Outbreaks of E. coli O104:H4 infection: update 27

On 28 June 2011, the Institut de veille sanitaire, France, published new figures for the continuing 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 infection 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 new cases in France or Sweden were in people who had travelled in Germany since 1 May 2011.

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

On 30 June 2011, the Institut de veille sanitaire announced that the results of the analyses performed by the French national reference centre for E. coli and Shigella and its associated laboratory showed that the E. coli O104:H4 that caused the outbreak in Germany in May–June 2011 and that causing the outbreak in France in June were genetically related. This further increased the evidence pointing to a common source behind these outbreaks.

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 other countries with cases in people with a history of travel to northern Germany, as of 29 June 2011.The table does not include the 16 cases from the outbreak in France or the new domestic case in Sweden.

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
14
 0
France 0
0
2
0
Germany
 841  30  3110 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  884  32  3189  17

In total, 16 countries have reported 4073 HUS and EHEC cases linked to the outbreak in Germany, including 49 fatalities.

In Germany, the latest date of onset of bloody diarrhoea is 24 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.

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.