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Published Date: 2011-05-24 11:50:16
Subject: PRO/AH/EDR> E. coli VTEC - Germany (02): increased case burden
Archive Number: 20110524.1578

E. COLI VTEC - GERMANY (02): INCREASED CASE BURDEN
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[1]
Date: Tue 24 May 2011
Source: Deutsche Welle [edited]
http://www.dw-world.de/dw/article/0,,6533461,00.html

German health authorities have registered over 400 confirmed or
suspected cases of a potentially lethal bacterial disease since
mid-May 2011. The reports represent a dramatic rise in comparison with
the last 10 years, in which 800 to 1200 cases occurred annually. The
condition is caused by a strain of the bacterium _E. coli_,
enterohemorrhagic _E. coli_ (EHEC), which is often foodborne and can
lead to severe digestive problems.

"The 1st symptom is diarrhea, and, in more severe cases, this is
typically followed by blood in the stool and massive cramping," said
Reinhard Burger in an interview with Deutsche Welle. Burger is
President of Germany's Robert Koch Institute, a federal institution
tasked with disease control and prevention.

While an average case runs its course in around a week, acute
instances of the ailment can lead to kidney failure and even death.
Symptoms generally take several days to show up after coming in
contact with the EHEC bacteria.

Both the rash of reports and the severity of the outbreaks in May has
alarmed public health officials. "This epidemic is really very
unusual, because in a normal year, we only see about 10 cases in
Hamburg," Rico Schmidt of Hamburg's Department of Health told Deutsche
Welle. In May 2011, Hamburg has already registered over 40 cases of
the more severe form of illness brought on by EHEC.

Health officials and scientists are working hard to isolate what is
causing this year's outbreaks while advising customers to exercise
extra caution in selecting and cleaning the foods they consume.

"Since the source of the infections hasn't yet been discovered, that
means we also can't put a stop to it, instead, we have to get warnings
out to people," said Dr. Susanne Huggett, Medical Director at the
MEDILYS laboratory in Hamburg, in an interview with Deutsche Welle.

Hamburg's Institute for Hygiene and Environment said unwashed
vegetables could be the prime suspect based on information gathered
from afflicted individuals, while sources like raw milk, cream cheese
and beef that more often contain the bacteria seem unlikely to have
caused the current epidemic.

"If fields are fertilized with liquid manure, then the EHEC bacteria
can make its way on to salad or vegetables sold in supermarkets,"
noted Werner Solbach, microbiologist at the University of Lubeck, in
an interview with Deutsche Welle. "These days, we have a lot of
pre-packaged and prepared salads for sale that may contain the
bacteria."

Although generally children and the elderly are most at risk of
infection, investigators have also noted an unusually high number of
adult women among the sufferers this year, leading to questions about
whether the source is in a product marketed more heavily to women.

So far, 1 death has been confirmed from this month's outbreak. An
83-year-old woman died due to complications from the bacteria on 21
May 2011, said Hannover's Department of Health on Tuesday. A number of
other patients infected with EHEC are currently in critical
condition.

[Byline: Greg Wiser]

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[2]
Date: Tue 24 May 2011
Source: Agence France-Presse [edited]
http://www.google.com/hostednews/afp/article/ALeqM5hwuIRVUhQuPHp_E3Abn4mPYSMxvQ?docId=CNG.70d06a6c49b3b0a2f5170461c7277a26.5a1

Worries grew in Germany Tue 24 May 2011 about infections caused by a
strain of the _E. coli_ bacterium after authorities reported the death
of an 83-year-old and a "very unusual" number of cases.

The health ministry in the northern state of Lower Saxony said that
an autopsy was being carried out on the woman who died after suffering
from bloody diarrhea for a week. The woman was confirmed to have been
infected with enterohemorrhagic _E. coli_ (EHEC), but tests were being
carried out to see if this led to her death, the ministry said in a
statement.

The Robert Koch Institute (RKI), the national disease-control and
prevention agency, said that over the past 2 weeks more than 80 cases
of potentially fatal hemolytic uraemic syndrome (HUS), caused by EHEC,
have been recorded. "The number of serious cases in such a short time
period is very unusual, and the age groups affected is also
untypical," the RKI said in a statement.

Currently it is mostly adults, in most cases women, who have been
affected, whereas previous outbreaks have been in children, the RKI
said. The majority of the cases are in northern Germany so far.

In 2010, for example, there were 65 cases of HUS, of which only 6
were aged 18 years or over. There were 2 fatalities.

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[With more than 80 cases of hemolytic-uremic syndrome, the total
number of cases of the outbreak strain should be more than 800 if the
10 percent figure of HUS occurring after Vero toxin producing _E.
coli_ is used. An outbreak of this many cases of HUS in adults is
quite unusual. It is likely that the vehicle of transmission is one
that is ingested more by adult women rather than other population
groups.

It may be postulated that this strain may be producing more toxin
than the more usual VTEC strains similar to what some of the
_Clostridium difficile_ strains have been found to do. ProMED awaits
more information regarding the strain and the outbreak. - Mod. LL]

See Also