International Case Count - 19 dead, 2000+ infected, 500 severe cases of E-coli - EHEC STEC hemolytic uremic syndrome
International Case Count - 19 dead, 2000+ infected, 500 severe cases of E-coli - EHEC STEC hemolytic uremic syndrome
Source: ProMed
http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,88725
Archive Number 20110603.1692
Published Date 03-JUN-2011
Subject PRO/AH/EDR> E. coli O104 - EU (08) & USA: genetic analysis, more cases
E. COLI O104 - EUROPEAN UNION (08) & USA: GENETIC ANALYSIS, MORE CASES
**********************************************************************
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 posting:
[1] EU report
[2] WHO report
[3] Science Journal: commentary on the organism
[4] Nature Journal: commentary on the organism
[5] Norway (suspected)
[6] Denmark
[7] USA
******
[1] EU report
Date: Thu 2 Jun 2011
Source: Eurosurveillance edition 2011; 16(22) [edited]
<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19883>
Update on the ongoing outbreak of haemolytic uraemic syndrome due to
Shiga toxin-producing _Escherichia coli_ (STEC) serotype O104,
Germany, May 2011
--------------------------------------------------------------------
[Authors: Askar M, Faber MS, Frank C, et al]
Since early May 2011, a large outbreak of hemolytic uremic syndrome
(HUS) and bloody diarrhea related to infections with Shiga
toxin-producing _E. coli_ (STEC) has been observed in Germany. The
outbreak is focused in the north, but cases have been reported from
all German states and other countries. Since our report last week [26
May 2011], the number of HUS cases has increased to 470 [in Germany]
and STEC serotype O104 has been confirmed in many cases.
Description of the ongoing outbreak
-----------------------------------
Since the beginning of May 2011, 470 cases of hemolytic uremic
syndrome HUS have been notified to the Robert Koch Institute (RKI).
Our initial findings have been presented (1), including background
information on STEC infections and HUS. The clinical and laboratory
case definitions used are available (2). Here we give an update on the
epidemiological characteristics of the outbreak concerning cases of
STEC and HUS notified to the Robert Koch Institute as of 31 May 2011.
Of 470 HUS cases, 273 (58 percent) were clinical cases with
laboratory confirmation of Shiga toxin-producing _E. coli_ (STEC)
infection. The German National Reference Centre for _Salmonella_ and
other Bacterial Enteric Pathogens alone has detected STEC serotype
O104, Shiga toxin 2 (stx2)-positive, intimin (eae)-negative in more
than 60 samples from cases in the outbreak, indicating that this
unusual serotype is the cause of the outbreak.
Geographical distribution of HUS cases
--------------------------------------
Cases of HUS have been notified from all German Federal states. The
highest cumulative incidence of HUS, since 1 May 2011, continues to be
observed in the 5 northern states: Hamburg, Schleswig-Holstein,
Bremen, Mecklenburg-Vorpommern, and Lower Saxony [for table, see
source URL above. - Mod.LL]. A total of 66 percent of HUS cases have
been notified from these states.
Epidemiological development
---------------------------
From 1 to 8 May 2011, the number of new HUS cases was between 1 and 2
cases per day, based on the date of onset of diarrhea (Figure 1) [see
source URL]. From 9 May 2011, we observed an initially steady increase
in the number of cases. This increase gained in intensity over the
following days and reached a maximum of 39 notified HUS cases on 16
May 2011.
Age and sex distribution of HUS cases
-------------------------------------
As reported on 26 May 2011 (1), the age and sex distribution of HUS
cases remain conspicuous: the majority of patients were aged 20 years
or older (88 percent) and female (71 percent). Notably, between 2006
and 2010, the proportion of adults in reported STEC and HUS cases was
only between 1.5 percent and 10 percent, and there were no marked
differences in sex distribution [3]. Figure 2 [see source URL] shows
the age- and sex-specific cumulative incidence of notified cases of
HUS since 1 May 2011.
