2011 Germany E. coli O104:H4 outbreak

Foodborne illness outbreak January 2020 2011 Germany E. coli O104:H4 outbreak Schizocyte smear 2009-12-22.JPG Schistocytes seen in a person with hemolytic-uremic syndrome Escherichia coli O104H4 bacterial outbreak Mk2.png Map of cases and restrictions in relation to the outbreak (click for key and enlarged version) Escherichia coli O104:H4 Western and Northern Europe, the United States and Canada Aachen, Germany 1 May–21 July 2011 Contaminated organic fenugreek sprouts 3,950 800 53 A novel strain of Escherichia coli O104:H4 bacteria caused a serious outbreak of foodborne illness focused in northern Germany in May through June 2011. The illness was characterized by bloody diarrhea, with a high frequency of serious complications, including hemolytic–uremic syndrome (HUS), a condition that requires urgent treatment. The outbreak was originally thought to have been caused by an enterohemorrhagic (EHEC) strain of E. coli, but it was later shown to have been caused by an enteroaggregative E. coli (EAEC) strain that had acquired the genes to produce Shiga toxins, present in organic fenugreek sprouts. Epidemiological fieldwork suggested fresh vegetables were the source of infection. The agriculture minister of Lower Saxony identified an organic farmhttp://www.gaertnerhof.org/ Gärtnerhof Bienenbüttel 13 June 2011 https://web.archive.org/web/20110612212804/http://www.gaertnerhof.org/ 12 June 2011 live in Bienenbüttel, Lower Saxony, Germany, which produces a variety of sprouted foods, as the likely source of the E. coli outbreak.http://www.cnn.com/2011/WORLD/europe/06/05/europe.e.coli/index.html?hpt=hp_t2 German-grown food named likely culprit in deadly outbreak CNN 5 June 2010 5 June 2011 The farm was shut down. Although laboratories in Lower Saxony did not detect the bacterium in produce, a laboratory in North Rhine-Westphalia later found the outbreak strain in a discarded package of sprouts from the suspect farm.http://www.thelocal.de/national/20110610-35583.html Deadly E. coli found on bean sprouts thelocal.de 11 June 2010 11 June 2011 A control investigation confirmed the farm as the source of the outbreak.http://www.sueddeutsche.de/wissen/ehec-epidemie-bahr-befuerchtet-weitere-todesfaelle-1.1107576 Bundesinstitut bestätigt Sprossen als Ehec-Quelle sueddeutsche.de 11 June 2010 13 June 2011 On 30 June 2011, the German Bundesinstitut für Risikobewertung (BfR) (Federal Institute for Risk Assessment), an institute of the German Federal Ministry of Food, Agriculture and Consumer Protection, announced that seeds of organicKing L. A. Nogareda F. Weill F.-X. Mariani-Kurkdjian P. Loukiadis E. Gault G. Jourdan-DaSilva N. Bingen E. Mace M. Thevenot D. Ong N. Castor C. Noel H. Van Cauteren D. Charron M. Vaillant V. Aldabe B. Goulet V. Delmas G. Couturier E. Le Strat Y. Combe C. Delmas Y. Terrier F. Vendrely B. Rolland P. de Valk H. Outbreak of Shiga Toxin-Producing Escherichia coli O104:H4 Associated With Organic Fenugreek Sprouts, France, June 2011 Clinical Infectious Diseases 54 11 2012 1588–1594 1058-4838 10.1093/cid/cis255 22460976 free fenugreek imported from Egypt were likely the source of the outbreak. http://www.bfr.bund.de/cm/343/samen_von_bockshornklee_mit_hoher_wahrscheinlichkeit_fuer_ehec_o104_h4_ausbruch_verantwortlich.pdf Samen von Bockshornklee mit hoher Wahrscheinlichkeit für EHEC O104:H4 Ausbruch verantwortlich in English: Fenugreek seeds with high probability for EHEC O104: H4 responsible outbreak 30 June 2011 Bundesinstitut für Risikobewertung (BfR) in English: Federal Institute for Risk Assessment de 17 July 2011 In all, 3,950 people were affected and 53 died, 51 of whom were in Germany.European Food Safety Authority E.coli: Rapid response in a crisis http://www.efsa.europa.eu/en/press/news/120711 there were 53 confirmed deaths. 11 July 2012 2 October 2012 https://web.archive.org/web/20181120064044/http://www.efsa.europa.eu/en/press/news/120711 20 November 2018 dead European Food Safety Authority 800 people suffered hemolytic–uremic syndrome (HUS), which can lead to kidney failure.New insight from whole-genome sequencing of Europe's 2011 E. coli outbreaks, Biotechnology, 6 February 2012. A handful of cases were reported in several other countries including Switzerland,Shiga toxin-producing E. coli (STEC): Update on outbreak in the EU (27 July 2011, 11:00) http://ecdc.europa.eu/en/activities/sciadvice/Lists/ECDC%20Reviews/ECDC_DispForm.aspx?List=512ff74f%2D77d4%2D4ad8%2Db6d6%2Dbf0f23083f30&ID=1166&RootFolder=%2Fen%2Factivities%2Fsciadvice%2FLists%2FECDC%20Reviews ECDC 27 July 2011 27 August 2011 https://web.archive.org/web/20111004233651/http://ecdc.europa.eu/en/activities/sciadvice/Lists/ECDC%20Reviews/ECDC_DispForm.aspx?List=512ff74f-77d4-4ad8-b6d6-bf0f23083f30&ID=1166&RootFolder=%2Fen%2Factivities%2Fsciadvice%2FLists%2FECDC%20Reviews 4 October 2011 dead Poland, the Netherlands, Sweden, Denmark, the UK,https://www.bbc.co.uk/news/world-europe-13597080 E. coli cucumber scare: Russia announces import ban BBC News 30 May 2011 30 May 2011 https://web.archive.org/web/20110531111850/http://www.bbc.co.uk/news/world-europe-13597080 