escherichia coli_
    (EAggEC VTEC) O104:H4 bacterium. The outbreak remains primarily
    centered in Germany.

    - The authorities now recommend that people in Germany should not eat
    raw bean and seed sprouts of any origin. Households, caterers, and
    restaurants should dispose of any bean and seed sprouts that they
    have, and any food items that might have been in contact with them,
    until further notice.
    - The recommendation not to eat cucumbers, tomatoes, and leafy salads
    in northern Germany is cancelled.
    - They recommend withdrawal from the market of all food products from
    a farm in Lower Saxony, where the implicated bean and seed sprouts
    - Numerous investigations continue, including into delivery chains.
    So far, there is no evidence that bean and seed sprouts from the farm
    have been exported beyond Germany.
    - The authorities recommend strict adherence to general hygiene
    advice when handling food items, after using the toilet, and when
    health professionals are in contact with patients.

    Hemolytic uremic syndrome (HUS)
    As of 10 Jun 2011 at 15:00 CET, Germany had reported 773 HUS cases
    (including 22 fatalities): 14 more cases and 1 additional deaths since
    the previous day. 68 percent of cases were in females and 88 percent
    in adults aged 20 years or older, with the highest attack rates per
    100 000 population in the group aged 20-49 years. Case-onset dates
    ranged from 1 May to 6 Jun 2011.

    Enterohemorrhagic _E. coli_ (EHEC)
    As of 10 Jun 2011 at 15:00 CET, 2374 cases of EHEC infection (without
    HUS) had been reported in Germany (12 fatal): 145 more cases and 3
    more deaths since the previous day. 60 percent of cases were in
    females and 87 percent in adults aged 20 years or older. Case-onset
    dates ranged from 1 May to 6 Jun 2011.

    RKI stated that the number of notified HUS/EHEC cases reported to it
    has declined over the past few days. The daily absolute and relative
    numbers of patients presenting to hospital emergency departments with
    bloody diarrhea have also decreased. It is still uncertain whether
    this decline in outbreak activity is due to changes in consumption of
    raw vegetables and/or the waning of the source of infection. However,
    the previously observed decrease of daily absolute and relative number
    of patients presenting to emergency departments with bloody diarrhea
    in hospitals participating in a voluntary surveillance system has not
    further decreased since 6 Jun 2011.

    Other countries
    As of 10 Jun 2011, 13 other European countries had reported a total
    of 36 HUS cases (12 fatal) and 66 EHEC cases (none fatal): 0 more HUS
    cases and 3 more EHEC cases since the previous day. In addition, the
    CDC in the USA have published information on 3 HUS cases (1 confirmed
    and 2 suspected) and 2 suspected EHEC cases (without HUS) in the USA
    linked to this outbreak. On 7 Jun 2011, the Public Health Agency of
    Canada reported on 1 suspected case of _E. coli_ O104 infection
    (without HUS), in a person with travel history to northern Germany and
    with links to a confirmed case of _E. coli_ O104 infection in

    There are 3255 HUS and EHEC cases in total, including 35 fatalities.
    All but 5 of the HUS and EHEC cases above were in people who had
    traveled to or lived in Germany during the incubation period for
    infection, typically 3-4 days after exposure (range: 2-10 days).

    EHEC and HUS have exclusive notification categories, so case numbers
    should not overlap. The figures in any rapidly evolving outbreak,
    however, are provisional and subject to change for a variety of

    Communicated by:

    [3] Medical care in the wake of the epidemic
    Date: Sat 11 Jun 2011
    Source: US National Public Radio (NPR), Associated Press (AP) report

    Blood specialist Dr Cay-Uwe von Seydewitz has been making his rounds
    16 to 18 hours a day, 7 days a week, since the outbreak of a deadly
    bacterial epidemic. The wing he's in charge of was a construction site
    a month ago, hastily converted back into useable space to keep up with
    the spike in patients needing massive blood plasma exchanges to try
    and purge their systems of the toxins from the aggressive, previously
    unknown form of _E. coli_.

