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Published Date: 2011-07-07 09:54:56
Subject: PRO/AH/EDR> E. coli O104 - EU (30): update, fenugreek susp
Archive Number: 20110707.2052

E. COLI O104 - EUROPEAN UNION (30): UPDATE, FENUGREEK SEED SUSPECTED
********************************************************************

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International Society for Infectious Diseases
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In this update:
[1] ECDC update
[2] Fenugreek seed tracing
[3] Egypt: _E. coli_ O104:H4, 2010
[4] Egyptian seed/bean alert
[5] Fenugreek seed search

******
[1] ECDC update
Date: Wed 6 Jul 2011
Source: European Centre for Disease Control (ECDC) [edited]
http://www.ecdc.europa.eu/en/activities/sciadvice/Lists/ECDC%20Reviews/ECDC_DispForm.aspx?List=512ff74f%2D77d4%2D4ad8%2Db6d6%2Dbf0f23083f30&ID=1133&RootFolder=%2Fen%2Factivities%2Fsciadvice%2FLists%2FECDC%20Reviews

Update since 5 Jul 2011
-----------------------
In the EU/EEA, 898 HUS [hemolytic uremic syndrome] cases, including
33 deaths, and 3338 non-HUS cases, including 17 deaths, have so far
been reported.

Since the last update, Germany reports one additional HUS case and 24
additional non-HUS STEC [Shiga toxin producing _Escherichia coli_]
cases. 4 HUS cases and 10 non-HUS STEC cases fell ill within the last
10 days (26 Jun-5 Jul 2011). The last known date of illness onset in a
patient with confirmed STEC O104 was 26 Jun 2011. The last reported
date of illness onset among all cases (also without O104 confirmation)
was 29 Jun 2011.

There is no update regarding the outbreak in France (Bordeaux
Region).

EFSA has now published its report on the trace-back investigation of
seeds implicated in the German and French outbreaks (see [2] below).

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[By noting the EU number of daily cases of HUS and non-HUS cases and
their total as well as deaths reported, the daily trends of the
numbers can be seen:

Date (2011): New HUS / New non-HUS / New Total / Overall Total
Deaths
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
Sun 27 Jun: 7 / 78 / 85 / 47 (5 day gap)
Tue 28 Jun: 4 / 97 / 101 / 48
Wed 29 Jun: 0 / 29 / 29 / 48
Thu 30 Jun: 3 / 19 / 22 / 48
Fri 1 Jul: 4 / 44 / 48 / 49
Mon 4 Jul: 0 / 48 / 48 / 49
Tue 5 Jul: 6 / 33 / 39 / 50
Wed 6 Jul: 1 / 24 / 25 / 50

Total cases: 4236 with 50 deaths -- 1.18 per cent 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 clearly decreased from the corresponding day in
the previous week. - Mod.LL]

******
[2] Fenugreek seed tracing
Date: Tue 5 Jul 2011
Source: European Food Safety Authority (EFSA) [edited]
http://www.efsa.europa.eu/en/supporting/doc/176e.pdf

Tracing seeds, in particular fenugreek (_Trigonella foenum-graecum_)
seeds, in relation to the Shiga toxin producing _E. coli_ (STEC)
O104:H4 2011 Outbreaks in Germany and France
----------------------------------------------------------------------
[The entire 23 page report can be found at the source URL above. The
discussion and conclusion are reproduced below. - Mod.LL]

4. Discussion
-------------
An EFSA task force composed of experts from the European Commission,
relevant EU member states, the ECDC, WHO, and the FAO, as well as EFSA
staff members was set up. The analysis and discussion in this report
focus primarily on data obtained from the back tracing process to
identify the source of the seeds suspected of causing the STEC O104:H4
outbreaks. The German EHEC [enterohemorrhagic _E. coli_] task force
trace back methodology was successfully extended to support the
investigations involving 5 other European member states.

