sharon sanders
Editor-in-Chief & President
Outbreak Notice
Shiga toxin-producing E. coli 0104:H4 infections in Germany
This information is current as of today, June 02, 2011 at 22:43 EDT
Released: June 02, 2011
Current Situation
German health authorities have reported an outbreak of a severe illness called hemolytic-uremic syndrome (HUS) in Germany since May 2, 2011. In this outbreak, HUS is being caused by an infection with a Shiga toxin-producing Escherichia coli (STEC) bacteria. Many people have been hospitalized, several requiring intensive care, and some people have died. New cases are still being reported. For case counts and situation information, please see Investigation Announcement: Outbreak of Shiga toxin-producing E. coli O104 (STEC O104:H4) Infections Associated with Travel to Germany. The organism causing the outbreak has been identified as E. coli O104:H4, producing Shiga toxin. This strain of E. coli causes an illness similar to infection with E. coli O157:H7.
Most infections have been reported in people in northern Germany (mainly Bremen, Hamburg, Lower Saxony, and Schleswig-Holstein) or in people who have recently traveled to these areas. Cases in travelers to northern Germany have been reported in Denmark, the Netherlands, Spain, Sweden, and the United Kingdom.
German health authorities are investigating the outbreak but have not confirmed a source. They suspect that the source is contaminated food, possibly raw vegetables.
Advice for US Travelers to Germany
German health authorities recommend that people in Germany, especially in the northern part of the country avoid eating raw tomatoes, fresh cucumbers, and leafy salads, until further notice. Travelers should also follow regular food safety measures when handling fruit and vegetables.
If you have traveled to Germany and have bloody diarrhea and stomach cramps or symptoms of HUS (see below), go to a doctor right away and tell him or her about your recent travel.
More Disease Information
STEC infections can cause different gastrointestinal symptoms, but often include severe stomach cramps, diarrhea (often bloody), and vomiting. If there is fever, it is generally not very high (less than 101˚F [38.3˚C]). HUS is a disorder that usually occurs when an infection in the digestive system (such as STEC) produces toxic substances that destroy red blood cells and cause kidney injury. Early symptoms of HUS include decreased frequency or volume of urination, feeling very tired, and losing pink color in the cheeks and inside the lower eyelids. Signs of HUS typically start 5–7 days after the start of diarrhea, and diarrhea or bloody stools may no longer be present when HUS develops.
Advice for Clinicians
If you care for a patient with bloody diarrhea or HUS who has recently been in Germany or has been in contact with someone recently returned from Germany, it is important to test for STEC 0104:H4. Complete testing for STEC 0104:H4 includes simultaneous culture of stool for E. coli O157 and assay of the stool for non-O157 STEC with a test that detects Shiga toxin. Clinicians and clinical laboratories should send E. coli O157 isolates and Shiga toxin-positive samples to public health laboratories as soon as possible for additional characterization. Any suspected STEC 0104:H4 and HUS cases should be reported to health departments.
Helpful Links
For more information about STEC and HUS, visit:
http://wwwnc.cdc.gov/travel/notices/outbreak-notice/2011-germany-europe-e-coli.htm?
Shiga toxin-producing E. coli 0104:H4 infections in Germany
This information is current as of today, June 02, 2011 at 22:43 EDT
Released: June 02, 2011
Current Situation
German health authorities have reported an outbreak of a severe illness called hemolytic-uremic syndrome (HUS) in Germany since May 2, 2011. In this outbreak, HUS is being caused by an infection with a Shiga toxin-producing Escherichia coli (STEC) bacteria. Many people have been hospitalized, several requiring intensive care, and some people have died. New cases are still being reported. For case counts and situation information, please see Investigation Announcement: Outbreak of Shiga toxin-producing E. coli O104 (STEC O104:H4) Infections Associated with Travel to Germany. The organism causing the outbreak has been identified as E. coli O104:H4, producing Shiga toxin. This strain of E. coli causes an illness similar to infection with E. coli O157:H7.
Most infections have been reported in people in northern Germany (mainly Bremen, Hamburg, Lower Saxony, and Schleswig-Holstein) or in people who have recently traveled to these areas. Cases in travelers to northern Germany have been reported in Denmark, the Netherlands, Spain, Sweden, and the United Kingdom.
German health authorities are investigating the outbreak but have not confirmed a source. They suspect that the source is contaminated food, possibly raw vegetables.
Advice for US Travelers to Germany
German health authorities recommend that people in Germany, especially in the northern part of the country avoid eating raw tomatoes, fresh cucumbers, and leafy salads, until further notice. Travelers should also follow regular food safety measures when handling fruit and vegetables.
If you have traveled to Germany and have bloody diarrhea and stomach cramps or symptoms of HUS (see below), go to a doctor right away and tell him or her about your recent travel.
More Disease Information
STEC infections can cause different gastrointestinal symptoms, but often include severe stomach cramps, diarrhea (often bloody), and vomiting. If there is fever, it is generally not very high (less than 101˚F [38.3˚C]). HUS is a disorder that usually occurs when an infection in the digestive system (such as STEC) produces toxic substances that destroy red blood cells and cause kidney injury. Early symptoms of HUS include decreased frequency or volume of urination, feeling very tired, and losing pink color in the cheeks and inside the lower eyelids. Signs of HUS typically start 5–7 days after the start of diarrhea, and diarrhea or bloody stools may no longer be present when HUS develops.
Advice for Clinicians
If you care for a patient with bloody diarrhea or HUS who has recently been in Germany or has been in contact with someone recently returned from Germany, it is important to test for STEC 0104:H4. Complete testing for STEC 0104:H4 includes simultaneous culture of stool for E. coli O157 and assay of the stool for non-O157 STEC with a test that detects Shiga toxin. Clinicians and clinical laboratories should send E. coli O157 isolates and Shiga toxin-positive samples to public health laboratories as soon as possible for additional characterization. Any suspected STEC 0104:H4 and HUS cases should be reported to health departments.
Helpful Links
For more information about STEC and HUS, visit:
- Investigation Announcement: Outbreak of Shiga toxin-producing E. coli O104 (STEC O104:H4) Infections Associated with Travel to Germany
- CDC’s Frequently Asked Questions page about Escherichia coli O157:H7 and other STEC
- Hemolytic-uremic syndrome
(Medline Plus, National Institutes of Health)
- Outbreak of life-threatening haemolytic uremic syndrome (HUS) caused by bacterial infection (Robert Koch Institut, Germany, May 31, 2011)
- World Health Organization
- EHEC outbreak: Increase in cases in Germany (June 2, 2011)
- Outbreak of haemolytic uraemic syndrome in Germany (May 27, 2011)
- EHEC outbreak: Increase in cases in Germany
- Outbreak of Shiga toxin-producing E. coli (STEC) in Germany (European Centre for Disease Prevention and Control, May 27, 2011)
- Large and ongoing outbreak of haemolytic uraemic syndrome, Germany, May 2011 (Eurosurveillance, May 26, 2011)
http://wwwnc.cdc.gov/travel/notices/outbreak-notice/2011-germany-europe-e-coli.htm?