    Like other doctors, nurses, and hospital staff around Germany, for
    von Seydewitz taking a day off has not been an option. "If you have a
    new illness, it's important to have the same doctor from the start to
    the end to see how it changes over time," said von Seydewitz, wearing
    blue hospital scrubs and sporting a 5 o'clock shadow at midday,
    standing near stacks of supplies in brown boxes still on their

    Investigators on Fri 10 Jun 2011, breathed a sigh of relief, saying
    that their epidemiological probe of the pattern of the outbreak
    produced enough evidence to conclude vegetable sprouts from a farm in
    Lower Saxony were the cause of the outbreak, even while noting that
    work for medical professionals was far from over.

    "There will be new cases," warned Reinhard Burger, head of the Robert
    Koch Institute -- Germany's national disease control center.

    In Kiel and Luebeck, which have also been hit hard in the outbreak,
    doctors have been taking only short naps on stretchers in hospital
    hallways and staying in the building for days in a row, said Oliver
    Grieve, the spokesman for the university hospitals in the northern

    Others canceled their vacations or called in from hospitals around
    the country to offer their help for overwhelmed clinics in northern
    Germany. "There has been a very high level of commitment," Grieve
    said. "It is amazing to see how everyone has done the utmost to help
    out in this crisis."

    More than 700 of the patients in Germany are suffering not only from
    diarrhea and cramps but have also developed a life-threatening
    complication that can cause kidney failure, and require
    round-the-clock medical care.

    Dr Friedrich Hagenmueller, the medical director of Asklepios Hospital
    Altona, the hospital where von Seydewitz works, which has seen about
    200 patients total, noted that with such an illness it's not just the
    doctors and nurses working overtime but the cleaning staff.

    "We brought people back from the holidays, they must constantly clean
    and disinfect the toilets," he told The Associated Press during a
    break in making his rounds. "The turnover of the patients is
    relatively quick, and when a patient is released they have to quickly
    clean and disinfect the toilets and I haven't heard a word of

    While the numbers of newly infected patients are slowly declining,
    hospitals are still working to the limit with hundreds of people still
    in intensive care. Earlier this week, health authorities said there
    were still some 670 patients suffering from severe complications
    including kidney failure, paralysis, and epileptic seizures. "We still
    have some extra 12 dialysis nurses from southern Germany working with
    us" at the university hospitals in Kiel and Luebeck, Grieve said.

    At Asklepios Hospital in Hamburg this week, von Seydewitz was
    overseeing 22 patients undergoing blood plasma exchange to try and
    remove the toxins from their system. In the procedure, doctors remove
    which 4 liters (quarts) of blood plasma and replace it with fresh
    plasma for 3 days in a row -- or longer if needed.

    At the start of the outbreak von Seydewitz said he only had 2
    machines to perform the relatively rare procedure, but since then has
    leased more machines, and borrowed others from the hospital's dialysis
    treatment area and now has a total of 8 functioning. "Now we also have
    patients from other hospitals for the procedure," he said.

    With the high demand for blood plasma, Germany's Red Cross has begun
    special blood drives. In normal times, hospitals need between 500 and
    700 of the 250 mL (8.5 fluid ounces) portions of blood plasma in 14
    days; they used 12 000 portions in the last 2 weeks, said Jense Lichte
    from the Red Cross.

    People responded, with donations up 14.5 percent since the outbreak
    began, he said. "Luckily, Germans have been coming to our blood
    drives," Lichte said, saying that despite the high demand the country
    never ran close to a real shortage.

    In addition to physical exhaustion, some doctors say the epidemic has
    also taken a high emotional toll. "It has been very stressful for all
    of us because we are dealing predominantly with younger patients
    without significant previous diseases ... many of us were deeply moved
    when a lot of these cases developed in such a dramatic way," said Marc
    Voss, a senior internist at Regio Clinic Elmshorn northwest of
    Hamburg. "The identification with the patients is very high, because
    one thinks 'it could have been me.'"