The comparison of the back tracing information from the French and
German outbreaks leads to the conclusion that lot no 48088 of
fenugreek seeds imported by the importer, from Egypt, is the common
link for these 2 outbreaks. The implication is that the seeds became
contaminated with STEC O104:H4 at some point prior to leaving the
importer. Such contamination typically reflects a production or
distribution process, which allowed contamination by fecal material of
human and/or animal origin. The results show that from this importer,
seeds were sold to many businesses in Germany and many other countries
in Europe. As the case of the UK shows, the seeds may pass through
many member states before being used or consumed. Many of the seeds
bought by the importer may already have been used. However it is noted
that some are still present in the supply chain.

Uncertainties on the origin and number of batches involved can be
linked to possible incorrect information about the seeds under
suspicion. A major difficulty and source of possible errors is that
the items, their naming and/or identification numbers might change at
each step of the whole supply chain, or errors might have occurred in
the reporting. In addition, missing information on possible cross
contamination due to handling such as repackaging and mixing, need to
be taken into account when doing further trace forward. This becomes
even more evident considering that several lots from the same exporter
were handled by the Importer during the same period and that, at least
in Germany, it could be demonstrated that more than one lot of
fenugreek seeds was used for the production of sprouts by
Establishment A during the likeliest time of exposure to the consumer.
The same scenario is possible for the UK distributor to France but
this is still under investigation.

5. Conclusions
--------------
The comparison of the back tracing information from the French and
German outbreaks leads to the conclusion that a lot (no 48088) of
fenugreek seeds imported from Egypt, is the most likely common link,
although it cannot be excluded that other lots coming through the same
production/supply chain may be implicated.

Given the possible severe health impact of exposure to a small
quantity of contaminated material, and, in the absence of information
regarding the source and means of contamination and possible cross
contamination, it seems appropriate to consider all lots of fenugreek
for the period 2009-2011 from the identified exporter as suspect. In
this regard, the thus far negative test results from the
microbiological tests carried out on seeds cannot be interpreted as
proof that a batch is not contaminated with STEC O104:H4 since these
results depend on and may be limited by both the analytical and
diagnostic performance characteristics as well as by the nature of the
sampling plan.

The number of member states that have received parts of the suspected
lots is much larger than previously known and it cannot be excluded
that other member states and 3rd countries were supplied. The trace
forward operation is becoming complex and widespread and may take
weeks.

This report is one of many elements contributing to the investigation
of the cause of this outbreak, and should not be considered in
isolation. The findings of this report are consistent with other
investigations conducted thus far. Specifically, it supports the
hypothesis that the outbreaks in Germany and France are linked, and
are due to the import of fenugreek seeds from Egypt, which became
contaminated with STEC O104:H4 at some point prior to leaving the
importer.

The contamination of seeds with the STEC O104:H4 strain reflects a
production or distribution process, which allowed contamination with
fecal material of human and/or animal origin. Where exactly this took
place is still an open question. Typically such contamination could
occur during production at the farm level.

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******
[3] Egypt: _E. coli_ O104:H4, 2010
Date: Wed 6 Jul 2011
From: Ann Lindberg <ann.lindberg@sva.se> [edited]

[re: ProMED-mail E. coli O104 - EU (29): update, fenugreek susp
20110705.2038]
---------------------------------------------------------------
A comment on the Egyptian statement: "No traces or infections of the
deadly bacteria were recorded in Egypt so far, the head of the
agricultural quarantine central department at the ministry Ali Soliman
said, stressing this bacterium is not proved existing in Egypt" that
the bacterium is not proven to exist in Egypt.

According to a report produced jointly by ECDC and EFSA
(http://www.efsa.europa.eu/en/supporting/pub/166e.htm), Finland
reported one travel related case of E. coli_ O104:H4, stx2 positive
and eae negative, in 2010 in an older man who had been in Egypt.

