E coli cases grow as more evidence points to sprouts

Jun 13, 2011 (CIDRAP News) – Cases and deaths in Germany's Escherichia coli outbreak continued to climb over the weekend as officials tied the outbreak more firmly to sprouts and health officials and politicians looked for lessons from the crisis.

The European Centre for Disease Prevention and Control (ECDC) today said European Union countries have had 2,508 cases of enterohemorrhagic E coli (EHEC), 817 additional EHEC cases accompanied by hemolytic uremic syndrome (HUS), and 36 deaths. The numbers are up by 221, 22, and 5, respectively, since Jun 10.

The vast majority of the cases are in Germany, which has had 2,447 non-HUS EHEC cases, 781 HUS cases, and 35 deaths, according to the ECDC. HUS is a type of life-threatening kidney failure.

German officials announced Jun 10 their conclusion that sprouts from a farm in the northern German state of Lower Saxony were the source of the outbreak, prompting cancellation of warnings against eating cucumbers, lettuce, and tomatoes, the previous suspected culprits. The finding was based on epidemiologic studies—comparisons of the diets of outbreak patients and healthy people.

On Jun 11 Germany's Federal Institute for Risk Assessment (BfR) said it had confirmed that bacteria on sprouts from the household of EHEC patients in North Rhine-Westphalia state were E coli O104:H4, the outbreak serotype.

News reports said the sprouts were from a household garbage bin, and the BfR acknowledged that the sprouts package had been opened. That raised the possibility that the sprouts had been contaminated by the sick people, instead of the other way around.

But the BfR statement said, "Although the samples originated from an open sprout packaging from a household in which patients infected with EHEC lived, it can be assumed with a very high probability that the EHEC outbreak with severe disorders and fatalities is attributable, more particularly to the consumption of raw sprouts," the BfR statement said.

EU Health Commissioner John Dalli welcomed the BfR's finding, according to The Local, an English-language German news site. "The source of contamination is now identified and the epidemiological findings are backed by laboratory results," a Jun 12 story quoted him as saying.

Meanwhile, a German opposition politician cited the nation's disease-reporting system as one of the reasons the outbreak grew so large, according to The Local's report. Reports of outbreak cases are passed along a chain from hospitals to local health officials to the state health office and then to the Robert Koch Institute (RKI), the national public health authority, the story said.

Karl Lauterbach, health spokesman for the opposition Social Democrats, called for the German parliament's health committee to investigate the reporting procedures and said hospitals should have to report future EHEC cases directly to the RKI, according to the story.

Health Minister Daniel Bahr, in an interview with the Bild am Sonntag newspaper, acknowledged a need for better reporting procedures, according to The Local's story.

In addition, Ilse Aigner, Germany's consumer protection and agriculture minister, said the nation needs to improve its regulation of food safety, according to the story.

A report in the Washington Post today quoted various observers citing a lack of coordination in Germany's response to the outbreak. Hans-Michael Goldmann, head of the German parliament's consumer affairs committee, called for a merger of the three separate federal agencies that deal with disease control, risk assessment, and food safety, according to the story.

In other recent developments, the US Centers for Disease Control and Prevention (CDC) said on Jun 10 that the United States has one confirmed and four suspected E coli O104:H4 cases, one more suspected case than cited in the previous update on Jun 7. Of the five patients, four recently traveled to Hamburg, Germany, and were probably exposed there, the CDC said.

Two of the suspected case-patients, one in Michigan and one in Wisconsin, have HUS, the agency reported previously.

Elsewhere, the Virginia Bioinformatics Institute at Virginia Tech University announced it has sequenced two E coli O104:H4 isolates from the outbreak and is making the data available to researchers.

See also:

Jun 13 ECDC statement and numbers

Jun 12 The Local story

Jun 10 CDC update

Jun 11 Virginia Bioinformatics Institute announcement about sequencing

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