    Some 77 percent of patients in Germany are women and the majority of
    them are between 20 and 50 years old, most fit and with healthy

    "Our staffers are used to seeing very severe cases," said Grieve.
    "But to see those young, healthy girls break down from one day to the
    next, getting cramps and slipping into coma, that's been the most
    stressful thing ever."

    Grieve added that even the psychologists at the hospitals were
    working day and night to comfort the traumatized family members of the
    sick who have been waiting for weeks in some cases for signs of

    [Byline: Kirsten Grieshaber, Dorothee Thiesing]

    Communicated by:

    [It is important to underscore this report. Any catastrophe (whether
    the morbidities and mortalities are caused by a tornado, an
    earthquake, a tsunami, or a natural or man-made epidemic) puts extreme
    stress upon the health care infrastructure. The ability to respond to
    the surge of needed emergency room visits, hospital admissions,
    surgical procedures, ventilators, medications, blood/blood products,
    and health care deliverers and their support staff can be extremely
    problematic and this moderator cannot stress any stronger what a
    phenomenal job the German medical infrastructure is doing. Seeing
    previously healthy relative young individuals on the edge of death or
    worse makes the long and severe environment even worse... really it is
    a war zone with the enemy being _E. coli instead of _H. sapiens_.

    Even as new cases in the EU appear to be dropping, the sprouts may be
    over, but the malady lingers on. - Mod.LL]

    [see also:
    E. coli O104 - EU (16): case update, 20110610.1766
    E. coli O104 - EU (15): case update, EaggEC VTEC O104:H4
    E. coli O104 - EU (14): case update, neurological symptoms
    E. coli O104 - EU (13): case update, new countries 20110607.1737
    E. coli O104 - EU (12): sprout cultures negative so far
    E. coli O104 - EU (11): case update, poss. sprout source
    E. coli O104 - EU (10): USA commentary 20110605.1718
    E. coli O104 - EU (09) & USA 20110603.1701
    E. coli O104 - EU (08) & USA: genetic analysis, more cases
    E. coli O104 - EU (07) & USA 20110601.1678
    E. coli O104 - EU (06) & USA 20110531.1666
    E. coli O104 - EU (05): (Germany) monoclonal antibody trial
    E. coli O104 - EU (04): (Germany) more deaths & HUS cases
    E. coli O104 - EU (03): (Germany, EU ex Germany) alert 20110527.1629
    E. coli O104 - EU (02): (Germany, EU ex Germany), alert
    E. coli O104 - EU: (Germany, Denmark, Sweden) Spanish cucumbers
    E. coli VTEC - Germany (04): O104, poss. salad source 20110526.1600
    E. coli VTEC - Germany (03): O104, spread South 20110525.1587
    E. coli VTEC - Germany (02): increased case burden 20110524.1578
    E. coli VTEC - Germany: RFI 20110523.1566
    E. coli VTEC non-O157 - Japan: O111, raw beef, alert 20110504.1378
    E. coli VTEC non-O157 - USA (07): O26, ground beef, alert, recall
    E. coli VTEC non-O157 - USA (06): O145, lettuce 20100528.1777
    E. coli VTEC non-O157 - USA (03): O145, lettuce, recall
    E. coli VTEC non-O157 - USA (02): (OH, MI, NY) O145 20100505.1460
    E. coli VTEC non-O157 - USA: (MI, OH) 20100427.1358
    E. coli VTEC non-O157, restaurant - USA (04): (OK), O111
    E. coli VTEC non-O157, restaurant - USA: (OK), O111 20080902.2748
    E. coli VTEC non-O157, past. ice cream, 2007 - Belgium: Antwerp
    E. coli VTEC non-O157, beef sausage - Denmark 20070602.1784
    E. coli VTEC non-O157, 2000-2005 - USA (CT) 20070118.0240
    E. coli VTEC non-O157, lettuce - USA (UT)(02): background
    E. coli VTEC non-O157, lettuce - USA (UT) 20060904.2521
    E. coli VTEC non-O157 - Norway (03) 20060416.1133
    E. coli VTEC non-O157 - Norway 20060329.0947
    E. coli VTEC non-O157, minced beef - Norway 20060304.0680
    E. coli O145, fatal - Slovenia 20050916.2739
    E. coli, VTEC non-O157 - UK (Scotland): correction 20030828.2166
    E. coli, VTEC non-O157 - UK (Scotland) 20030825.2144
    E. coli O26 - South Korea 20010509.0896
    E. coli O111, diarrhea - USA (Texas) 19990707.1134
    E. coli, non-0157 - Belgium 19970610.1215]
    .................................................s b/ll/mj/mpp
    *################################################# #########*
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    • #17
      Re: Europe - 36 dead, 3500+ infected, 800+ severe cases of E-coli - EHEC STEC hemolytic uremic syndrome

