Outbreaks of E. coli O104:H4 infection: update 28

On 28 June 2011, the Institut de veille sanitaire, France, published new figures for the verocytotoxin-producing Escherichia coli (VTEC)/haemolytic uraemic syndrome (HUS) outbreak in the Bordeaux region in France, where in total 8 cases of bloody diarrhoea and 8 HUS cases have been reported since 22 June. E. coli O104:H4 infection has been confirmed in 4 of these cases. Also on 28 June, Sweden reported a confirmed case of E. coli O104:H4 infection in southern Sweden in an adult male. None of these patients in France or Sweden had travelled in Germany since 1 May 2011.

In France, current results from the continuing investigations suggest that sprouted beans or sprouted seeds 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 strain that caused the outbreak in Germany in May–June 2011 and the one causing the outbreak in France in June are genetically related. This strengthens 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 outbreak, enteroaggregative verocytotoxin-producing E. coli (EAggEC VTEC) O104:H4, is sprouted beans and sprouted seeds, and the Robert Koch Institute has warned people in Germany not to eat raw sprouts of any origin. In Germany, the latest date of onset of bloody diarrhoea is 22 June for HUS cases and 26 June for EHEC cases. The last known date of illness onset in a patient with confirmed E. coli O104:H4 infection was 18 June 2011.

Global situation of E. coli O104:H4 infections

The table below shows the total number of globally reported (as of 30 June) cases of and deaths from E. coli (EAggEC VTEC) O104:H4 infection since the beginning of the outbreak in Germany on 1 May 2011, now including the cases from the outbreak in the Bordeaux region of France. In total, 16 countries in Europe and North America have reported 4137 cases of E. coli O104:H4 infection, including 50 fatalities.

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 8
0
10
0
Germany
 845  31  3154 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  896  33  3241  17

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.

Starting from 4 July 2011, WHO/Europe will be issuing these updates as required, and not daily.