Copenhagen / DK. (who) On June 10th, 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.
Mounting evidence, new recommendations
On June 10th, 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 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.
- In addition, BfR advises against eating home-grown, uncooked sprouts and seedlings.
- The recommendation not to eat cucumbers, tomatoes and leafy salads in northern Germany is cancelled.
- The authorities 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.
RKI, BfR and BVL issued a joint press release on 10 June with more details. The press release was updated on 12 and 13 June – the World Health Organization (WHO) says in its «Update No. 15» on 14 June.
Haemolytic uraemic syndrome (HUS)
As of 13 June at 15:00 CET, Germany had reported 782 HUS cases (including 22 fatalities): only one more case since the previous day. 68 percent of cases were in females and 88 percent in adults aged 20 years or older, with the highest attack rates per 100.000 population in the group aged 20 to 49 years. Case-onset dates ranged from 01 May to 08 June.
Enterohemorrhagic Escherichia coli (EHEC)
As of 13 June at 15:00 CET, 2’453 cases of EHEC infection (without HUS) had been reported in Germany (13 fatal): six more cases and one more death since the previous day. 59 percent of cases were in females and 87 percent in adults aged 20 years or older. Case-onset dates ranged from 01 May to 09 June.
On 14 June, RKI stated that, for approximately the past week, the number of notified HUS/EHEC cases reported to them had markedly declined. Data from sentinel surveillance of bloody diarrhoea in hospital emergency departments also suggest a decrease in the absolute and relative numbers of cases presenting since 30 May. It is still uncertain whether this decline in outbreak activity is due to changing consumption of raw vegetables and/or the waning of the source of infection.
Other countries
As of 13 June, 13 other European countries had reported a total of 36 HUS cases (one fatal) and 66 EHEC cases (none fatal): In addition, the Centers for Disease Control and Prevention (CDC) in Atlanta, United States of America published information on three HUS cases (one confirmed and two suspected) and two suspected EHEC cases (without HUS) in the United States linked to this outbreak. On 07 June, the Public Health Agency of Canada reported on one 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.
Since 10 June, no more HUS or EHEC cases or deaths have been reported from outside Germany. The EHEC bacteria strain found in a Helsinki daycare centre last week is not the same as that causing the German outbreak, according to the Finnish National Institute for Health and Welfare (THL). As of 14 June, no further EHEC cases had emerged at the daycare centre. 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 | – |
| Germany | 782 | 22 | 2’453 | 13 | – |
| Greece | 0 | 0 | 1 | 0 | A German tourist |
| Luxembourg | 0 | 0 | 2 | 0 | – |
| Netherlands | 4 | 0 | 4 | 0 | – |
| Norway | 0 | 0 | 1 | 0 | Contact with a German in Norway |
| Poland | 2 | 0 | 1 | 0 | – |
| Spain | 1 | 0 | 1 | 0 | – |
| Sweden | 17 | 1 | 30 | 0 | – |
| Switzerland | 0 | 0 | 5 | 0 | – |
| United Kingdom | 3 | 0 | 3 | 0 | – |
| United States of America | 3 | 0 | 2 | 0 | 3 HUS cases (1 confirmed and 2 suspected) and 2 suspected EHEC cases |
| Total | 821 | 23 | 2’522 | 12 | 2011-06-13 |
There are 3’343 HUS and EHEC cases in total, including 36 fatalities. All but five 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 three to four days after exposure (range: two to ten 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.
Addendum: On 15 June, another patient, born 1920, died in Hamburg, Germany. Until today (2011-06-15), HUS/EHEC claimed all in all 37 fatalities.
RKI: EHEC and HUS Cases in Germany per Federal Land
| Federal Land | EHEC Cases | Cases in % | HUS Cases | Cases in % |
| Schleswig-Holstein | 713 | 28,9% | 183 | 23,3% |
| Niedersachsen | 503 | 20,4% | 174 | 22,2% |
| Hamburg | 395 | 16,0% | 127 | 16,2% |
| Nordrhein-Westfalen | 260 | 10,5% | 107 | 13,6% |
| Mecklenburg-Vorpommern | 107 | 4,3% | 52 | 6,6% |
| Bayern | 92 | 3,7% | 36 | 4,6% |
| Baden-Württemberg | 89 | 3,6% | 25 | 3,2% |
| Hessen | 86 | 3,5% | 19 | 2,4% |
| Bremen | 52 | 2,1% | 18 | 2,3% |
| Berlin | 49 | 2,0% | 13 | 1,7% |
| Thüringen | 34 | 1,4% | 6 | 0,8% |
| Sachsen-Anhalt | 25 | 1,0% | 6 | 0,8% |
| Rheinland-Pfalz | 23 | 0,9% | 5 | 0,6% |
| Sachsen | 20 | 0,8% | 5 | 0,6% |
| Brandenburg | 14 | 0,6% | 5 | 0,6% |
| Saarland | 7 | 0,3% | 3 | 0,4% |
| no data collected | 1 | 0,0% | 0 | 0,0% |
| Total | 2.470 | 100% | 784 | 100% |
|
EHEC and HUS Cases in Germany – as of 2011-06-14 – 15:00 CET – Source: RKI |
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