      EU Ban on Egyptian Fenugreek Seeds Extended

      BY NEWS DESK | OCT 21, 2011

      Last week the European Commission lifted import restrictions on fresh and chilled podded peas and green beans and other fresh produce from Egypt. The ban had been an emergency action imposed in July, after imported Egyptian fenugreek seeds were blamed for the outbreak of E. coli O104:H4 linked to sprouts in Germany and France.

      But while fresh peas and beans got a green light, the temporary ban on Egyptian seeds and sprouts, scheduled to expire Oct. 31, will be extended until the end of March, following an "unsatisfactory audit" of seed producers in Egypt, the EC has decided.

      The extended ban involves arugula sprouts, leguminous vegetable sprouts (fresh or chilled), soy bean sprouts, dried (shelled) leguminous vegetables, fenugreek seeds, soy beans and mustard seeds.

      Details of the audit, which was conducted by the EC's Food & Veterinary Office from Aug. 21-25, are still under review, but will be published soon, the EC said in a statement.

      Briefly, the EC said the audit showed that measures taken by the Egyptian authorities to address shortcomings in the production of seeds that may be sprouted for human consumption were not sufficient "to tackle the identified risks."

      Those shortcomings were not seen in the growing and processing sites for fresh peas and beans, the EC said, therefore those vegetables are no longer considered a food safety risk.

      The European Commission's Standing Committee on the Food Chain and Animal Health endorsed the extension of the seed and sprout ban on Monday.

      Meanwhile, the European Commission awaits a scientific opinion from the European Food Safety Authority (EFSA) on the risk posed by Shiga-toxin producing E. coli (STEC) and other pathogenic bacteria in seeds and sprouts, shoots and cress derived from seeds. EFSA is expected to deliver that opinion by the end of this month.

      “Addressing chronic disease is an issue of human rights – that must be our call to arms"
      Richard Horton, Editor-in-Chief The Lancet

      ~~~~ Twitter:@GertvanderHoek ~~~ ~~~


      • #18
        Re: Europe - 36 dead, 3500+ infected, 800+ severe cases of E-coli - EHEC STEC hemolytic uremic syndrome

        Two years after: EHEC shaft with 53 deaths has left deep traces

        The EHEC epidemic can recur at any time with 53 deaths two years ago from the perspective of the Hanoverian kidney doctor Jan Kamal stone in a similar form. 'Our medical system must adapt to such events – whether EHEC or the swine flu,' said the expert of the EHEC from the medical school of Hanover of the dpa. The Berlin Robert Koch Institute dated the beginning of the outbreak of the epidemic on May 8, 2011. About 3800 people especially in Northern Germany suffer from the dangerous intestinal germ, 855 of the severe form of HUS. Currently, much less former EHEC patients suffer complications than was feared from Kiel stone according to. 'Well over 90 percent feel anything more,' said the Professor workers at the clinic for Nephrology. But long-term damage could turn out to be only after a few years. Together with colleagues and the German society for Nephrology, Kiel stone has built up an EHEC register that collects data from former EHEC patients. 'Throughout Germany are less than ten patients on dialysis, and they already had kidney problems', the doctor reported. A small number have more memory problems as well as anxiety and panic disorders.