Fatal cases
-----------
To date, 13 deaths have been notified [now 18 - Mod.LL]: in 9 cases,
the deaths were in connection with HUS; in the remainder, the cases
had had symptomatic STEC infection that was laboratory confirmed. The
cases who died were between 22 and 91 years of age: 5 were aged
between 22 and 40 years and 8 between 75 and 91 years of age.
Foreign cases with connection to the present outbreak
-----------------------------------------------------
Further HUS cases have been communicated from Denmark, UK, France,
Netherlands, Norway, Austria, Spain, Sweden (including 1 death),
Switzerland and the USA. Nearly all of these cases had a travel
history to northern Germany. For some cases, however, detailed
investigations are ongoing. After a stay in northern Germany between 8
and 10 May 2011, 15 members of a Swedish travel group (30 members in
total) developed symptoms of STEC infection and HUS was diagnosed in 5
of these cases.
Evaluation of the situation
---------------------------
The present situation marks one of the largest outbreaks ever
described of HUS worldwide, and the largest outbreak ever reported in
Germany. Because of the delay in notification and reporting of cases,
the current notification data cannot be interpreted as a decrease in
case numbers.
The age and sex distribution of cases in this outbreak is highly
unusual, as is the identified outbreak strain: STEC O104, Shiga toxin
2 (stx2)-positive, intimin (eae)-negative. Serotype STEC O104 has
caused foodborne outbreaks of diarrhea and HUS, or isolated cases of
HUS before (4,5), but is not known to have caused previous outbreaks
in Germany.
Current epidemiological activities
----------------------------------
RKI is currently conducting the following studies to further
investigate the outbreak:
- representative online survey within the German population to
describe the disease burden;
- case/control study in heavily affected hospitals, in Lubeck (in
Schleswig-Holstein) and Hamburg;
- case/control study in hospitals that have observed a recent
increase in cases numbers and had not been previously affected;
- analyses of questionnaires on cases completed by nephrologists
treating the cases;
- investigation of human-to-human transmission (and of information
about purchases made by analysis of till receipts) within the setting
of a special outbreak in a canteen;
- cohort investigations of various groups, in which several members
developed symptoms of STEC infection after dinner in a restaurant (the
members of the groups are questioned about the food products they
consumed);
- exploration of several events and festivities that can be related
to cases.
Furthermore, the RKI is cooperating with colleagues from Sweden and
Denmark, who are performing cohort studies of groups in which several
members developed symptoms of STEC infection.
The Federal Institute for Risk Assessment (BfR) has recommended that
consumers in Germany abstain from eating raw tomatoes, cucumbers, and
leafy salads -- based on results from an epidemiological study,
conducted by the RKI in cooperation with regional and local health
departments from Hamburg (1). As long as the studies outlined above do
not lead to new evidence and as long as the outbreak is still ongoing,
these recommendations concerning goods available in northern Germany
in particular remain in effect.
References
----------
1. Frank C, Faber MS, Askar M, et al: Large and ongoing outbreak of
haemolytic uraemic syndrome, Germany, May 2011. Euro Surveill. 2011;
16(21): pii=19878. Available from
<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19878>.
2. Robert Koch Institute (RKI): Case definition for HUS-cases
associated with the outbreak in the spring 2011 in Germany. Available
from
<http://www.rki.de/cln_116/nn_217400/EN/Home/HUS__Case__definition,templateId=raw,property=publicationFile.pdf/HUS_Case_definition.pdf>.
3. Robert Koch Institute (RKI). SurvStat@RKI. Berlin: RKI. [Accessed
24 May 2011]. German. Available from <http://www3.rki.de/SurvStat>.
4. Bae WK, Lee YK. Cho MS, et al: A case of hemolytic uremic syndrome
caused by _Escherichia coli_ O104:H4. Yonsei Med J. 2006; 47(3):
437-9. [Available from
<http://www.eymj.org/Synapse/Data/PDFData/0069YMJ/ymj-47-437.pdf>].
