Published Date: 2011-06-28 15:46:26
Subject: PRO/AH/EDR> E. coli O104 - EU (25): updates
Archive Number: 20110628.1969
E. COLI O104 - EUROPEAN UNION (25): UPDATES
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
In this update:
 ECDC update
 WHO update
 ECDC update
Date: Mon 27 Jun 2011
Source: European Center for Disease Control (ECDC) [edited]
Update since 25 Jun 2011
In the EU/EEA, 880 HUS cases, including 31 deaths, and 3039 non-HUS
cases, including 16 deaths have so far been reported. Germany reports
7 additional HUS cases and 1 new HUS death since the last update, as
well as 77 non-HUS STEC [Shiga toxin producing _Escherichia coli_]
cases and 2 non-HUS deaths. Denmark reports 1 new non-HUS STEC case.
The latest known date of onset of diarrhea for cases is 22 Jun 2011.
On Fri 24 Jun 2011, France reported a cluster of 8 patients with
bloody diarrhea, after having participated in an event in the commune
of Begles around Bordeaux on 8 Jun 2011. Of these, 7 have developed
HUS, a severe complication of _E. coli_ infection. 6 of the patients
are women between 31-78 years of age, and 2 are men, aged 34 and 41
years. The date of onset of disease for the 8 patients was between
15-21 Jun 2011. In 3 of the patients, infection with _E. coli_ O104:H4
has been confirmed.
The French authorities are investigating this new cluster of STEC. 6
of the cases reported having eaten sprouts at the event on 8 Jun 2011,
and leftovers are currently being analyzed. 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.
In the view of these recent developments, ECDC is preparing an update
of its risk assessment. EFSA, the European Food Safety Authority, has
set up a task force to coordinate investigations to track down the
source of any contaminated sprouted seeds in the European Union. Both
European agencies are closely collaborating with the Member States,
the European Commission, and the WHO to respond to the STEC outbreak
in Germany and the latest cluster reported by France.
[By noting the EU number of cumulative cases of HUS and non-HUS cases
and their total as well as deaths, the daily rise of the numbers can
Date (2011): New HUS / New non-HUS / New Total / Overall Total
Mon 6 Jun: 3 / 67 / 70 / 22
Tue 7 Jun: 13 / 83 / 96 / 23
Wed 8 Jun: 48 / 266 / 314 / 25
Thu 9 Jun: 35 / 121 / 156 / 27
Fri 10 Jun: 38 / 115 / 153 / 31
Sat 11 Jun: 14 / 177 / 191 / 35
Sun 12 Jun: 0 / 40 / 40 / 35
Mon 13 Jun: 8 / 34 / 42 / 36
Tue 14 Jun: 1 / 6 / 7 / 36
Wed 15 Jun: 3 / 17 / 20 / 37
Thu 16 Jun: 2 / 48 / 50 / 39
Fri 17 Jun: 14 / 92 / 106 / 39
Mon 20 Jun: 12 / 74 / 96 / 40 (3 day gap)
Tue 21 Jun: 4 / 89 / 93 / 40
Wed 22 Jun: 8 / 79 / 87 / 43
Mon 27 Jun: 7 / 78 / 85 / 47 (4 day gap)
Total cases: 3919 with 47 deaths -- 1.2 percent case fatality rate.
[The cases do not necessarily reflect date of onset of disease but
rather when the diagnosis was made and reported. The number of newly
reported cases per day has clearly decreased from the corresponding
day in the previous week. - Mod.LL]
 WHO update
Date: Mon 27 Jun 2011
Source: WHO, Regional Office for Europe [edited]
Since week 23/2011 [6-12 Jun 2011], the number of reported cases of
hemolytic uremic syndrome (HUS)/enterohemorrhagic _E. coli_ (EHEC) has
declined significantly. In Germany, the daily numbers of reported
cases have steadily decreased since they peaked on 22 May 2011.
Nevertheless, the cumulative numbers of cases from Germany continue to
rise, primarily owing to delays in notification.
Investigations by the German authorities indicate that the vehicle of
the bacterium responsible for the outbreak, enteroaggregative
verocytotoxin-producing _E. coli_ (EAggEC VTEC) O104:H4, is bean and
seed sprouts, and the Robert Koch Institute has warned people in
Germany not to eat raw sprouts of any origin.
On 24 Jun 2011, France reported an outbreak of
verocytotoxin-producing _E. coli_ (VTEC)/HUS with 8 cases in adults (6
women and 2 men). _E. coli_ O104:H4 has been confirmed in 3 cases.
Investigations are ongoing, but the 1st findings suggest that locally
grown sprouts might be involved. Intensive traceback is under way to
identify a possible common source of the German and French sprout
seeds. Other potential vehicles are also under investigation.
[Curiouser and curiouser! The finding of O104:H4 in France with links
to locally grown sprouts without clear association to Germany puts
another layer of intrigue on top of an already fascinating outbreak.
It is not likely that there is no link at all between the new French
outbreak and the disaster in Germany. We await reports on the genetic
comparisons of the strains in France with the German strain. - Mod.LL