EHEC outbreak: update 12

The outbreak remains primarily centred in Germany, and investigations continue into both the nature of the unusual enteroaggregative verocytotoxin-producing Escherichia coli (EAggEC VTEC) O104:H4 bacterium, which is causing the outbreak, and its source.

Haemolytic uraemic syndrome (HUS)

As of 8 June at 15:00 CET, Germany had reported 722 HUS cases (including 18 fatalities): 33 more cases (but with no additional deaths) since the previous day. 69% of cases were in females and 88% in adults aged 20 years or older, with the highest attack rates per 100 000 population in the group aged 20–49 years. Case-onset dates ranged from 1 May to 6 June.

Enterohaemorrhagic Escherichia coli (EHEC)

As of 8 June at 15:00 CET, 2086 cases of EHEC infection (without HUS) had been reported in Germany (8 fatal): 127 more cases and 2 more deaths since the previous day. 60% of cases were in females and 88% in adults aged 20 years or older. Case-onset dates ranged from 1 May to 6 June.

The Robert Koch Institute, in Germany, states that the current HUS and EHEC notification data, as well as data from the surveillance of bloody diarrhoea in emergency departments, show an overall decreasing trend in the number of cases. It is uncertain whether this decline is due to the changing consumption of raw vegetables and/or the waning of the source of infection.

Other countries

As of 8 June, 13 other European countries had reported a total of 35 HUS cases (1 fatal) and 61 EHEC cases (none fatal). There were 2 more HUS cases and 3 fewer EHEC cases reported since the previous day. As the revised European Union (EU) case definition is being applied, some cases reported earlier have now been excluded. In addition, the Centers for Disease Control and Prevention (CDC) in Atlanta, United States of America have published information on 3 HUS cases (1 confirmed and 2 suspected) and 1 suspected EHEC case (without HUS) in the United States linked to this outbreak. On 7 June, the Public Health Agency of Canada reported on 1 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.

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 USA who travelled in Germany
Denmark 8
0
12
 0  
France 0
0
2
0
+7 cases of bloody diarrhoea not yet confirmed as EHEC
Germany
 722  18  2086 8
 
Greece 0
 0  1 0
A German tourist
Luxembourg 0
 0 1
0
 
Netherlands 4
 0 2
0
 
Norway 0
0
1
0
Contact with a German in Norway
Poland 2
0
0
 0  
Spain 1
 0 1
0
 
Sweden 16
1
30
0
 
Switzerland 0
0
5
0
 
United Kingdom 3
0
2
0
All 5 cases confirmed
United States of America  3 0
 1 0
3 HUS cases (1 confirmed and 2 suspected) and 1 suspected EHEC case without HUS
 Total  760  19  2149  8  

Note: There are 2909 HUS and EHEC cases in total.

All but one 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 3–4 days after exposure (range: 2–10 days).

The cause of the outbreak has been proved to be E. coli serotype O104:H4, or more precisely a strain of enteroaggregative verocytotoxin-producing E. coli (EAggEC VTEC) O104:H4.

Investigations continue into the source of the outbreak.

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.