5. CDC: Outbreak of acute gastroenteritis attributable to
_Escherichia coli_ serotype O104:H21 -- Helena, Montana, 1994. MMWR
Morb Mortal Wkly Rep. 1995; 44(27): 501-3. [Available from
<http://www.cdc.gov/mmwr/preview/mmwrhtml/00038146.htm>].
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[This is the latest report from Eurosurveillance, which covers data
through 31 May 2011. It does not cover issues relating to the genetic
analysis of the organism, which are reported below. - Mod.LL]
******
[2] WHO report
Date: Thu 2 Jun 2011
Source: WHO Outbreak Reports [edited]
<http://www.who.int/csr/don/2011_06_02/en/index.html>
***Overall in Europe, 499 cases of HUS and 1115 cases of EHEC have
been reported, 1614 in total. Cases have now also been notified from:
Austria (HUS 0, EHEC 2), Denmark (7, 7), France (0, 6), Netherlands
(4, 4), Norway (0, 1), Spain (1, 0), Sweden (15, 28), Switzerland (0,
2), and the United Kingdom (2, 1). All these cases except 2 are in
people who had recently visited northern Germany or in 1 case, had
contact with a visitor from northern Germany.***
[Plus 3 suspected cases imported from Germany to the USA -- see [7]
below].
EHEC outbreak: increase in cases in Germany
-------------------------------------------
Cases of hemolytic uremic syndrome (HUS) and enterohemorrhagic _E.
coli_ (EHEC) continue to rise in Germany. 10 countries have now
reported cases to WHO/Europe.
As of 31 May 2011, 9 patients in Germany have died of HUS, and 6 of
EHEC. 1 person in Sweden has also died. There are many hospitalized
patients, several of them requiring intensive care, including
dialysis. The number of patients in Germany presenting with HUS and
bloody diarrhea caused by STEC is 470, which is 97 more than the day
before, and 1064 of EHEC, which is an increase of 268.
Overall in Europe, 499 cases of HUS and 1115 cases of EHEC have been
reported, 1614 in total.
Cases have now also been notified from: Austria (HUS 0, EHEC 2),
Denmark (7, 7), France (0, 6), Netherlands (4, 4), Norway (0, 1),
Spain (1, 0), Sweden (15, 28), Switzerland (0, 2), and the United
Kingdom (2, 1). All these cases except 2 are in people who had
recently visited northern Germany or in 1 case, had contact with a
visitor from northern Germany.
Numerous investigations are continuing into the cause of the
outbreak, which is still unclear.
In accordance with the International Health Regulations (IHR), WHO is
keeping Member States informed about the latest developments and
providing technical guidance on further investigation of the ongoing
outbreak.
WHO does not recommend any trade restrictions related to this
outbreak.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
******
[3] Science Journal: commentary on the organism
Date: Thu 2 Jun 2011
Source: Science Insider, American Association for the Advancement of
Science (AAAS) [edited]
<http://news.sciencemag.org/scienceinsider/2011/06/sequence-yields-clues-to-germany.html?ref=hp>
DNA sequence yields clues to Germany's 'super toxic' _E. coli_
outbreak
-----------------------------------------------------------------------
[Author: M Enserink]
Just from the high number of deaths and severe cases, scientists and
public health experts battling Germany's massive _E. coli_ [O104:H4]
outbreak knew they were up against something unusual. Now, early
results from sequencing projects of the enterohemorrhagic _E. coli_
(EHEC) strain appear to confirm that a never-before-seen hybrid,
combining the worst of several bacterial strains, is causing the
havoc.
The Beijing Genomics Institute (BGI), in Shenzhen, China, which
today, 2 Jun 2011, announced that it has sequenced the microbe's
entire 5.2-million-base-pair genome says that its acquisition of
several virulence genes make this EHEC strain "super toxic."