31 May 2011 live Canada and the USA.http://www.nbcnews.com/id/43227702 https://web.archive.org/web/20200211224019/http://www.nbcnews.com/id/43227702 dead 11 February 2020 E. Two in U.S. infected in German E. coli outbreak NBC News Online 31 May 2011 2 June 2011 Essentially all affected people had been in Germany or France shortly before becoming ill. Initially, German officials made incorrect statements on the likely origin and strain of Escherichia coli.https://www.ft.com/content/46118688-8c76-11e0-883f-00144feab49a / Europe – Cucumber crisis widens European rift Financial Times 4 June 2011 https://web.archive.org/web/20110603221348/http://www.ft.com/cms/s/0/46118688-8c76-11e0-883f-00144feab49a.html?ftcamp=rss 3 June 2011 livehttp://ec.europa.eu/food/food/docs/stec_outbreak_flash_report_27052011_en.pdf European Commission-Audio conference of the STEC Outbreak in Germany 4 June 2011 dead https://web.archive.org/web/20121103205239/http://ec.europa.eu/food/food/docs/stec_outbreak_flash_report_27052011_en.pdf 3 November 2012 https://webgate.ec.europa.eu/rasff-window/portal/index.cfm?event=notificationDetail&NOTIF_REFERENCE=2011.0703 14 March 2018 Notification details – 2011.0703 RASFF Portal 7 August 2019 https://web.archive.org/web/20190807081209/https://webgate.ec.europa.eu/rasff-window/portal/index.cfm?event=notificationDetail&NOTIF_REFERENCE=2011.0703 dead http://www.periscopepost.com/2011/06/e-coli-outbreak-sickens-european-diplomatic-relations/ E. coli outbreak sickens European diplomatic relations The Periscope Post 4 June 2011 https://web.archive.org/web/20110715064517/http://www.periscopepost.com/2011/06/e-coli-outbreak-sickens-european-diplomatic-relations/ 15 July 2011 live The German health authorities, without results of ongoing tests, incorrectly linked the O104 serotype to cucumbers imported from Spain.https://www.theglobeandmail.com/news/world/europe/toll-climbs-in-european-e-coli-outbreak/article2040566/ Toll climbs in European E. coli outbreak Globe and Mail 30 May 2011 31 May 2011 https://web.archive.org/web/20110601212936/http://www.theglobeandmail.com/news/world/europe/toll-climbs-in-european-e-coli-outbreak/article2040566/ 1 June 2011 live Toronto, Canada Later, they recognised that Spanish greenhouses were not the source of the E. coli and cucumber samples did not contain the specific E. coli variant causing the outbreak.http://ec.europa.eu/food/food/docs/stec_summary_note_audioconference_02062011_en.pdf European Commission – Health and Consumers Directorate General 2 June 2011 4 June 2011 dead https://web.archive.org/web/20121103214527/http://ec.europa.eu/food/food/docs/stec_summary_note_audioconference_02062011_en.pdf 3 November 2012 http://www.eitb.com/news/life/detail/671223/germany-now-say-spanish-cucumbers-not-source-ecoli/ Germany now say Spanish cucumbers not source of E. coli Euskal Irrati Telebista 31 May 2011 31 May 2011 dead https://web.archive.org/web/20110622070212/http://www.eitb.com/news/life/detail/671223/germany-now-say-spanish-cucumbers-not-source-ecoli/ 22 June 2011 Spain consequently expressed anger about having its produce linked with the deadly E. coli outbreak, which cost Spanish exporters US$200 million per week.https://www.bbc.co.uk/news/world-europe-13605910 E. coli cucumber scare: Spain angry at German claims BBC 31 May 2011 31 May 2011 https://web.archive.org/web/20110601112924/http://www.bbc.co.uk/news/world-europe-13605910 1 June 2011 live Russia banned the import of all fresh vegetables from the European Union from early June until 22 June 2011.Chelsom-Pill Charlotte Russia lifts ban on EU vegetables http://www.dw-world.de/dw/article/0,,15182434,00.html 26 June 2011 Deutsche Welle 22 June 2011 Background Enterohemorrhagic E. coli has been linked to foodborne outbreaks of bloody diarrhea and hemolytic–uremic syndrome around the world since at least the early 1980s.Overview and Historical Perspectives Kaper JB, O'Brien AD 10.1128/microbiolspec.EHEC-0028-2014 25590020 4290666 American Society for Microbiology Enterohemorrhagic Escherichia coli and Other Shiga Toxin-producing E. coli Microbiology Spectrum 2 6 Sperandio V, Hovde CJ 3–14 2015 9781555818784 The majority of disease has been attributed to E. coli with the serotype O157:H7; however, over 100 E. coli serotypes have been associated with human diarrheal disease.The Emerging Clinical Importance of Non-O157 Shiga Toxin-Producing Escherichia coli Hughes JM, Wilson ME, Johnson KE, Thorpe CM, Sears CL Clinical Infectious Diseases 43 12 2006 1587–1595 10.1086/509573 17109294 free In the five years before the outbreak (2006 to 2010) Germany experienced an average of 218 cases of EHEC gastroenteritis and 13 cases of hemolytic–uremic syndrome each year.Final presentation and evaluation of epidemiological findings in the EHEC O104:H4 outbreak – Germany 2011 Robert Koch Institut 2011 https://www.rki.de/EN/Content/infections/epidemiology/outbreaks/EHEC_O104/EHEC_final_report.pdf?