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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
E. COLI O104 - EUROPEAN UNION (17): CASE UPDATE, MEDICAL CARE
STRETCHED
************************************************** *********************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
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]
<http://www.ecdc.europa.eu/en/activities/sciadvice/Lists/ECDC%20Reviews/ECDC_DispForm.aspx?List=512ff74f%2D77d4%2D4ad8%2Db 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:
ProMED-mail
<promed@promedmail.org>
******
[2] WHO update
Date: Sat 11 Jun 2011
Source: WHO, Regional Office for Europe, International Health
Regulations [edited]
<http://www.euro.who.int/en/what-we-do/health-topics/emergencies/international-health-regulations/news/news/2011/06/ehec-outbreak-update-14>
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
originated.
- 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
Germany.
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
reasons.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
******
[3] Medical care in the wake of the epidemic
Date: Sat 11 Jun 2011
Source: US National Public Radio (NPR), Associated Press (AP) report
[edited]
<http://www.npr.org/2011/06/11/137122719/german-hospitals-stretched-thin-in-e-coli-crisis>
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
pallets.
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
cities.
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
complaint."
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
lifestyles.
"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
recovery.
[Byline: Kirsten Grieshaber, Dorothee Thiesing]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[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
20110609.1753
E. coli O104 - EU (14): case update, neurological symptoms
20110609.1747
E. coli O104 - EU (13): case update, new countries 20110607.1737
E. coli O104 - EU (12): sprout cultures negative so far
20110606.1731
E. coli O104 - EU (11): case update, poss. sprout source
20110605.1720
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
20110603.1692
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
20110529.1646
E. coli O104 - EU (04): (Germany) more deaths & HUS cases
20110528.1635
E. coli O104 - EU (03): (Germany, EU ex Germany) alert 20110527.1629
E. coli O104 - EU (02): (Germany, EU ex Germany), alert
20110527.1620
E. coli O104 - EU: (Germany, Denmark, Sweden) Spanish cucumbers
20110526.1611
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
2010
----
E. coli VTEC non-O157 - USA (07): O26, ground beef, alert, recall
20100831.3097
E. coli VTEC non-O157 - USA (06): O145, lettuce 20100528.1777
E. coli VTEC non-O157 - USA (03): O145, lettuce, recall
20100507.1483
E. coli VTEC non-O157 - USA (02): (OH, MI, NY) O145 20100505.1460
E. coli VTEC non-O157 - USA: (MI, OH) 20100427.1358
2008
----
E. coli VTEC non-O157, restaurant - USA (04): (OK), O111
20081201.3779
E. coli VTEC non-O157, restaurant - USA: (OK), O111 20080902.2748
E. coli VTEC non-O157, past. ice cream, 2007 - Belgium: Antwerp
20080218.0655
2007
----
E. coli VTEC non-O157, beef sausage - Denmark 20070602.1784
E. coli VTEC non-O157, 2000-2005 - USA (CT) 20070118.0240
2006
----
E. coli VTEC non-O157, lettuce - USA (UT)(02): background
20060905.2523
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
2005
----
E. coli O145, fatal - Slovenia 20050916.2739
2003
----
E. coli, VTEC non-O157 - UK (Scotland): correction 20030828.2166
E. coli, VTEC non-O157 - UK (Scotland) 20030825.2144
2001
----
E. coli O26 - South Korea 20010509.0896
1999
----
E. coli O111, diarrhea - USA (Texas) 19990707.1134
1997
----
E. coli, non-0157 - Belgium 19970610.1215]
.................................................s b/ll/mj/mpp
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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
E. COLI O104 - EUROPEAN UNION (17): CASE UPDATE, MEDICAL CARE
STRETCHED
************************************************** *********************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
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]
<http://www.ecdc.europa.eu/en/activities/sciadvice/Lists/ECDC%20Reviews/ECDC_DispForm.aspx?List=512ff74f%2D77d4%2D4ad8%2Db 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:
ProMED-mail
<promed@promedmail.org>
******
[2] WHO update
Date: Sat 11 Jun 2011
Source: WHO, Regional Office for Europe, International Health
Regulations [edited]
<http://www.euro.who.int/en/what-we-do/health-topics/emergencies/international-health-regulations/news/news/2011/06/ehec-outbreak-update-14>
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
originated.
- 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
Germany.
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
reasons.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
******
[3] Medical care in the wake of the epidemic
Date: Sat 11 Jun 2011
Source: US National Public Radio (NPR), Associated Press (AP) report
[edited]
<http://www.npr.org/2011/06/11/137122719/german-hospitals-stretched-thin-in-e-coli-crisis>
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
pallets.
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
cities.
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
complaint."
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
lifestyles.
"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
recovery.
[Byline: Kirsten Grieshaber, Dorothee Thiesing]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[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
20110609.1753
E. coli O104 - EU (14): case update, neurological symptoms
20110609.1747
E. coli O104 - EU (13): case update, new countries 20110607.1737
E. coli O104 - EU (12): sprout cultures negative so far
20110606.1731
E. coli O104 - EU (11): case update, poss. sprout source
20110605.1720
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
20110603.1692
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
20110529.1646
E. coli O104 - EU (04): (Germany) more deaths & HUS cases
20110528.1635
E. coli O104 - EU (03): (Germany, EU ex Germany) alert 20110527.1629
E. coli O104 - EU (02): (Germany, EU ex Germany), alert
20110527.1620
E. coli O104 - EU: (Germany, Denmark, Sweden) Spanish cucumbers
20110526.1611
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
2010
----
E. coli VTEC non-O157 - USA (07): O26, ground beef, alert, recall
20100831.3097
E. coli VTEC non-O157 - USA (06): O145, lettuce 20100528.1777
E. coli VTEC non-O157 - USA (03): O145, lettuce, recall
20100507.1483
E. coli VTEC non-O157 - USA (02): (OH, MI, NY) O145 20100505.1460
E. coli VTEC non-O157 - USA: (MI, OH) 20100427.1358
2008
----
E. coli VTEC non-O157, restaurant - USA (04): (OK), O111
20081201.3779
E. coli VTEC non-O157, restaurant - USA: (OK), O111 20080902.2748
E. coli VTEC non-O157, past. ice cream, 2007 - Belgium: Antwerp
20080218.0655
2007
----
E. coli VTEC non-O157, beef sausage - Denmark 20070602.1784
E. coli VTEC non-O157, 2000-2005 - USA (CT) 20070118.0240
2006
----
E. coli VTEC non-O157, lettuce - USA (UT)(02): background
20060905.2523
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
2005
----
E. coli O145, fatal - Slovenia 20050916.2739
2003
----
E. coli, VTEC non-O157 - UK (Scotland): correction 20030828.2166
E. coli, VTEC non-O157 - UK (Scotland) 20030825.2144
2001
----
E. coli O26 - South Korea 20010509.0896
1999
----
E. coli O111, diarrhea - USA (Texas) 19990707.1134
1997
----
E. coli, non-0157 - Belgium 19970610.1215]
.................................................s b/ll/mj/mpp
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