The outbreak, which has caused mayhem in European trade relations, is
still growing; so far, more than 16 patients have died. The origin of
the microbe remains a riddle; cucumbers from Spain, originally
fingered as the potential source, were acquitted on Tue 1 Jun 2011,
and have not been replaced by other suspects. All researchers know is
that raw vegetables are the most likely carrier.
Scientific results announced in 2 press releases, both also intended
to tout the extraordinary speed of today's sequencing technology,
suggest that within the microbe's DNA lie clues to its aggressive
nature.
The 2nd came from Life Technologies Corporation, which manufactures
so-called 3rd-generation sequencing machines. Today, 2 Jun 2011, the
company announced that sequencing at its lab in Darmstadt, Germany, in
collaboration with the nearby University of Munster, "strongly
suggests that the bacterium is a new hybrid type of pathogenic _E.
coli_ strains." Spokespeople for the company in the USA and Germany
could not provide details. "Further analyses on Ion PGMT", the
company's flagship sequencing machine, "will confirm [the] data," the
press release promised.
BGI, meanwhile, says that the microbe's genome, which it says took
just 3 days to sequence, also using Life Technologies equipment
reveals that it shares 93 percent of its sequence with EAEC 55989 _E.
coli_, a strain isolated in the Central African Republic and known to
cause serious diarrhea. It appears to have acquired several genes that
make it more pathogenic, however, probably in a process called
horizontal gene transfer, by which microbes exchange bits of genetic
information.
In an e-mail to ScienceInsider, Yang Bicheng, director of BGI's
marketing department, wrote that one gene fragment appears to have
come from another foodborne pathogen, _Salmonella enterica_, while
other genes are highly homologous to those found in other,
phylogenetically distinct _E. coli_ strains, including a strain called
O25:H4-ST131.
BGI, which has made the sequence available for researchers to
download, says the analysis also confirmed that the microbe is
resistant to many antibiotics. These include aminoglycosides, the
macrolides, and the beta-lactams "all of which makes antibiotic
treatment extremely difficult," according to the press release.
However, German EHEC patients aren't treated with antibiotics; most
scientists believe they make matters worse, because killing EHEC
results in the release of more toxin.
Yang acknowledged that finding the resistance genes may not be
clinically relevant, but says they may help understand how the strain
arose. "The evolutionary process of this very strange hybrid strain
may be a very interesting scientific story," Yang wrote in his
e-mail.
Microbial genomicist Frederick Blattner of the University of
Wisconsin, Madison who worked for almost 15 years to sequence the 1st
_E. coli_ strain and finished in 1997 says the results have to be
considered preliminary; it's not clear whether BGI assembled the
entire genome from its sequenced pieces, he notes, and usually in such
efforts, a number of stretches need to be resequenced. Still, "they
did this at an amazing speed, and it looks like they found some very
intriguing information," Blattner says.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[This commentary primarily regarding the genetic analysis of the
outbreak organism outlines the unique nature of the pathogen. It is
indeed tempting to speculate on its origin. It is most likely a
'laboratory experiment' under the direction of clearly the world's
most successful bioterrorist, Mother Nature. ProMED-mail awaits more
information about the genetic analyses. - Mod.LL]
******
[4] Nature Journal: commentary on the organism
Date: Thu 2 Jun 2011
Source: Nature News [edited]
<http://www.nature.com/news/2011/110602/full/news.2011.345.html>
German _E. coli_ outbreak caused by previously unknown strain
-------------------------------------------------------------
[Author: M Turner]
The bacterium responsible for the current outbreak of
enterohemorrhagic _E. coli_ (EHEC) infections in Germany is a strain
that has never before been isolated in humans. The discovery,
announced today [2 Jun 2011] by the food safety office of the WHO in
Geneva, Switzerland, means that the infection could prove unusually
difficult to bring under control.