__blob=publicationFile 12 January 2018 16 June 2019 https://web.archive.org/web/20190616195633/https://www.rki.de/EN/Content/infections/epidemiology/outbreaks/EHEC_O104/EHEC_final_report.pdf%3F__blob%3DpublicationFile dead According to the German National Reference Centre for Salmonella and Other Enteric Pathogens, the most common serotypes in those years were O157, O26, O103, and O91.Molecular epidemiological view on Shiga toxin-producing Escherichia coli causing human disease in Germany: Diversity, prevalence and outbreaks Fruth A, Prager R, Tietze E, Rabsch W, Fliger A 10.1016/j.ijmm.2015.08.020 26372529 International Journal of Medical Microbiology 305 7 2015 697–704 Serotype O104 was relatively rare in Europe in the years preceding the outbreak, with just 11 reported cases in the EU and Norway between 2004 and 2009.Shiga toxin-producing E. coli (STEC) O104:H4 2011 outbreaks in Europe: Taking stock EFSA Journal 9 10 2390 European Food Safety Authority 10.2903/j.efsa.2011.2390 2011 free Outbreak Cases Cases began as early as 1 May 2011 with a man in Aachen reporting bloody diarrhea. Cases then rapidly increased, with over 100 cases of EHEC gastroenteritis and/or HUS were being reported each day by 16 May. The outbreak centered on the five northern German states of Hamburg, Schleswig-Holstein, Bremen, Lower Saxony, and Mecklenburg-Western Pomerania. Cases would eventually be reported in all 16 German states; however most cases outside of the northern states were linked to travel in northern Germany. Additionally, a small number of cases were reported from other countries, although most of those ill had previously travelled to Germany. The most substantial outbreak outside of Germany was in Bordeaux, France where 15 cases of EHEC gastroenteritis were associated with the same strain of E. coli which caused the outbreak in Germany. The French cases had not previously travelled to Germany, suggesting they acquired the bacteria from contaminated sprouts grown in France. Cases of EHEC HUS and gastroenteritis peaked on 21 and 22 May respectively. Cases then slowly decreased over the following month, with cases reported throughout the month of June and ending during July 2011. German authorities deemed the outbreak over in early July 2011. The outbreak disproportionately affected adults and the elderly. 88% of hemolytic–uremic syndrome patients were over 17 years of age, and the median age of hemolytic–uremic syndrome patients was 42 years. The median age of patients who died of gastroenteritis was 82 years, while the median age of patients who died from hemolytic–uremic syndrome was 74 years. Most or all victims were believed to have become infected in Germany or France. Confirmed cases are listed below according to their location when diagnosed. + Number of cases reported to the WHO as of 21 July 2011 Country Non-HUS cases HUS cases DeathsAustria 4 4 1 1 0 0Canada 1 1 0 0 0 0Czech Republic 1 1 0 0 0 0Denmark 16 16 10 10 0 0France 4 4 9 9 0 0Germany 2947 2947 818 818 51 51Greece 1 1 0 0 0 0Luxembourg 1 1 1 1 0 0Netherlands 7 7 4 4 0 0Norway 1 1 0 0 0 0Poland 1 1 2 2 0 0Spain 1 1 1 1 0 0Sweden 35 35 18 18 1 1Switzerland 5 5 0 0 0 0United Kingdom 3 3 4 4 0 0United States 2 2 4 4 1 1Total 2987 2987 855 855 53 53 Source investigation The investigation into the cause of the outbreak officially began with the notification of the Robert Koch Institute on 19 May concerning three cases of HUS in children in Hamburg.10.1056/NEJMoa1106483 21696328 Epidemic Profile of Shiga-Toxin–Producing Escherichia coliO104:H4 Outbreak in Germany New England Journal of Medicine 365 19 1771–1780 2011 Frank Christina Werber Dirk Cramer Jakob P. Askar Mona Faber Mirko An Der Heiden Matthias Bernard Helen Fruth Angelika Prager Rita Spode Anke Wadl Maria Zoufaly Alexander Jordan Sabine Kemper Markus J. Follin Per Müller Luise King Lisa A. Rosner Bettina Buchholz Udo Stark Klaus Krause Gérard HUS Investigation Team 205093464 free On 26 May, German health officials hastily and prematurely announced that cucumbers from Spain were identified as a source of the E. coli outbreak in Germany,http://www.thelocal.de/national/201l10526-35261.html https://web.archive.org/web/20200312032600/http://www.thelocal.de/national/201l10526-35261.html dead 12 March 2020 Deadly E. coli found in Spanish cucumbers – The Local Thelocal.de 5 June 2011 when in fact the source were Egyptian sprouts. On 27 May 2011, German officials issued an alert distributed to nearby countries, identifying organic cucumbers from Spain and withdrawing them from the market. The European Commission on 27 May said the two Spanish greenhouses suspected to be the sources had been closed, and were being investigated.Spanish Cucumbers Blamed for Outbreak in Germany Food Safety News 27 May 2011 http://www.foodsafetynews.com/2011/05/spanish-cucumbers-blamed-for-outbreak-in-germany/#.Vqgq81nO-VA 26 January 2016https://www.bbc.co.uk/news/world-europe-13592765 E. coli cucumber scare: Germany seeks source of outbreak BBC News 30 May 2011 30 May 2011 https://web.archive.org/web/20110531070932/http://www.bbc.co.uk/news/world-europe-13592765 31 May 2011 live The investigation included analyzing soil and water samples from the greenhouses in question, located in the Andalusia region, with results expected by 1 