Europe - 19 dead, 2000+ infected, 500 severe cases of E-coli - EHEC STEC hemolytic uremic syndrome

[german-docter]

Within a few days a rising number of acute infections with Enterohemorrhagic Escherichia coli (EHEC) have occurred in Germany, especially in the northern states of Germany (Lower Saxony and Bremen, recently Hessia as well). Enterohemorrhagic Escherichia coli (EHEC) can cause severe hemorrhagic colitis characterized by gastrointestinal symptoms and bloody diarrhea. Health officials reported a total of at least 80 persons with suspected or confirmed EHEC-infection, some of whom are treated at intensive care units because of hemolytic uremic syndrome and acute renal failure (7 patients have been admitted to the ICU of the University Hospital at L?beck on Sunday, May 22, 2011). Most of the acute infections seem to occur in female adults (EHEC-infections typically and predominantly occur in children). The source of the infection is unknown; Robert Koch-Institute is involved.


http://www.spiegel.de/wissenschaft/medizin/0,1518,764184,00.html

22.05.2011

EHEC-Erreger
Zahl lebensgef?hrlicher Darminfekte im Norden steigt stark

Der hochgef?hrliche EHEC-Erreger breitet sich im Norden Deutschlands weiterhin schnell aus - vor allem erwachsene Frauen sind betroffen. Die Beh?rden suchen mit Hochdruck nach der Ursache: Inzwischen r?ckt Gem?se in den Fokus der Ermittler.
Hamburg/Hannover - Eine ungew?hnliche H?ufung schwerer Darminfektionen mit dem lebensgef?hrlichen EHEC-Erreger alarmiert die Gesundheitsbeh?rden in Deutschland. Mindestens 80 Menschen haben sich bislang mit dem lebensgef?hrlichen Darmbakterium infiziert, das sich schnell ausbreitet und au?ergew?hnlich schwere Krankheitsf?lle mit Nierenleiden hervorruft. Viele Patienten liegen auf Intensivstationen.
In Niedersachsen und Bremen gibt es nach Ministeriumsangaben inzwischen jeweils fast 25 gemeldete Verdachtsf?lle, in Schleswig-Holstein und Hamburg jeweils rund 20. Hessen meldete Sonntagabend 16 Verdachtsf?lle, Mecklenburg-Vorpommern vier. Ein Gro?teil der Patienten wird in Kliniken behandelt. Allein in Bremerhaven w?rden derzeit etwa 20 F?lle behandelt, sagte ein Sprecher des nieders?chsischen Gesundheitsministeriums. Er sprach von einer "beunruhigenden H?ufung in so kurzer Zeit".
Zu den Krankheitssymptomen geh?ren w?ssriger oder blutiger Durchfall, ?belkeit, Erbrechen und Bauchschmerzen. Als m?gliche Komplikation kommt es zu Nierenversagen, das zum Tod f?hren kann. Ein Sprecher des nieders?chsischen Sozialministeriums rief dazu auf, bei Symptomen sofort zu reagieren und zum Arzt zu gehen.
Experten empfehlen gr?ndliche Hygiene in der K?che
Gesundheitsexperten suchen unter Hochdruck nach der Quelle des Krankheitserregers. "Wir haben eindeutig eine ungew?hnliche Situation", sagte Epidemiologe G?rard Krause vom Robert Koch-Institut (RKI) in Berlin. Mittlerweile gehen die Experten davon aus, dass die Erreger durch ungewaschenes Gem?se oder Obst ?bertragen wurden. Zuerst hatten sie vor allem Rohmilch und Rindfleisch im Visier - das EHEC-Bakterium befindet sich oftmals im Kot von Nutztieren.
Einen Hinweis auf Gem?se oder Obst als m?gliche ?bertr?ger sehen die Wissenschaftler darin, dass diesmal ?berraschenderweise besonders Frauen betroffen sind: "Die Frauen bereiten h?ufiger Lebensmittel zu, und da k?nnen sie sich m?glicherweise bei der Reinigung des Gem?ses oder anderer Lebensmittel infizieren", sagte RKI-Experte Krause. Das RKI empfiehlt, auch bei der Verarbeitung von Gem?se auf gute K?chenhygiene zu achten sowie Bretter und Messer gr?ndlich zu reinigen.
Nach Angaben aus dem nieders?chsischen Sozialministerium ist noch unklar, ob es ?berhaupt einen gemeinsamen Erreger gibt. Experten vermuten dies. "Der Hauptanhaltspunkt ist das gemeinsame zeitliche Auftreten der F?lle", sagte ein Ministeriumssprecher. Die Ermittlung der Quelle f?r die Erkrankungen gestaltet sich nach Angaben des nieders?chsischen Ministeriums auch deswegen schwierig, weil die Erkrankten detailliert dazu befragt werden m?ssen, was sie in den letzten Tagen gegessen haben. Viele Patienten seien aber so schwer erkrankt, dass solche Befragungen gar nicht m?glich sind.
EHEC-Keime (Enteroh?morrhagische Escherichia coli) treten in Deutschland immer wieder auf. Das RKI hat seit Einf?hrung der Meldepflicht 2001 bundesweit j?hrlich 800 bis 1200 Erkrankungen registriert, die aber oft einen leichteren Verlauf nahmen.