Scientists in Germany are feverishly analysing the genome sequence of
the bacterium, and have found clues as to how this strain, which has
so far infected more than 1500 people and killed 18, is making so many
people ill.
The bacterium is relatively unusual in that it produces
extended-spectrum beta-lactamase enzymes that render the bacteria
resistant to many different antibiotics. Patients with EHEC infections
are not typically treated with antibiotics anyway, because the
bacteria are thought to respond to the medication by increasing
production of the Shiga toxin, which can lead to the life-threatening
complication hemolytic-uremic syndrome (HUS). But antibiotic
resistance might have helped the bacteria to survive and persist in
the environment.
"EHEC outbreaks usually only last around 2 weeks, but this outbreak
has been going on since 1 May 2011 or earlier," says Angelika Fruth, a
microbiologist based in Wernigerode who works for the Robert Koch
Institute, the federal agency responsible for disease control. The
number of new cases is still rising, suggesting that whatever their
source, the bacteria are still infecting people.
Fresh vegetables are still the prime suspect, but Flemming Scheutz,
head of the WHO Collaborative Centre for Reference and Research on
_Escherichia_ and _Klebsiella_ in Copenhagen, suggests that the
bacteria might not have originated in the food chain at all. "This
strain has never been found in any animal, so it is possible that it
could have come from straight from the environment into humans."
Lothar Wieler, a veterinary microbiologist at the Free University of
Berlin, cautiously agrees with this theory. In addition to the
antibiotic-resistance genes, the bacteria contain a gene for
resistance to the mineral tellurite (tellurium dioxide).
Tellurium oxides were used as antimicrobial agents against diseases
such as leprosy and tuberculosis before the development of
antibiotics. Some strains of bacteria may have evolved resistance to
tellurium during its historical medical use, or after its use in the
mining and electronics industries increased its presence in the
environment. According to Wieler, the strain's resistance
characteristics could point towards an environmental source, such as
water or soil.
The ongoing genetic characterization of the strain might also reveal
why the bacterium is mostly infecting adults, and women in particular.
EHEC infections usually occur in children, and affect boys and girls
equally. Initial theories suggested that young adult women are the
people most likely to purchase, handle, and consume salad vegetables.
"This is still our only explanation for this demographic," says
Wieler. But he suspects that the strain might have biological
characteristics that make adults more susceptible to the infection.
A telltale sign is that the strain does not contain the eae gene,
which codes for a protein called intimin, an adhesion protein that
allows the bacteria to attach to cells in the gut. Eae-negative EHEC
have been specifically associated with adult infections before,
although it is still unclear why this particular protein is more
effective in adult guts than in those of children.
Gad Frankel, a microbiologist at Imperial College London, suspects
that the genome of this strain will reveal more information about the
adherence mechanisms of _E. coli_. "Some pathogenic bacteria don't
just stick to cells in our guts, they also have active adherence
mechanisms to stick to some vegetables," says Frankel.
It is possible that the strain has evolved a combination of adhesion
proteins that makes it particularly hard to remove from food, or for
the human body to eliminate. "This outbreak has shown we need to be
prepared to deal with emerging strains with properties that give them
enhanced virulence," says Frankel.
--
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******
[5] Norway (suspected)
Date: Tue 31 May 2011
Source: Health Canal [edited]
<http://www.healthcanal.com/infections/17562-Patient-Norway-with-possible-connection-EHEC-outbreak-Germany.html>
The Norwegian Institute of Public Health has been notified of a case
of EHEC infection with a possible connection to the current outbreak
in Germany.
The patient is a man in his 40s who was admitted to Sorlandet
Hospital in Kristiansand with bloody diarrhea. It is not yet known if
the bacterial strain is the same as that which is involved in the
German outbreak.
Local health authorities and the Food Safety Authority are following
up the case in co-operation with the Norwegian Institute of Public
Health, and are working to identify the source of infection. The
number of confirmed cases in Europe is increasing so it would be
unsurprising if more cases arise in Norway.
