Shiga toxin-producing E. coli (STEC): Update on outbreak in Germany and cluster in France (29 June 2011, 11:00) (ECDC, edited)

[Giuseppe]

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

Shiga toxin-producing E. coli (STEC): Update on outbreak in Germany and cluster in France (29 June 2011, 11:00)



29 Jun 2011


Update since 28 June ? 11:00:

In the EU/EEA, 885 HUS cases, including 31 deaths, and 3 170 non-HUS cases, including 17 deaths have so far been reported.

The table below shows the distribution of reported cases per country.

Germany reports 28 non-HUS STEC cases since the last update.

Sweden reports one new non-HUS STEC case, who does not have any known links to Germany, and claims not to have eaten sprouts.

The latest known date of onset of diarrhoea for cases is 23 June in Germany.

On Friday 24 June, France reported a cluster of patients with bloody diarrhoea, who had participated in an event in the commune of B?gles around Bordeaux on 8 June.

As of 28 June, eight cases of bloody diarrhoea and a further eight cases with HUS have been identified. Eleven of these patients had attended the event in B?gles. They are seven women and four men, between 31 and 64 years of age. Infection with E. coli O104:H4 has been confirmed for four patients with HUS.

The French authorities are investigating this new cluster of STEC. Nine of the cases reported having eaten sprouts at the event on 8 June, and leftovers are currently being analysed. These suspected sprouts were locally produced, and were not imported from the farm implicated in the outbreak in Germany.

Thorough investigations are now being carried out to determine the suspected vehicle of infection for the cases reported in the French cluster, and whether there is any link between that cluster and the large outbreak reported from Germany.



Table 1: Number of probable and confirmed HUS cases and non-HUS STEC cases with associated deaths per EU/EEA Member State as of 29 June, 11:00

[Member States - Number of HUS cases (death) - Number of non-HUS STEC cases (death)]

1. Austria - 1 (0) - 4 (0)
2. Czech Republic - 0 (0) - 1 (0)
3. Denmark - 9 (0) - 14 (0)
4. France ? HUS: 4 (0) Confirmed cases* - 4 (0) Suspected cases* ? EHEC: 2 (0) Probable and confirmed cases** - 8 (0) Suspected cases*
5. Germany - HUS: 685 (23) Probable and confirmed - 153 (7) Suspected cases ? EHEC: 3091 (17)
6. Greece - 0 (0) - 1 (0)
7. Luxembourg - 1 (0) - 1 (0)
8. Netherlands - 4 (0) - 7 (0)
9. Norway - 0 (0) - 1 (0)
10. Poland - 2 (0) - 1 (0)
11. Spain - 1 (0) - 1 (0)
12. Sweden - 18 (1) - 35 (0)
13. The United Kingdom - 3 (0) - 3 (0)
14. TOTAL - 885 (31) - 3 170 (17)

Note: the numbers in this table represent the total number of cases reported at the European level (ECDC) so far. Although daily numbers of reported cases have steadily decreased in the last three weeks, these cumulative numbers continue to rise due to reporting delays at the various levels.

* Cases reported from the new outbreak in Bordeaux
** Cases reported earlier, linked to travel to Germany


Read more:

Escherichia coli (E. coli) health topic site: See list of all epidemiological updates, disease information

ECDC updated its risk assessment on 15 June

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[Anne]

Re: Shiga toxin-producing E. coli (STEC): Update on outbreak in Germany and cluster in France (29 June 2011, 11:00) (ECDC, edited)

http://www.efsa.europa.eu/en/scdocs/doc/rraefsaecdcstec0104.pdf


Food trace-back investigations at the EU level
The consumption of sprouts is the suspected vehicle of infection in both the French cluster and the German outbreak, and the isolated E. coli O104:H4 strain in human cases in both countries is the same, indicating a potential link between these two public health events. Therefore, it is opportune to strengthen trace-back and trace-forward investigations at national and EU level to identify what commonalities exist between the sprout production chains (distributor chains, distributors, retail outlets and suppliers) in Germany and France, and to identify any potentially contaminated batches of sprout seeds, so as to implement recall notifications in order to remove the vehicle of transmission quickly. Such trace-back investigations require close collaboration between national level, EU level and international public health and food safety institutions. They are currently being coordinated by the European Food Safety Authority (EFSA) taskforce established for this purpose, following a request from the European Commission.
The tracing back is progressing and has thus far shown that fenugreek seeds imported from Egypt either in 2009 and/or 2010 are implicated in both outbreaks. There is still much uncertainty about whether this is truly the common cause of all the infections as there are currently no positive bacteriological results. In particular, the 2009 lot appears to be implicated in the outbreak in France and the 2010 has been considered to be implicated in the German outbreak. Furthermore, this link does not explain the most recent case in Sweden, currently under investigation and in which, thus far, no consumption of sprouts has been implicated.
All this is being further investigated. In particular, an investigation on the distribution of seeds from these lots throughout Germany and Europe has been urgently requested. The export of some of the seeds imported from Egypt to another company in the UK (from where seeds were exported to France) demonstrates the necessity of this information.
It is also noted that seeds sold for sprouting are often sold as seed mixes and that during re-packaging cross-contamination can not be excluded. Therefore, any advice to consumers should at this time cover all seeds and raw sprouts derived thereof.