 

[Shiloh]

Germany - Super-bug (E.Coli sub-strain - EHEC) kills 3 - 400+ cases

Germany - Super-bug (E.Coli sub-strain - EHEC) kills 3 - 400+ cases

Source: http://www.timeslive.co.za/scitech/article1083758.ece/Super-bug-kills-first-German

Super-bug kills first German
May 24, 2011 12:55 PM | By Sapa

Germany reported its first death from a virulent super-bacterium that has spread through the north of the country in just a week, possibly via fresh produce sold in supermarkets.

Hundreds of people have fallen gravely ill from the new sub-strain of E. coli. It causes internal bleeding, diarrhoea and kidney failure and is partly resistant to antibiotics, scientists said.

An 83-year-old woman died of her infection in a hospital at Diepholz near Hanover, state health officials said. She was admitted to hospital in "mid-May." Lab tests showed she had enterohaemorrhagic Escherichia coli (EHEC), a dangerous form of E. coli.

A second death, of a young woman in a hospital at Bremen, may have been caused by EHEC, officials said as lab tests were under way...

 

[Gert van der Hoek]

Re: Super-bug (E.Coli sub-strain) kills first German

Re: Super-bug (E.Coli sub-strain) kills first German

May 24, 2011

INTESTINAL GERM EHEC

Diarrheal pathogen spreads rapidly

In northern Germany, the EHEC suspected cases have doubled in one day. Two infected female pensioners were killed, the death of a young woman is being investigated.

The dangerous diarrhea germ Ehec seems to have killed so far three people.

One of the victims, a 83-year-old woman from Lower Saxony, had been hospitalized since mid-May because of bloody diarrhea, said the health ministry in Hanover.

The laboratory evidence has shown an EHEC infection. In Bremen, died, according to the Health Authority, a young woman who had bloody diarrhea - a typical symptom after such an infection. The finding of a laboratory test is still pending, it said.

- snip -

Nationwide, the competent authorities were far more than 400 suspected cases and cases of illness. Alone in Schleswig-Holstein, the number had doubled, according to the State Health Department within one day to more than 200. "This development exceeds any historic measure," said the microbiologist Werner Solbach, University Hospital Schleswig-Holstein.

Caused by the intestinal bacterial disease often heavy and is accompanied by renal failure, it said. Many patients had to intensive care units. Professionals of the health authorities and researchers are still looking for the cause of the infectious disease.

More: Zeitonline

 

[Gert van der Hoek]

Re: Super-bug (E.Coli sub-strain) kills first German - 2 more suspect deaths - 400 cases

Re: Super-bug (E.Coli sub-strain) kills first German - 2 more suspect deaths - 400 cases

May 24, 2011

Canteens closed, employees will be investigated

The EHEC pathogen spreads further in Germany . The Robert Koch Institute, calls the number of patients alarming .

Some snips from the article:


"There is speculation that EHEC pathogens had been sprayed on manure on the vegetables. It is totally absurd, vegetables fertilized with manure," said the spokesman for the Chamber of Agriculture of North Rhine-Westphalia, Bernard Rüb.

-----------------------

The Robert Koch Institute (RKI) sees a "frightening" spread of dangerous intestinal bacteria EHEC in Germany. In the past few days more than 80 patients with a severe course been registered with kidney damage, said President Reinhard Burger Robert Koch Institute.