June.https://www.telegraph.co.uk/news/worldnews/europe/germany/8546207/Killer-cucumbers-row-breaks-out-between-Spain-and-Germany.html 'Killer cucumbers' row breaks out between Spain and Germany The Telegraph 30 May 2011 30 May 2011 https://web.archive.org/web/20110601232703/http://www.telegraph.co.uk/news/worldnews/europe/germany/8546207/Killer-cucumbers-row-breaks-out-between-Spain-and-Germany.html 1 June 2011 London Fiona Govan dead Cucumber samples from the Andalusian greenhouses did not show E. coli contamination,http://europa.eu/rapid/pressReleasesAction.do?reference=MEMO/11/366 Efforts intensify to identify source of 'E. coli outbreak in Germany as final tests clear Spanish cucumbers Europa (web portal) 4 June 2011https://www.irishtimes.com/newspaper/breaking/2011/0601/breaking34.html Europe lifts cucumber warning The Irish Times 1 June 2011 4 June 2011 4 December 2011 https://web.archive.org/web/20111204043934/http://www.irishtimes.com/newspaper/breaking/2011/0601/breaking34.html dead http://www.msps.es/gabinetePrensa/notaPrensa/desarrolloNotaPrensa.jsp?id=2120 Ministry of Health Spain Msps.es 4 June 2011 dead https://web.archive.org/web/20110720114422/http://www.msps.es/gabinetePrensa/notaPrensa/desarrolloNotaPrensa.jsp?id=2120 20 July 2011 but cross-contamination during transport in Germany and distribution in Hamburg are not discounted; in fact, the most probable cause is cross-contamination inside Germany.https://www.independent.co.uk/life-style/health-and-families/health-news/cucumbers-in-clear-ndash-so-what-is-causing-deadly-ecoli-outbreak-2291600.html Cucumbers in clear – so what is causing deadly E.coli outbreak? The Independent London 1 June 2011 4 June 2011 Jonathan Brown 3 June 2011 https://web.archive.org/web/20110603052934/http://www.independent.co.uk/life-style/health-and-families/health-news/cucumbers-in-clear-ndash-so-what-is-causing-deadly-ecoli-outbreak-2291600.html dead The Robert Koch Institute advises against eating raw tomatoes, cucumbers, and lettuces in Germany to prevent further cases.http://www.bfr.bund.de/en/press_information/2011/14/new_epidemiological_data_corroborate_existing_recommendation_on_consumption_by_bfr-70992.html New epidemiological data corroborate existing recommendation on consumption by BfR Bundesinstitut für Risikobewertung 27 June 2011 On 31 May, an EU official said the transport chain was so long, the cucumbers from Spain could have been contaminated at any point along the transit route.http://en.news.maktoob.com/20090000774696/Europeans_trade_blame_over_E_coli_outbreak/Article.htm Europeans trade blame over E.coli outbreak, Belgium Health Maktoob News 5 June 2011 https://web.archive.org/web/20110603211812/http://en.news.maktoob.com/20090000774696/Europeans_trade_blame_over_E_coli_outbreak/Article.htm 3 June 2011 dead Spanish officials said before, there was no proof that the outbreak originated in Spain; Spanish Secretary of State for European Affairs Diego López Garrido said, "you can't attribute the origin of this sickness to Spain." On Tuesday 31 May, lab tests showed two of the four cucumbers examined did contain toxin-producing E. coli strains, but not the O104 strain found in patients. The bacteria in the other two cucumbers have not yet been identified.January 2021 Genomic sequencing by BGI Shenzhen confirm a 2001 finding that the O104:H4 serotype has some enteroaggregative E. coli (EAEC or EAggEC) properties, presumably acquired by horizontal gene transfer.http://www.genomics.cn/en/news_show.php?type=show&id=644 BGI Sequences Genome of the Deadly E. coli in Germany and Reveals New Super-Toxic Strain 2 June 2011 2 June 2011 BGI https://web.archive.org/web/20110707031240/http://www.genomics.cn/en/news_show.php?type=show&id=644 7 July 2011 dead http://www.biofortified.org/2011/06/german-ehec-strain-is-a-chimera/ BGI Sequencing news: German EHEC strain is a chimera created by horizontal gene transfer David Tribe Biology Fortified 2 June 2011 2 June 2011Maev Kennedy and agencies https://www.theguardian.com/world/2011/jun/02/e-coli-outbreak-who-bacterium-new-strain E. coli outbreak: WHO says bacterium is a new strain The Guardian London 2 June 2011 4 June 2011 https://web.archive.org/web/20110602112917/http://www.guardian.co.uk/world/2011/jun/02/e-coli-outbreak-who-bacterium-new-strain 2 June 2011 live The only previous documented case of EHEC O104:H4 was in South Korea in 2005, and researchers pointed at contaminated hamburgers as a possible cause."A Case of Hemolytic Uremic Syndrome Caused by Escherichia coli O104:H4" https://web.archive.org/web/20180725191125/https://synapse.koreamed.org/Synapse/Data/PDFData/0069YMJ/ymj-47-437.pdf 25 July 2018 , Yonsei Medical Journal, Vol. 47, No. 3, pp. 437 – 439, 2006 On 4 June, German and EU officials had allegedly been examining data that indicated an open catering event at a restaurant in Lübeck, Germany, was a possible starting point of the ongoing deadly E. coli outbreak in Europe.http://www.novinite.com/view_news.php?id=128960 E. coli Outbreak Started from German Restaurant – Sofia News Agency Novinite.com 4 June 2011 4 June 