--
Ann Lindberg, DVM
Swedish Zoonosis Centre
Department of Disease Control and Epidemiology
National Veterinary Institute
Uppsala, Sweden
<ann.lindberg@sva.se>

[ProMED-mail thanks Dr Lindberg for this information that the O104:H4
serotype could have existed in Egypt prior to this 2011 outbreak. The
mechanism of contamination of the seeds, if they were the reservoir,
remains unclear. - Mod.LL]

******
[4] Egyptian seed/bean alert
Date: Tue 5 Jul 2011
Source: Reuters Africa [summ., edited]
http://af.reuters.com/article/egyptNews/idAFL6E7I50B920110705

Europe banned imports of some seeds and beans from Egypt on Tue 5 Jul
2011, after food safety investigators said a single shipment of
fenugreek seeds from there was the most likely source of an _E. coli_
epidemic which has killed 49 [now 50] people.

The European Food Safety Authority (EFSA) said beyond France and
Germany, where outbreaks of the deadly _E. coli_ strain have made
thousands ill in recent months, other European Union countries may
have received batches of suspect seeds. It urged the officials to make
"all efforts" to prevent any further exposure and said consumers
should not eat sprouts or sprouted seeds unless they are thoroughly
cooked.

"An imported lot of fenugreek seeds which was used to grow sprouts
imported from Egypt by a German importer is the most common likely
link," the EFSA said in a statement. EU health commissioner John Dalli
said that as a result of EFSA's findings, the EU would ban imports of
all seeds and beans from Egypt until 31 Oct 2011.

"The report published today [5 Jul 2011] leads us to withdrawing some
Egyptian seeds from the EU market and to a temporary ban on imports of
some seeds and beans originating from that country," he said in a
statement. The ban covers imports of Egyptian seeds and beans for
sprouting, including legumes, fenugreek, and soya beans.

The EFSA report said the contamination of the seeds with a highly
toxic strain of _E. coli_ had taken place "at some point prior to
leaving the importer."

"Other lots of fenugreek imported from Egypt during the period 2009
to 2011 may be implicated," EFSA said, adding that investigations
should be carried out in all countries that may have received seeds
from the lots concerned.

The European Commission said all fenugreek seeds exported to Europe
since 2009 by the Egyptian company identified as the source of the
contaminated batch must be withdrawn, tested, and destroyed. It did
not identify the company involved.

[byline: Kate Kelland]

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******
[5] Fenugreek seed search
Date: Tue 5 Jul 2011
Source: The New York Times [edited]
http://www.nytimes.com/2011/07/06/business/06seeds.html?_r=1

Authorities are frantically trying to trace all of the tainted
fenugreek seeds from a large shipment linked to a deadly _E. coli_
outbreak in Europe, saying the product was distributed more widely
than previously thought. In a new report, a large shipment of organic
Egyptian fenugreek seeds was distributed to dozens of companies in at
least 12 European countries, the European Food Safety Authority said
on Tue 5 Jul 2011. Investigators were still trying to determine if
additional countries had received some of the seeds.

"The trace forward operation is becoming complex and widespread and
may take weeks," the report said, referring to efforts to locate the
seed shipments. Investigators are now focusing on a single shipment of
more than 16 tons of Egyptian fenugreek seeds that was received by a
German importer in December 2009, according to the report.

The new report showed that only a fraction of the suspect shipment,
about 165 pounds [75 kg], was sold to the German sprout grower whose
sprout mixes authorities think caused the devastating outbreak there.
About 880 pounds [400 kg] were sent to a British company linked to the
illnesses in France. The company, previously identified as Thompson &
Morgan, repackaged the seeds into 50-gram packets and sold them
through a French garden supply chain.

Investigators are still scrambling to figure out where the rest of
the seeds were sent. The report said that more than 11 tons of the
seeds were sold to a German distributor that resold them to 54
companies in Germany and 16 companies in 11 other European countries.
The report said the original importer also sold some seeds to several
companies in Germany, one in Austria, and one in Spain.

The report said that an unknown quantity of the seeds was still in
company supply chains, although much of it may already have been
used.

The German importer received 3 other shipments of fenugreek seeds
from the same Egyptian supplier since 2008. A previous report said
that one of those shipments, in 2010, was suspected as a source of the
German outbreak, but the 2009 shipment alone is now thought to be the
cause of both outbreaks.

[byline: William Neuman]

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See Also