EHEC outbreaks: update 24: France reports 8 cases in new outbreak

Since week 23/2011, the number of reported cases of haemolytic uraemic syndrome (HUS)/enterohaemorrhagic Escherichia coli (EHEC) has declined significantly. In Germany, the daily numbers of reported cases have steadily decreased since they peaked on 22 May. 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 June, 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 first 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.

The table shows the reported cases of and deaths from HUS and EHEC infection as of 24 June at 15:00 CET. It does not include the 8 cases reported by France on 24 June, as these are considered a separate outbreak.

Country
HUS
EHEC
Comments
 Cases Deaths
 Cases  Deaths  
Austria 1
 0 4
0
 
Canada  0 0
 1  0  
Czech Republic 0
 0 1
 0 A tourist from the United States who had travelled in Germany
Denmark 9
0
13
 0  
France 0
0
2
0

Germany
 834  30  2967 16  
Greece 0
 0  1 0
A German tourist
Luxembourg 1
 0 1
0
 
Netherlands 4
 0 7
0
 
Norway 0
0
1
0
Contact with a German in Norway
Poland 2
0
1  0  
Spain 1
 0 1
0
 
Sweden 18
1
33
0
 
Switzerland 0
0
5
0
 
United Kingdom 3
0
3 0

United States of America  4 1
 2 0
3 HUS cases and 2 EHEC cases – all confirmed; in addition, 1 fatal HUS case with travel history to Germany reported by the state of Arizona (not yet confirmed as O104:H4)
 Total  877  32  3043  16  

Note. There are 3920 HUS and EHEC cases in total, including 48 fatalities.

In Germany, the latest date of onset of diarrhoea is 22 June for HUS cases and 20 June for EHEC cases. All but 5 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 remaining 5 cases can also be linked to the outbreak in Germany.

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.