2011https://www.smh.com.au/world/focus-shifts-to-german-restaurant-in-hunt-for-outbreak-source-20110605-1fnb8.html#ixzz1OPYauQbo Focus shifts to German restaurant in hunt for outbreak source The Sydney Morning Herald 6 June 2011 Marco Krefting German hospitals were nearly overwhelmed by the number of E. coli victims.Germany 'Struggling To Cope' With E.coli 5 June 2011 https://news.sky.com/story/germany-struggling-to-cope-with-ecoli-10487741 14 March 2018 SkyNews A spokesman for the agriculture ministry in Lower Saxony, warned people on 5 June to stop eating local bean sprouts, as they had become the latest suspected cause of the E. coli outbreak.https://www.theguardian.com/world/2011/jun/05/ecoli-beansprouts-identified-likely-source E coli outbreak: German officials identify bean sprouts as likely source | World news The Guardian London 5 June 2011 6 June 2011 A farm in Bienenbuettel, Lower Saxony, was announced as the probable source,http://www.cnn.com/2011/WORLD/europe/06/05/europe.e.coli/ German-grown sprouts named likely culprit in deadly outbreak – CNN News International Edition CNN 5 June 2011 5 June 2011Connolly Allison https://www.bloomberg.com/news/2011-06-07/e-coli-deaths-at-23-after-another-fatality-as-source-eludes-investigators.html E. coli Outbreak Kills One More Patient as Source Eludes Investigators Bloomberg 19 July 2008 9 June 2011 but on 6 June, officials said this could not be substantiated by tests. Of the 40 samples from the farm that were being examined, 23 had tested negative.James Gallagher https://www.bbc.co.uk/news/world-europe-13672161 BBC News – E. coli outbreak: First German sprout tests negative BBC 5 June 2011 9 June 2011 But on 10 June, the head of the Robert Koch Institute confirmed the sprouts were the source of the outbreak, and people who ate the sprouts were nine times more likely to have bloody diarrhea.Germany says sprouts are most likely source of E.coli https://www.jpost.com/Headlines/Article.aspx?id=224434 10 June 2011 The Jerusalem Post 10 June 2011https://www.bbc.co.uk/news/world-europe-13725953 German tests link bean sprouts to deadly E. coli BBC News 10 June 2011 10 June 2011 https://web.archive.org/web/20110610111934/http://www.bbc.co.uk/news/world-europe-13725953 10 June 2011 live The WHO have confirmed on 10 June this statement on the update 13 of the EHEC outbreak.http://www.euro.who.int/en/what-we-do/health-topics/emergencies/international-health-regulations/news/news/2011/06/ehec-outbreak-update-13 EHEC outbreak: update 13 WHO News 10 June 2011 10 June 2011 https://web.archive.org/web/20110611013457/http://www.euro.who.int/en/what-we-do/health-topics/emergencies/international-health-regulations/news/news/2011/06/ehec-outbreak-update-13 11 June 2011 live According to the head of the national E. coli lab at the German Federal Institute for Risk Assessment, the strain responsible for the outbreak has been circulating in Germany for 10 years, and in humans not cattle. He said it is likely to have gotten into food via human feces.MacKenzie Debra Bean sprouts to blame for 'decade-old' E. coli https://www.newscientist.com/article/dn20562-bean-sprouts-to-blame-for-decadeold-e-coli.html New Scientist 11 June 2011 A joint risk-assessment by EFSA/ECDC, issued 29 June 2011, made a connection between the German outbreak and a HUS outbreak in the Bordeaux area of France, first reported on 24 June, in which infection with E. coli O104:H4 has been confirmed in several patients.Cluster of haemolytic uremic syndrome (HUS) in Bordeaux, France EFSA/ECDC joint risk-assessment European Centre for Disease Prevention and Control 29 June 2011 The assessment implicated fenugreek seeds imported from Egypt in 2009 and 2010, from which sprouts were grown, as a common source of both outbreaks, but cautioned, "there is still much uncertainty about whether this is truly the common cause of the infections", as tests on the seeds had not yet found any E. coli bacteria of the O104:H4 strain.William Neuman Scott Sayare Egyptian Seeds Are Linked to E. coli in Germany and France https://www.nytimes.com/2011/06/30/world/middleeast/30ecoli.html The New York Times 29 June 2011 30 June 2011 https://web.archive.org/web/20110701020631/http://www.nytimes.com/2011/06/30/world/middleeast/30ecoli.html 1 July 2011 liveJames Gallagher E. coli outbreaks linked to Egypt https://www.bbc.co.uk/news/health-13973002 BBC News 30 June 2011 30 June 2011 https://web.archive.org/web/20110701015034/http://www.bbc.co.uk/news/health-13973002 1 July 2011 live The potentially contaminated seeds were widely distributed in Europe.Maryn McKenna E. coli: A Risk for 3 More Years From Who Knows Where https://www.wired.com/wiredscience/2011/07/e-coli-3-years/ Wired 7 July 2011 12 July 2011 https://web.archive.org/web/20110710155607/http://www.wired.com/wiredscience/2011/07/e-coli-3-years/ 10 July 2011 live Egypt, for its part, steadfastly denied it may have been the source of deadly E. coli strain, with the Minister of Agriculture calling speculations to that effect "sheer lies".Egypt denies fenugreek-German E coli link http://www.monstersandcritics.com/news/health/news/article_1648784.php/Egypt-denies-fenugreek-German-E-coli-link 2 