This was "shocking many." That number are infected with the so-called HUS syndrome will usually be achieved within one year. Nor is it apparent that this development will be declining.

-----------------------

After the outbreak of EHEC pathogen in Germany the first with the dangerous intestinal germ infected people died: on Tuesday, two known deaths. A third victim was suspected of infection. However, it was unclear whether the intestinal infection in fact was the cause of death among the three women.

welt.de

 

[Gert van der Hoek]

Re: Super-bug (E.Coli sub-strain - EHEC) kills first German - 2 more suspect deaths - 400 cases

Re: Super-bug (E.Coli sub-strain - EHEC) kills first German - 2 more suspect deaths - 400 cases

Welt Online - LIVE-TICKER EHEC (German)

17:05 The Numbers of EHEC infections rose again

A survey by the news agency DPA showed there have been more than 460 confirmed and suspected cases. In Schleswig-Holstein the authorities recorded particularly large quantity of EHEC patients. There are about 100 people are infected with the virus, twice as many samples are still under consideration. "This development exceeds any historic measure," said the microbiologist Professor Werner Solbach, University Hospital Schleswig-Holstein.


16.53 RKI-President warns of more deaths

After the outbreak of the intestinal bacterium EHEC the Robert Koch Institute (RKI) expects other victims. So far, more than 80 were called HUS cases are known, "said Reinhard Burger Robert Koch Institute president. This hemolytic-uremic syndrome is the most serious complication of infection. "We must say clearly that we must reckon with more death," said Burger. The source of infection is still unknown.

 

[Pathfinder]

Re: Super-bug (E.Coli sub-strain - EHEC) kills first German - 2 more suspect deaths - 400 cases

Re: Super-bug (E.Coli sub-strain - EHEC) kills first German - 2 more suspect deaths - 400 cases

Translation Google

Epidemie in Germania. Epidemic in Germany. A contagious bacteria killed two people.

19:20, 24 Mai 2011 7:20 p.m., May 24, 2011 , Stirile Pro TV , Pro TV News

Health authorities in Germany trying to discover the source of an outbreak of infection with the bacteria E-coli. There are already two dead, one patient in a coma and hundreds of other cases of illness. Many so severe that dialysis is needed.

In many cases, patients went straight to intensive care and doctors expect the number of admittances to grow, as E-coli bacteria infection in an aggressive form, is contagious.

There is an intestinal virus again, but what is exceptional in this epidemic is "large number of serious cases," said experts.

"When the disease is discovered too late, then the therapy does not give any results, even dialysis," says Dr. Jan Kielstein, specilist dialysis at a hospital in Hanover.

"It is important to identify the cause of these diseases in the table with a severe evolution. I still do not know when we will be able to find the causes," said Thomas Spieker, an expert in the Ministry of Health.

Most of the sick are women, and experts say that inadequate washing raw vegetables and spread infection among housewives who prepare meals for their families. And unpasteurized milk or raw meat may be contaminated with E-coli battery.

"Especially for those with low immunity, the disease can be fatal. Also, outcome may be fatal in children," warns Susanne Glasmacher, Robert-Koch Institute expert.

http://www.protv.md/stiri/internati...bacterie-contagioasa-a-ucis-2-oameni-cum.html

 

[Pathfinder]

Re: Super-bug (E.Coli sub-strain - EHEC) kills first German - 2 more suspect deaths - 400 cases

Re: Super-bug (E.Coli sub-strain - EHEC) kills first German - 2 more suspect deaths - 400 cases

Critical hours for E. coli outbreak in Germany - May 24, 2011

Posted on behalf of Marian Turner

The next 24 hours will be critical for scientists in Germany who are trying to understand if an outbreak of infections from a deadly strain of E. coli currently sweeping the country is a severe instance of a normal infection, or something different.

Three women have died today from suspected infections with the bacteria enterohaemorrhagic Escherichia coli (EHEC) which causes dysentery-like, bloody diarrhoea, severe cramping and fever. Health authorities have registered a further 400 confirmed cases ? mostly young women. First cases emerged barely two weeks ago and authorities have been shocked at the rate at which this outbreak has spread.

At least a hundred patients are being treated in hospital. The Robert Koch Institute, the national institute responsible for disease control, confirmed this morning that 80 patients with EHEC infection had gone on to develop the life-threatening haemolytic uraemic syndrome (HUS), which can lead to acute kidney failure.

