Outbreaks of E. coli O104:H4 infection: update 26

On 28 June 2011, the Institut de veille sanitaire published new figures for the ongoing verocytotoxin-producing Escherichia coli (VTEC)/haemolytic uraemic syndrome (HUS) outbreak in Bordeaux, France. In total, 8 enterohaemorrhagic E. coli (EHEC) cases and 8 HUS cases were reported since 22 June. E. coli O104:H4 has been confirmed in 4 cases.

Also on 28 June, Sweden reported a confirmed case of E. coli O104:H4 in southern Sweden in an adult male. None of the cases in France or Sweden were in people with a history of travel to Germany.

In France, investigations continue, but initial findings suggest that locally grown bean or seed sprouts might be involved. In Sweden, the source of infection remains under investigation.

EHEC outbreak in Germany

In Germany, the daily numbers of reported HUS/EHEC 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 German 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.

The table shows reported cases of and deaths from HUS and EHEC infections in Germany and in other countries with cases in people with a history of travel to northern Germany, as of 29 June at 18:00 CET.

Country
HUS
EHEC
 Cases Deaths
 Cases  Deaths
Austria 1
 0 4
0
Canada  0 0
 1  0
Czech Republic 0
 0 1
 0
Denmark 9
0
13
 0
France 0
0
2
0
Germany
 838  30  3091 17
Greece 0
 0  1 0
Luxembourg 1
 0 1
0
Netherlands 4
 0 7
0
Norway 0
0
1
0
Poland 2
0
1  0
Spain 1
 0 1
0
Sweden 18
1
35
0
Switzerland 0
0
5
0
United Kingdom 3
0
3 0
United States of America  4 1
 2 0
 Total  881  32  3169  17


In Germany, the latest date of onset of bloody diarrhoea is 23 June for HUS cases and 22 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.

In total, 16 countries have reported 4050 HUS and EHEC cases, including 49 fatalities: Austria, Canada, the Czech Republic, Denmark, France, Germany, Greece, Luxembourg, the Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United Kingdom and the United States of America.

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.