July 2011 Monsters and Critics 1 July 2011 Deutsche Presse-Agentur Cairo/Berlin Egypt on Friday dismissed as untrue European reports that fenugreek seeds from Egypt were a suspected source of a deadly E coli outbreak. dead https://web.archive.org/web/20110818083043/http://www.monstersandcritics.com/news/health/news/article_1648784.php/Egypt-denies-fenugreek-German-E-coli-link 18 August 2011 Using epidemiological methods the outbreaks in 2011 were traced to a shipment of seeds from Egypt that arrived in Germany in December 2009. International response European Union On 22 May, Health Commissioner John Dalli of the European Commission declared the issue to be an 'absolute priority', saying the commission is working with member states, particularly Germany, to identify the source of the outbreak.Escherichia coli outbreak in Germany: Shiga toxin-Producing Escherichia coli (STEC) https://web.archive.org/web/20110604183803/http://ec.europa.eu/food/food/coli_outbreak_germany_en.htm 4 June 2011 European Commission Speaking again on 1 June, Commissioner Dalli noted the outbreaks have been limited in origin to the greater Hamburg area and declared any product ban would be disproportionate. He also said he is working with Agriculture Commissioner Dacian Cioloş "to address the hardship faced by this group of our citizens that has also been hit hard by the E. coli outbreak".Statement by Commissioner Dalli on the E. coli outbreak https://web.archive.org/web/20110617120528/http://ec.europa.eu/food/food/docs/ecoli_press_statement_01062011.pdf 17 June 2011 European Commission He also said, "In the future, we need to see how the timing of the alerts can be closer to the actual scientific basis and proof."http://www.dw-world.de/dw/article/0,,15136009,00.html Germany and Spain talk cucumbers amid E. coli outbreak | Europe | Deutsche Welle | 08.06.2011 Dw-world.de 9 June 2011 By 7 June, EU Ministers held an emergency meeting in Luxembourg to discuss the growing crisis, which had left 23 people dead, and more than 2,000 ill so far.http://english.aljazeera.net/news/europe/2011/06/20116771510528902.html EU ministers to meet on E.coli outbreak – Europe Al Jazeera English 9 June 2011 https://web.archive.org/web/20110607113727/http://english.aljazeera.net/news/europe/2011/06/20116771510528902.html 7 June 2011 live Germany's Federal Agriculture Minister, Ilse Aigner, repeated her warnings to EU consumers to avoid eating any bean sprouts, cucumbers, tomatoes, and salads. The United States Centers for Disease Control and the United States Department of Agriculture has long been concerned regarding risks involving the E. coli risk in raw bean sprout production.February 2022 EU member states Apart from the German government, which warned against the consumption of all raw cucumbers, tomatoes, and lettuce,http://www.ft.com/intl/cms/s/0/aac94310-8ada-11e0-b2f1-00144feab49a.html E-coli cucumber deaths reach 14 Financial Times 30 May 2011 31 May 2011 https://web.archive.org/web/20220618204640/http://www.ft.com/cms/s/aac94310-8ada-11e0-b2f1-00144feab49a,Authorised=false.html?_i_location=http%3A%2F%2Fwww.ft.com%2Fcms%2Fs%2F0%2Faac94310-8ada-11e0-b2f1-00144feab49a.html&_i_referer= 18 June 2022 dead several countries implemented restrictions or bans on the import of produce. Non-EU European nations Many other European countries took restrictive actions or lost sales of produce, including Albania, Croatia,http://www.croatiantimes.com/news/Business/2011-06-01/19689/Croatian_greengrocers_complain_of_drop_in_sales_due_to_E.coli_panic Croatian greengrocers complain of drop in sales due to E. coli panic – Business News – Croatian Times Online News – English Newspaper Croatiantimes.com 5 June 2011 https://web.archive.org/web/20110708205540/http://www.croatiantimes.com/news/Business/2011-06-01/19689/Croatian_greengrocers_complain_of_drop_in_sales_due_to_E.coli_panic 8 July 2011 dead and Russia. The ban on EU vegetables was lifted on 10 June, but stiff safety measures remained in place.http://www.monstersandcritics.com/news/health/news/article_1644797.php/Germany-blames-bean-sprouts-for-E-coli-clears-cucumbers https://web.archive.org/web/20110613222929/http://www.monstersandcritics.com/news/health/news/article_1644797.php/Germany-blames-bean-sprouts-for-E-coli-clears-cucumbers dead Germany blames bean sprouts for E coli, clears cucumbers 10 June 2011 Deutsche Presse-Agentur Monsters and Critics 13 June 2011 Middle East Many countries took restrictive action. Egypt was a focus of the epidemiological investigation because the fenugreek seeds were imported into Germany from Egypt.January 2021 Egypt's Minister of Health Ashraf Hatem denied his nation had any patients infected with the new E. coli strain, due to the strict precautions brought in to test overseas tourists entering the country on 2 June.http://english.ahram.org.eg/~/NewsContent/1/64/13507/Egypt/Politics-/No-E-coli-bacteria-in-Egypt-Ministry-of-Health-.aspx No E. coli bacteria in Egypt: Ministry of Health – Politics – Egypt – Ahram Online English.ahram.org.eg 5 June 2011http://news.egypt.com/english/permalink/7824.html Egypt.com News – Egypt News – No E. coli bacteria in Egypt: Ministry of Health News.egypt.com 9 June 2011 https://web.archive.org/web/20110710173817/http://news.egypt.com/english/permalink/7824.html 10 July 2011 live Responding to claims that Egyptian fenugreek seeds were the cause of the E. coli outbreak, Egyptian Minister of Agriculture Ayman Abu-Hadid told the Egyptian press the problem had nothing to do with Egypt and instead asserted, "Israel is waging a commercial war against Egyptian exports."In new Egypt, old conspiracies live on David E. Miller https://www.jpost.com/MiddleEast/Article.aspx?id=230235 The Jerusalem Post 20 July 2011 20 July 2011 https://web.archive.org/web/20110720225658/http://www.jpost.com/MiddleEast/Article.aspx?id=230235 20 July 2011 live North America Canada and the United States reported cases of E. coli infection that had been acquired in Europe.January 2021 On 2 June, Canada brought in stricter anti E. coli-related food inspections,http://www.healthzone.ca/health/newsfeatures/article/1001705--canadian-experts-alarmed-at-spread-of-mutant-e-coli-in-europe?bn=1 E. coli outbreak sparks beefed up Canadian food import inspections The Toronto Star Healthzone.ca 2 June 2011 6 June 2011 and by 3 June the Public Health Agency of Canada said no Canadians had been reported sick with the strain as of that date. The Canadian government also brought in heavier import and hygiene restrictions on EU cucumbers, lettuces, and tomatoes.http://www.ctvnews.ca/canadian-inspectors-testing-europe-veggies-for-e-coli-1.652395 https://web.archive.org/web/20121022161800/http://www.ctvnews.ca/canadian-inspectors-testing-europe-veggies-for-e-coli-1.652395 dead 22 October 2012 Canadian inspectors testing Europe veggies for E. coli – CTV News 3 June 2011 Ctv.ca 6 June 2011 The United States Department of Agriculture and the Food and Drug Administration (FDA) stated that emerging strains of E. coli are a significant problem, but regulatory bodies in the US have concentrated on the more infamous E. coli O157 serotype.http://ecolio104h4.com/e-coli-o104h4-responses-usa/ E. coli O104:H4 responses from the USA Ecolio104h4.com 22 February 1999 5 June 2011 https://web.archive.org/web/20110710165737/http://ecolio104h4.com/e-coli-o104h4-responses-usa/ 10 July 2011 dead https://www.huffingtonpost.com/william-marler/e-coli-outbreak-exporting_b_867819.html William Marler: E. coli Outbreak: Exporting Bill Marler to Germany or Japan Huffington Post 27 May 2011 5 June 2011 The FDA noted nearly all of America's fresh produce is grown in the US and areas of Central America, and the EU has not been a significant source of fresh produce for the US.http://eastcountymagazine.org/node/6365 FDA Statement on E. COLI 0104 Outbreak in Europe East County Magazine 9 June 2011 Other countries Other countries, including Nigeria, Hong Kong, and Thailand, expressed concern regarding imported produce.January 2021 Economics By 1 June, Italian, Austrian, and French cucumber sales had begun to decline sharply, but the Austrian Health Ministry official, Dr. Pamela Rendi-Wagner, claimed Austrian customers were still safe.http://news.xinhuanet.com/english2010/video/2011-06/01/c_13905346.htm https://web.archive.org/web/20110604075552/http://news.xinhuanet.com/english2010/video/2011-06/01/c_13905346.htm dead 4 June 2011 Cucumber sales plummet in Europe News.xinhuanet.com 1 June 2011 5 June 2011 On 3 June, the governments of Spain, Portugal, and Germany said they would formally request EU agricultural aid for farmers affected by the outbreak.Stevens Laura https://www.wsj.com/articles/SB10001424052702303657404576362821286583788 Europe's E. coli Cases Rise The Wall Street Journal 4 June 2011 4 June 2011 That day, Russia also set up plans for new imports of cucumbers from Ukraine, Azerbaijan, Egypt, and Turkey.http://abc.az/eng/news/main/54726.html Azerbaijan Business Center – Azerbaijan gets chance to increase sharply export of vegetables to Russia Abc.az 4 June 2011 dead https://web.archive.org/web/20111003222641/http://abc.az/eng/news/main/54726.html 3 October 2011 http://www.hurriyetdailynews.com/n.php?n=russian-ban-may-support-turkish-exports-2011-06-02 Russian ban may support Turkish exports – Hurriyet Daily News and Economic Review Hurriyet Daily News Turkey 4 June 2011 By 7 June, the EU's farmers had reported they had lost millions of dollars in exports during the outbreak, with Fepex, Spain's fruit and vegetable industry group, saying its growers had $256,000,000 in turnover. French, Swiss, Bulgarian, German, Dutch, Belgian, and Portuguese producers have also been similarly affected. That day, the EU proposed issuing £135,000,000 in agricultural compensation to its farmers. The EU agriculture commissioner said the EU's farmers could get back up to 30% of the cost of vegetables they were unable to sell.Peter Walker, Adam Gabbatt and agencies https://www.theguardian.com/world/2011/jun/07/ecoli-outbreak-farmers-compensation E coli: European commissioner suggests £135m payout for farmers | World news The Guardian London 7 June 2011 9 June 2011 The EU's health commissioner, John Dalli, had formally criticised Germany earlier that