Today?s deaths were of two women in their 80s ? one of these has already been confirmed as an EHEC case - and one young woman.

More...
http://blogs.nature.com/news/2011/05/critical_hours_for_e_coli_outb.html?WT.mc_id=TWT_natureblogs

 

[Pathfinder]

Re: Super-bug (E.Coli sub-strain - EHEC) kills first German - 2 more suspect deaths - 400 cases

Re: Super-bug (E.Coli sub-strain - EHEC) kills first German - 2 more suspect deaths - 400 cases

E. coli O104 cause of German outbreak; 3 dead, over 400 sick; fresh produce suspected

Posted: May 24th, 2011 - 2:19pm by Doug Powell

Klaus Stark, group leader of gastrointestinal infections and zoonotic diseases at the Robert Koch Institute (RKI) told Der Tagesspiegel that E. coli O104 appears to be the cause of an E. coli epidemic sweeping Germany, with at least three dead, over 400 sick including 80 cases of hemolytic uremic syndrome.

"It looks right now like it is a type EHEC O104 cause of the disease."

More...
http://barfblog.foodsafety.ksu.edu/...-3-dead-over-400-sick-fresh-produce-suspected

 

[german-docter]

Re: Rising number of acute EHEC-infections in Germany (May 22, 2011)

Re: Rising number of acute EHEC-infections in Germany (May 22, 2011)

update (May 25, 2011):
3 deaths (at least one definitively confirmed by health officials: EHEC), over 400 sick including 80 cases of hemolytic uremic syndrome


http://barfblog.foodsafety.ksu.edu/...-3-dead-over-400-sick-fresh-produce-suspected

Quote (Posted: May 24th, 2011 - 2:19pm by Doug Powell):

"Klaus Stark, group leader of gastrointestinal infections and zoonotic diseases at the Robert Koch Institute (RKI) told Der Tagesspiegel that E. coli O104 appears to be the cause of an E. coli epidemic sweeping Germany, with at least three dead, over 400 sick including 80 cases of hemolytic uremic syndrome."

additional link (German language only):
http://www.tagesspiegel.de/wissen/was-haben-sie-gegessen/4213454.html

 

[Gert van der Hoek]

Re: Germany - Super-bug (E.Coli sub-strain - EHEC) kills 3 - 400+ cases

Re: Germany - Super-bug (E.Coli sub-strain - EHEC) kills 3 - 400+ cases

From Robert Koch Institut (= German CDC)

Accumulation of life-threatening, hemolytic-uremic syndrome (HUS), caused by bacteria

Update 25.05.2011, 12:00

Since the second week of May more people are ill from bloody diarrhea and the so-called
hemolytic-uremic syndrome (HUS). The cases occurred mainly in northern Germany,
There are also preliminary reports from southern and eastern Germany.

The Robert Koch Institute has confirmed to the evening of May 24, 2011, approximately 140 cases of HUS,
including 3 deaths. The number of severe cases in a short period is very
unusual , also the affected age groups are not typical.

We have mainly adults, mostly women, are affected. Usually
mainly children developed this serious disease: In 2010, for example, the Robert Koch Institute confirmed 65 cases of HUS, 6 affected were older than 18 years.

The HUS is a severe and sometimes fatal complication in bacterial
intestinal infections which can occur with so-called enterohemorrhagic Escherichia coli (EHEC).
Each year, the Robert Koch Institute confirms about 1,000 cases of EHEC. The full picture of HUS is characterized
by acute renal failure, anemia in red blood cells by the decay and lack of
platelets. In 2010, the Robert Koch Institute cofirmed two deaths.

Read more - RKI

 

[Gert van der Hoek]

Re: Germany - Super-bug (E.Coli sub-strain - EHEC) kills 3 - 400+ cases

Re: Germany - Super-bug (E.Coli sub-strain - EHEC) kills 3 - 400+ cases

Snip from BBC news:

A Reuters news agency report suggests that the infection may be spread through contaminated vegetables, and the high number of affected young women points to a product more often bought or prepared by women.

Susan Huggett of the Medilys laboratories in Hamburg advised against eating pre-packaged or prepared salad, which might contain the bacterium.

She also recommended standard hygienic procedures such as washing hands before eating or cooking.

