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International Health Regulations

EHEC outbreak: update 13

10-06-2011

On 10 June, German authorities stated that mounting epidemiological and food-chain evidence indicated that bean and seed sprouts (including fenugreek, mung beans, lentils, adzuki beans and alfalfa) are the vehicle of the outbreak in Germany.

Bean-sprout evidence mounting, new recommendations

On 10 June, authorities from the Robert Koch-Institute (RKI), the Federal Institute for Risk Assessment (BfR) and the Federal Office of Consumer Protection and Food Safety (BVL) jointly stated that mounting epidemiological and food-chain evidence indicated that bean and seed sprouts (including fenugreek, mung beans, lentils, adzuki beans and alfalfa) are the vehicle of the outbreak in Germany caused by the unusual enteroaggregative verocytotoxin-producing Escherichia coli (EAggEC VTEC) O104:H4 bacterium. The outbreak remains primarily centred in Germany.

  • The authorities now recommend that people in Germany should not eat raw bean and seed sprouts of any origin. Households, caterers and restaurants should dispose of any bean and seed sprouts that they have, and any food items that might have been in contact with them, until further notice.
  • The recommendation not to eat cucumbers, tomatoes and leafy salads in northern Germany is cancelled.
  • They recommend withdrawal from the market of all food products from a farm in Lower Saxony, where the implicated bean and seed sprouts originated.
  • Numerous investigations continue, including into delivery chains. So far, there is no evidence that bean and seed sprouts from the farm have been exported beyond Germany.
  • The authorities recommend strict adherence to general hygiene advice when handling food items, after using the toilet and when health professionals are in contact with patients.

BfR, BVL and RKI have issued a joint press release with more details.

Haemolytic uraemic syndrome (HUS)

As of 9 June at 15:00 CET, Germany had reported 759 HUS cases (including 21 fatalities): 37 more cases and 3 additional deaths since the previous day. 68% of cases were in females and 88% in adults aged 20 years or older, with the highest attack rates per 100 000 population in the group aged 20–49 years. Case-onset dates ranged from 1 May to 6 June.

Enterohemorrhagic Escherichia coli (EHEC)

As of 9 June at 15:00 CET, 2229 cases of EHEC infection (without HUS) had been reported in Germany (9 fatal): 143 more cases and 1 more death since the previous day. 60% of cases were in females and 88% in adults aged 20 years or older. Case-onset dates ranged from 1 May to 6 June.

RKI stated that the number of notified HUS/EHEC cases reported to it has declined over the past few days. The daily absolute and relative numbers of patients presenting to hospital emergency departments with bloody diarrhoea have also decreased. It is still uncertain whether this decline in outbreak activity is due to changes in consumption of raw vegetables and/or the waning of the source of infection.

Other countries

As of 9 June, 13 other European countries had reported a total of 36 HUS cases (1 fatal) and 63 EHEC cases (none fatal): 1 more HUS case and 2 more EHEC cases since the previous day. In addition, the Centers for Disease Control and Prevention (CDC) in Atlanta, United States of America have published information on 3 HUS cases (1 confirmed and 2 suspected) and 1 suspected EHEC case (without HUS) in the United States linked to this outbreak. On 7 June, the Public Health Agency of Canada reported on 1 suspected case of E. coli O104 infection (without HUS), in a person with travel history to northern Germany and with links to a confirmed case of E. coli O104 infection in Germany.

The table shows totals for all affected countries.


Country
HUS
EHEC
Comments
 Cases Deaths
 Cases  Deaths  
Austria 1
 0 3
0
 
Canada  0 0
 1  0  
Czech Republic 0
 0 1
 0 A tourist from the United States who had travelled in Germany
Denmark 8
0
12
 0  
France 0
0
2
0
+7 cases of bloody diarrhoea not yet confirmed as EHEC
Germany
 759  21  2229 9
 
Greece 0
 0  1 0
A German tourist
Luxembourg 0
 0 1
0
 
Netherlands 4
 0 4
0
 
Norway 0
0
1
0
Contact with a German in Norway
Poland 2
0
0
 0  
Spain 1
 0 1
0
 
Sweden 17
1
30
0
 
Switzerland 0
0
5
0
 
United Kingdom 3
0
2
0
All 5 cases confirmed
United States of America  3 0
 1 0
3 HUS cases (1 confirmed and 2 suspected) and 1 suspected EHEC case
 Total  798  22  2294  9  

Note: There are 3092 HUS and EHEC cases in total.

All but 2 of the above HUS and EHEC cases were in people who had travelled to or lived in Germany during the incubation period for infection, typically 3–4 days after exposure (range: 2–10 days).

Note

EHEC and HUS have exclusive notification categories, so case numbers should not overlap. The figures in any rapidly evolving outbreak, however, are provisional and subject to change for a variety of reasons.

In providing the above information, WHO wishes to recognize the contribution of its Member States, and technical partners such as the European Commission, the European Centre for Disease Prevention and Control and a number of WHO collaborating centres.

EHEC outbreak in Germany