Outbreaks of E. coli O104:H4 infection: WHO/Europe gives public health advice

There is an outbreak of Escherichia coli O104:H4 infection in France, south of Bordeaux, where 8 cases of haemolytic uraemic syndrome (HUS) and 8 cases of bloody diarrhoea have been reported. This rare infection is caused by the same serotype, and probably the same strain, as seen in the recent and severe outbreak in Germany, which started in May. The consumption of sprouted seeds and beans has been implicated in both outbreaks. Epidemiological, microbiological and trace-back investigations are continuing, to identify the origin of the contamination responsible for these outbreaks. The European Food Safety Authority has set up a task force – with participation by the European Commission, the European Centre for Disease Prevention and Control, WHO and Member States – to coordinate and advance investigations to track down the primary source of contamination.

Given the intersectoral and international nature of these outbreaks, WHO advises Member States to strengthen surveillance of severe diarrhoeal disease, particularly bloody diarrhoea, and to share information rapidly between sectors and at all levels. At the international level, this should be done through joint formal reporting mechanisms, making full use of the International Health Regulations’ and the European Union’s reporting procedures. The investigation should also make full use of specialized reference laboratories and collaborating centres.


Until the investigations have been completed, WHO advises consumers in the WHO European Region that bean sprouts or sprouted seeds – whether commercially or home grown – should only be eaten when they have been thoroughly cooked. E. coli bacteria are killed at a cooking temperature of 70 °C. Since measuring the temperature of sprouting beans and seeds is difficult, it is recommended to cook them until they are steaming hot, not just warm. In addition, people should wash their hands after handling seeds intended for planting or sprouting.

Further, people should always follow normal food-hygiene measures: washing fruit and vegetables thoroughly in clean running water, washing their hands after using the toilet and before and after handling food, keeping raw and cooked food separate and using different equipment when handling raw and cooked food, and cooking food thoroughly.

People experiencing bloody diarrhoea should seek medical attention urgently.