See also: http://www.flutrackers.com/forum/showpost.php?p=409602&postcount=3

 

[sharon sanders]

Re: Rising number of acute EHEC-infections in Germany (May 22, 2011)

Re: Rising number of acute EHEC-infections in Germany (May 22, 2011)

I merged 2 threads on this topic. The URL that is working for this thread is the one that started with german-docter's first post.

Thank you everyone.

 

[Giuseppe]

Re: Rising number of acute EHEC-infections in Germany (May 22, 2011)

Re: Rising number of acute EHEC-infections in Germany (May 22, 2011)

[Source: European Centre for Disease Prevention and Control (ECDC), full page: (LINK).]

Outbreak of Shiga toxin-producing E. coli in Germany



25 May 2011

Outbreak of Shiga toxin-producing E. coli in Germany
Epidemiological update, 25 May 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 the end of April, 138 cases of HUS have been reported.

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 more than two thirds being women.

Two of the HUS cases have died. Preliminary diagnostic investigations indicate that serogroup O104 (Stx2-positve, eae-negative) might be the causative agent.

The source of the outbreak is under investigation, but contaminated food seems the most likely vehicle of infection. There is currently no indication that raw milk or meat is associated with the outbreak.

Most cases are from, or have a history of travel to the North of Germany (mainly Hamburg, Northern Lower Saxony, Mecklenburg-Western Pomerania).

Sweden is currently the only EU Member State reporting an unusual increase of STEC and HUS cases, and probable links with Germany are being investigated.

To date, this non-O157 STEC outbreak is limited to Germany, and there is no evidence that there is a risk for infection outside of the country.

Identification of the vehicle of infection will further determine the assessment of this risk. Rapid identification of potential cases linked to this outbreak, within Germany or among persons who have travelled to Germany since the beginning of May, is essential to prevent the development of severe disease.
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.

​

- -------

 

[german-docter]

Re: Rising number of acute EHEC-infections in Germany (May 22, 2011)

Re: Rising number of acute EHEC-infections in Germany (May 22, 2011)

Deutsche Welle May 26, 2011:

http://www.dw-world.de/dw/article/0,,15107804,00.html


Germans told to avoid some vegetables in E.coli [EHEC] outbreak

Author: Mark Hallam (dapd, dpa, Reuters)

A German health organization says it's 'highly probable' that the recent spate of E.coli infections in Germany will be traced back to eating raw salads, tomatoes and cucumbers - possibly from northern Germany.

The precise cause of an outbreak of poisoning by the dangerous E.coli bacteria in Germany remains unclear, but the Robert Koch Institute - responsible for the monitoring of diseases and their prevention on behalf of the German government - said on Wednesday that raw vegetables and tomatoes from Northern Germany were strong candidates.
(?)
An 89-year-old woman in the northernmost state of Schleswig-Holstein, who passed away on Wednesday, was thought to be the second EHEC death, according to preliminary information from the state health ministry. Three other possible EHEC fatalities were being investigated elsewhere in the country. Authorities confirmed on Tuesday that an 83-year-old woman died of EHEC infection near Hanover.
(?)
One popular theory for the contamination is that farmers might have sprayed contaminated dung on their produce, possibly explaining the unusual vegetable source of the infection.
(?)

 

[Gert van der Hoek]

Re: Rising number of acute EHEC-infections in Germany (May 22, 2011)

Re: Rising number of acute EHEC-infections in Germany (May 22, 2011)

From Gothenburg , Sweden - Machine translation

Thursday 26 May 2011

"I feel terrible"

Twelve golf travelers from the town have fallen ill with bowel disease EHEC in connection with a trip to northern Germany. Seriously ill.

On the trip, organized by Alingsås Golf Club were 30 passengers. They left Sweden for a couple weeks ago to play golf for four days in a small town outside Hamburg. Barely a week after returning home the first of them were hit with bloody diarrhea in what would later turn out to be bowel disease EHEC.

- I have never experienced anything similar. I am exhausted and still feel terribly bad, said Lena Broberg from a hospital bed in East Infection Clinic in Gothenburg.

GP.SE

 

[Gert van der Hoek]

Re: Rising number of acute EHEC-infections in Germany (May 22, 2011)

Re: Rising number of acute EHEC-infections in Germany (May 22, 2011)

machinetranslation, edited

EU fears Ehec epidemic

The rapid spread of EHEC organism could provide a pan-European alert. That it will jump over to other countries, according to experts "only a matter of time".