day for rushing out "premature conclusions" about the source of an outbreak, and only helped to spread alarm among the public and farmers and untimely leading to the damaging the EU's agriculture sector.Janicek Karel 29 May 2011 E. coli cucumbers may be in Austria, Hungary https://www.nbcnews.com/health/health-news/e-coli-cucumbers-may-be-austria-hungary-flna1c9459594 5 June 2011 NBC Newsmedic John Dalli also told the EU parliament in Strasbourg that claims had to be scientifically sound, unbiased, and fool-proof in nature before it was publicised in future.https://www.telegraph.co.uk/health/healthnews/8561406/Germany-criticised-by-EU-health-chief-over-premature-E.coli-claims.html https://web.archive.org/web/20110608181938/http://www.telegraph.co.uk/health/healthnews/8561406/Germany-criticised-by-EU-health-chief-over-premature-E.coli-claims.html dead 8 June 2011 Germany criticised by EU health chief over 'premature' E. coli claims Telegraph 5 June 2011 9 June 2011 London Spain then rejected the European Commission's €150,000,000/£135,000,000 compensation deal for their farmers who were hit by the E. coli outbreak, on 8 June, saying it was too small.Driver Alistair http://www.farmersguardian.com/home/business/business-news/spain-rejects-%E2%82%AC150m-e-coli-compensation/39517.article Spain rejects €150m E. coli compensation | News Farmers Guardian 9 June 2011 https://web.archive.org/web/20110723221836/http://www.farmersguardian.com/home/business/business-news/spain-rejects-%E2%82%AC150m-e-coli-compensation/39517.article 23 July 2011 dead France, the European Union's largest agricultural grower, said it would support the plan to compensate producers hurt by the outbreak, according to the French Agriculture Minister Bruno Le Maire. Ministers from both EU and Russia were scheduled to meet on 8 June over Russia's earlier decision to ban all its vegetable imports from the EU.http://www.rte.ie/news/2011/0608/russia.html EU increases E coli compensation offer – RTÉ News Rte.ie 20 October 2010 9 June 2011 On 8 June, the EU's E. coli O104:H4 outbreak was estimated to have cost $2,840,000,000 in human losses (such as sick leave), regardless of material losses (such as dumped cucumbers).http://www.foodpoisonjournal.com/foodborne-illness-outbreaks/german-e-coli-o104h4-outbreak---284-billion-in-human-damage/ German E. coli O104:H4 Outbreak – $2.84 Billion in Human Damage : Food Poison Journal : Food Poisoning Lawyer & Attorney : Bill Marler : Marler Clark Food Poison Journal 31 May 2011 9 June 2011 Consumers across Europe were shunning fruit and vegetables en masse by 8 June, as the German government's edict against eating raw cucumbers, tomatoes, lettuce and sprouts remained in place. EU farmers claimed to have losses up to C$417,000,000 a week as ripe vegetables rotted in their fields and warehouses.https://www.ctvnews.ca/cucumbers-suspected-again-in-european-e-coli-outbreak-1.654470 https://archive.today/20130115220137/http://www.ctvnews.ca/cucumbers-suspected-again-in-european-e-coli-outbreak-1.654470 dead 15 January 2013 Cucumbers suspected again in European E. coli outbreak 8 June 2011 CTV News Associated Press On 8 June, The EU Farm Commissioner Dacian Cioloş said the EU had increased its offer of compensation to farmers for the losses caused by the E. coli outbreak to C$210,000,000. Cause The outbreak was caused by a strain of E. coli of the serotype O104:H4, that was unusual for having characteristics of both enteroaggregative E. coli and enterohemorrhagic E. coli.10.1128/microbiolspec.EHEC-0008-2013 26104460 Escherichia coli O104:H4 Pathogenesis: An Enteroaggregative E. coli/Shiga Toxin-Producing E. coli Explosive Cocktail of High Virulence Microbiology Spectrum 2 6 2014 Navarro-Garcia Fernando 25978948 The strain has a number of virulence genes typical of enteroaggregative E. coli, including attA, aggR, aap, aggA, and aggC, in addition to the Shiga toxin variant 2. All bacteria isolated from patients in this outbreak were resistant to beta-lactam antibiotics, third-generation cephalosporins, and partially resistant to nalidixic acid, but susceptible to carbapenems and ciprofloxacin. See also Crisis situations and protests in Europe since 2000 Health crisis List of foodborne illness outbreaks References Category:2011 disease outbreaks Category:2011 in Denmark Category:2011 in Germany Category:2011 in Poland Category:2011 in Sweden Category:2011 in Switzerland Category:2011 in the Netherlands Category:2011 in the United Kingdom 2011 Category:Disease outbreaks in Denmark Category:Health disasters in Poland Category:Disease outbreaks in the United Kingdom Category:Disease outbreaks in Germany Category:Food safety in the European Union Category:May 2011 in Europe Category:June 2011 in Europe Category:May 2011 in Germany Category:June 2011 in Germany Category:May 2011 in the United Kingdom Category:June 2011 in the United Kingdom Category:2011 disasters in Europe Category:Health disasters in Sweden Category:Health disasters in Switzerland Category:Health disasters in the Netherlands Category:Health disasters in the United Kingdom Category:Health disasters in Germany