On 22 May, Germany reported a significant increase in the number of patients with haemolytic uremic syndrome (HUS) and bloody diarrhoea caused by Shiga toxin-producing E. coli (STEC).
Since 2 May 2011, 661 cases of HUS and 1672 non-HUS STEC cases have been reported from European Union Member States, including 630 HUS cases and 1601 non-HUS STEC cases in Germany. Sixteen of the HUS cases and six non-HUS STEC cases in EU Member states have died. See table below.
While HUS, caused by STEC infections, is usually observed in children under 5 years of age, in this outbreak the great majority of cases are adults, with more than two thirds being women.
Laboratory results indicate that STEC serogroup O104:H4 (Stx2-positve, eae-negative, hly-negative, ESBL, aat, aggR, aap) is the causative agent. PFGE results shows indistinguishable pattern of 7 human O104:H4 outbreak strains in Germany and 2 strains of O104:H4 in Denmark.
The source of the outbreak is under investigation, but contaminated food seems the most likely vehicle of infection.
Most cases are from, or have a history of travel to the North of Germany (mainly Schleswig-Holstein, Lower Saxony, North-Rhine-Westphalia and Hamburg). Within the EU also Denmark, the Netherlands, Poland, Spain, Sweden and the United Kingdom have reported cases of HUS, related to the ongoing outbreak as well as cases of non-HUS STEC cases.
Number of HUS and non-HUS STEC cases and associated deaths per EU Member States as of 6 June 2011, 10:00
|EU Member States
|Number of HUS cases (deaths)||Number of non-HUS STEC cases (deaths)|
|Austria||0 (0)||2 (0)|
|Czech Republic||0 (0)||1 (0)|
|Denmark||7 (0)||11 (0)|
|Finland||0 (0)||1 (0)|
|France||0 (0)||10 (0)|
|Germany||630 (15)||1601 (6)|
|The Netherlands||4 (0)||4 (0)|
|Norway||0 (0)||1 (0)|
|Poland||1 (0)||0 (0)|
|Spain||1 (0)||0 (0)|
|Sweden||15 (1)||32 (0)|
|The United Kingdom||3 (0)||8 (0)|
|Total||661 (16)||1672 (6)|
Based on the available information, cases are associated with an exposure in Germany (mainly northern parts). The vehicle of the outbreak has not yet been identified and intensive investigations are ongoing. The results of these investigations will determine the assessment of this risk. Rapid identification of potential cases linked to this outbreak, within Germany or among persons who have travelled to Germany since the beginning of May, is essential to prevent the development of severe disease.
STEC is a group of pathogenic Escherichia coli (E. coli) strains capable of producing Shiga toxins, with the potential to cause severe enteric and systemic disease in humans.