The Robert Koch Institute warns of the EHEC outbreak against the consumption of raw tomatoes, cucumber and lettuce leaves. Many of the intestinal bacterial sufferers had eaten this kind of food.

Because of EHEC infections in Germany, Europe could soon be the alert level 1 are declared. "It's only a matter of time before the dangerous EHEC pathogen will jump to other EU countries " said Jo Leinen, Chairman of the Committee for Health and Food Safety in the EU Parliament, in the Neue Osnabruecker newspaper .

In case of alarm level 1 all EU Member States are called to take measures to protect their populations, it said. In the opinion of chief Reinhard Burger Robert Koch Institute Germany is experiencing the strongest ever recorded outbreak of EHEC. There were so many patients per week as usual in a year. Two thirds of those people are women.

On Wednesday more than 600 cases were registered, of which not all are confirmed, but - on Tuesday it was still about 460th The number of very serious disease processes bloody diarrhea and kidney failure has increased at least 140, according to RKI .

Read more - Zeit Online

 

[german-docter]

Re: Rising number of acute EHEC-infections in Germany (May 22, 2011)

Re: Rising number of acute EHEC-infections in Germany (May 22, 2011)

The Local : 26 May 11 14:11 CET

http://www.thelocal.de/national/20110526-35261.html

E.coli found in Spanish cucumbers

Cucumbers from Spain have been identified as a source of the deadly E. coli outbreak gripping Germany, health officials announced Thursday.

The contaminated vegetables were sold at a Hamburg market before they were taken off the shelves, Hamburg?s Health Minister Cornelia Storck said.

Of four cucumbers found to be carrying the bacteria, three came from two separate Spanish suppliers and the fourth was listed as an organic project whose place of origin was unknown.

(?)

The strain of E. coli gripping Germany is a particularly virulent one, said Helge Karch, a researcher at the University Hospital of M?nster, whose team discovered the identity of the strain and is developing a test to more easily detect it.

The discovery is ?an important step in the search for paths of transmission,? Karch said.

(?)

 

[Gert van der Hoek]

Re: Rising number of acute EHEC-infections in Germany (May 22, 2011)

Re: Rising number of acute EHEC-infections in Germany (May 22, 2011)

machinetranslation - edited

EHEC reached Germany's neighboring countries

The patients are said to have been infected while traveling to Germany: the dangerous intestinal germ EHEC has now reached Great Britain, Sweden, Denmark and the Netherlands. Source of infection now suspected are Spanish cucumbers - local farmer organizations react somewhat relieved.


Hamburg - The source of infection appears to be found - but the dangerous intestinal germ EHEC continues to spread and has apparently already crossed the borders. From Germany he came to the UK, Sweden and the Netherlands. In these countries there have been the first cases, the European Commission said Thursday in Brussels. The patients had recently been to Germany, said the spokesman for EU health commissioner John Dalli.

Spiegel

 

[Giuseppe]

Re: Rising number of acute EHEC-infections in Germany (May 22, 2011)

Re: Rising number of acute EHEC-infections in Germany (May 22, 2011)

[Source: Health Protection Agency, United Kingdom, full page: (LINK).]

Large outbreak of haemolytic uraemic syndrome caused by E. coli in Germany ? important advice for travellers



26 May 2011


14:00


The Health Protection Agency (HPA) is aware that Germany is currently experiencing a large outbreak of haemolytic uraemic syndrome (HUS), which is a serious complication from verocytotoxin-producing E. coli (VTEC) infection that requires hospitalisation. Since the second week of May, there have been reports of approximately 214 cases of HUS and two people are reported to have died.


The outbreak is mainly affecting adults - almost 70 per cent of who are female. The cases are occurring mainly in northern Germany, but there are also reports from southern and eastern Germany.

This strain of VTEC infection suspected in this outbreak is O104 which is a rare strain of the infection and seldom seen in the UK.

England has so far seen two cases in German nationals with compatible symptoms. Other European countries have also seen cases of HUS and bloody diarrhoea among returning travellers.