--
Communicated by:
ProMED-mail
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******
[6] Denmark
Date: Tue 31 May 2011
Source: Crienglish.com, Xinhua News Agency report [edited]
<http://english.cri.cn/6966/2011/05/31/189s640241.htm>
The number of confirmed _E. coli_ [O104] cases has risen to 14 in
Denmark, with at least 26 others suspected of having the intestinal
infection, the National Serum Institute said Mon 30 May 2011; 7 of the
confirmed cases show symptoms of kidney failure, which marks an
advanced stage of the sickness, the institute said.
"Almost all of the 14 infected people have been in northern Germany
recently except just one. There is a 24-year-old man from Jutland, he
has not even been to Germany, so he does not quite fit with the rest
of the pattern," said Kaare Moelbak, chief physician at the institute.
"We do not know yet how he has been so unlucky to get this infection
but we assume that it has been a person-to-person transmission, or
that he has eaten infected vegetables," he added.
--
Communicated by:
ProMED-mail
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[This reports a single case which was not clearly related to travel
to Germany. It is not clearly stated that this case was shown to be
O104, or has been in contact with anyone who was in Germany recently.
- Mod.LL/JW]
******
[7] USA
Date: Thu 2 Jun 2011
Source: msnbc.com [edited]
<http://www.msnbc.msn.com/id/43256788/ns/health-food_safety/>
A 3rd USA resident who recently traveled to Germany has been
hospitalized with an infection that may be linked to the killer
bacterium in Europe, officials from the CDC said Thu 2 Jun 2011.
That person joins 2 other travelers, including someone from
Massachusetts, who are being tested to determine whether they are
victims of a massive food poisoning outbreak that has killed 18
people, sickened more than 1600, and spread to at least 10 European
countries since early May 2011.
But even if they are infected, the USA travelers are unlikely to
spark a spreading outbreak at home, say food safety experts who urge
both common sense and caution.
"These humans aren't going to introduce this strain into the USA and
have it become a permanent, common resident," said Dr Timothy Jones,
an epidemiologist who serves on the FDA's Food Safety committee. The
bacterium can be spread by touch, but it's not like other foodborne
pathogens which can be highly contagious. Good hand hygiene and
careful food preparation can reduce risks.
"The only way it would sort of erupt or explode in this country is if
the original reservoir, whatever's holding it in nature, got infected
and spread it. Unless that happened, it wouldn't really lodge here,"
Jones said.
A spokeswoman for the Massachusetts Department of Public Health
confirmed that the state had reported a case of hemolytic uremic
syndrome, or HUS, a serious side effect of EHEC infection, in a
traveler who'd been to northern Germany. She declined to release
information about the patient's gender, hometown, or condition. No
information about the other 2 travelers, both of whom contracted HUS,
has been released.
USA residents have little to fear from produce imported from Europe
and there's no reason to stop eating fresh fruits and vegetables,
government officials said. The FDA has received no shipments of
tomatoes, cucumbers, or lettuce from countries associated with the
outbreak, said Siobhan DeLancey, an FDA spokeswoman. The USA imports
very little produce during this time of year, she added
[Byline: JoNel Aleccia]
--
Communicated by:
ProMED-mail
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[Regarding the speculation in Nature in [4] above about a possible
non-animal origin, it could have evolved in the soil on some unlucky
horticultural farm with tellurite-rich soil, and got from there onto
the vegetable harvest. My bet is it's the lettuce, because cucumbers
& tomatoes easily wash clean -- but unless it is hydroponically
produced, lettuce is pulled up with soil-covered roots, and every cook
knows how difficult it is to wash leafy vegetables. I myself have
found a little slug tucked inside a lettuce that I had rinsed in a
colander under the tap; and who in a food service kitchen is going to
wash lettuce leaf by leaf? - Mod.JW.
]
[see also:
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]
.................................................sb/ll/mj/jw
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