The German authorities believe that a food source of infection is likely, and, early studies implicate raw tomatoes, cucumbers and lettuce. Although it is not clear whether one or more of these food items are associated with the outbreak, as a precaution they are advising people in Germany against eating raw tomatoes, cucumbers and lettuce, especially in the north of the country, until further notice.

The HPA and the National Travel Health Network and Centre (NaTHNaC) advises anyone travelling to Germany to follow the advice from the German authorities. In addition, returning travellers with illness including bloody diarrhoea should seek urgent medical attention and make sure they mention any recent travel history.

The public health organisation in Germany investigating the outbreak also recommend following the standard food and water hygiene advice.

Dr Dilys Morgan, head of the gastrointestinal, emerging and zoonotic infections department at the HPA, said: "The HPA is actively monitoring the situation very carefully and liaising with the authorities in Germany, the European Centre for Disease Control (ECDC) and the World Health Organization (WHO) as to the cause of the outbreak.

"We are keeping a close watch for potential cases reported in England and are working with colleagues in the devolved administrations to recommend they do the same. In addition we are in the process of alerting health professionals to the situation and advising them to urgently investigate potential cases with a travel history to Germany."

The HPA is also working closely with the Department of Health and the Food Standards Agency. The FSA is monitoring the situation closely and if there are any implications for food distributed in the UK they will provide an update.

ENDS


Notes to editors:

1. In this outbreak many more people are suspected to have bloody diarrhoea, which can be serious, or milder forms of the infection which are usually self limiting and clears within seven days. The public health organisation investigating the outbreak in Germany is the Robert Kock Institute http://www.rki.de/

2. Haemolytic Uraemic Syndrome (HUS) is a serious complication from verocytotoxin-producing E. coli (VTEC) infection that affects the blood, kidneys and in severe cases, the central nervous system. It is a serious illness that requires treatment in hospital and can be fatal.

3. The number of severe cases of HUS in a short period is very unusual and the affected age groups in this outbreak are not typical ? HUS is a more common complication from E. coli infection in children.

4. Escherichia coli (commonly referred to as E coli) bacteria usually cause diarrhoea which settles within seven days without treatment. There are many strains of the infection. Occasionally, serious kidney and blood complications can occur, such as HUS.

5. Most people normally carry harmless strains of E. coli in their intestine. Both the harmless strains and the strains that cause diarrhoea are acquired primarily through ingestion of contaminated food or water. Person-to-person and animal-to-human transmission is through the oral-faecal route.

6. Good hygiene is very important in preventing person-to person spread and small children should be supervised with hand washing after using the toilet and before eating. Advice on food safety can be found on the NHS Choices website: http://www.nhs.uk/Livewell/homehygiene/Pages/Homehygienehub.aspx

7. Verocytotoxin- producing E. coli (VTEC) O104 is a rare serogroup and further testing of samples is needed to confirm this as the cause of the outbreak. Reports from Germany refer to the VTEC cases as cases of Shiga-toxin producing E. coli (STEC). VTEC is also sometimes called Entrohaemorrhagic E. coli (EHEC).

8. Healthcare professionals and members of the public can find more information about travel health (including country specific advice) by logging onto the National Travel Health Network and Centre (NaTHNaC) website www.nathnac.org

9. The Health Protection Agency is an independent UK organisation that was set up by the government in 2003 to protect the public from threats to their health from infectious diseases and environmental hazards. It does this by providing advice and information to the general public, to health professionals such as doctors and nurses, and to national and local government. In 2012 the HPA will become part of Public Health England. To find out more, visit our website: www.hpa.org.uk

10. For media enquiries please contact the national HPA press office at Colindale on 020 8327 7901 or email cfipressoffice@hpa.org.uk. Out of hours the duty press office can be contacted on 020 8200 4400.

Last reviewed: 26 May 2011
​

- ------

 

[Tomek]

Re: Rising number of acute EHEC-infections in Germany (May 22, 2011)

Re: Rising number of acute EHEC-infections in Germany (May 22, 2011)

German Scientists Finger Rare Serotype in Massive E. coli Outbreak

by unusual Kai Kupferschmidt on 25 May 2011, 11:18 AM

http://news.sciencemag.org/scienceinsider/2011/05/german-scientists-finger-rare.html?ref=hp

BERLIN?German scientists are scrambling to find the source of an outbreak of enterohemorrhagic Escherichia coli (EHEC), a dangerous intestinal pathogen that has sent hundreds of people to the hospital with bloody diarrhea and killed at least one. The investigation is complicated by the fact that the outbreak has apparently been caused by a very rare EHEC serotype called O104.

"I hope that more patient samples will be identified today, but it certainly looks as if an E. coli O104 is the cause of these infections," says Klaus Stark, head of the division of gastrointestinal infections, zoonoses, and tropical infections at Robert Koch Institute (RKI) here, the German center for disease prevention and control.

RKI researchers first took notice last Thursday, when a clinic in Hamburg notified them of a host of patients suffering from hemolytic-uremic syndrome (HUS). The syndrome?characterized by a destruction of red blood cells and severe kidney problems?is the most severe complication of an EHEC infection.

According to RKI, nearly 140 patients in Germany have developed HUS since the second week of May, compared with only about 60 cases in an average year. "This is one of the biggest EHEC outbreaks in the world, certainly the biggest one we have ever had in Germany," says Stark.

Scientists have been baffled not only by the outbreak's size and rapid spread in northern Germany but also by the fact that it affects mostly adults and females, an odd pattern because EHEC usually sickens children. Of the 65 HUS cases in Germany in 2010, only six patients were more than 18 years old.

While E. coli bacteria are part of the human gut flora and usually not pathogenic, the strains classed together as EHEC produce a dangerous Shiga toxin that enters the cells in the gut and inhibits protein synthesis by cleaving ribosomal RNA. The destruction of cells lining the gut leads to abdominal cramping, watery diarrhea, and eventually bloody diarrhea. In about 10% of cases, the toxin also attacks the kidneys, leading to the potentially fatal HUS. EHEC has been confirmed as the cause of death in an 83-year-old woman who had been admitted to a hospital in Bremen on 15 May and who died on Saturday; another potential EHEC fatality is still under investigation.

Most EHEC infections are caused by a notorious serotype called O157:H7; researchers refer to that serotype and four others frequently found in Europe as the "gang of five." But the German reference laboratory for EHEC in Wernigerode has so far identified the serotype of EHEC in stool samples from five patients as O104.

That makes the outbreak highly unusual, says Helge Karch, head of the National Consulting Laboratory on Hemolytic Uremic Syndrome in M?nster. Among Karch's E. coli isolates from 588 HUS patients collected over the past 20 years, only two are O104. In another unusual twist, Karch has found the strain to be eae-negative. The gene eae codes for the protein intimin, which the bacteria uses to attach to the intestinal wall. Most pathogenic EHEC serogroups are eae-positive.

It is still unclear whether the serotype might explain the strange pattern of infections. E. coli O104 first emerged as a pathogen in a small outbreak in Helena in early 1994. Four people developed abdominal cramps and bloody diarrhea. Experts at the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta identified a serotype called O104:H21 as the culprit. A CDC investigation later found up to 18 patients; most of them were women and the median age was 36 years.

The source of infection in Germany is still unclear, and the rare serotype could make it harder for authorities to find it. "O104 is very hard to distinguish from normal, non-pathogenic E. coli," says Lothar Beutin, head of the National Reference Laboratory for E.coli at the Federal Institute for Risk Assessment here. He and other researchers are now trying to develop a more rapid and specific test for the rare serotype.

The natural reservoir of EHEC bacteria are ruminants such as cows and sheep, which carry the pathogens in their guts and spread them with their feces. It is transmitted to humans primarily through consumption of contaminated foods.

"When we first interviewed patients, a lot of them mentioned eating raw vegetables, but that does not mean that vegetables are the source," Stark says. RKI is using a detailed questionnaire to ask patients what they have eaten in the days before falling ill and comparing their answers with those of healthy controls who match the patients in characteristics such as age and sex, a common method in epidemiology.

In order to save time, however, the epidemiologists are not searching public records to find the matching controls. Instead, a team of 15 experts went door to door yesterday in the areas in Hamburg where some patients live, looking for roughly matching controls. "If we get a clear signal, something that 90% of the cases but only 10% of the controls ate, then we can be very sure that we have found the source," says Stark.

But a first statistical analysis this morning did not yield any clear results. Indeed, the cause of most of the smaller EHEC outbreaks in recent years has never been established definitely. Scientists are hoping that the current outbreak will turn out to be unusual in that respect as well.