Lines within the arrow indicate single day progression, with the date noted every 5th day. H4 outbreak occurred in germany from may to july 2011, causing numerous cases of hemolyticuremic syndrome hus and deaths. Lessons learned from recent food federal institute for. A series of environmental and traceback and traceforward investigations linked sprout consumption with the disease, but fecaloral transmission was also documented. Bean sprouts from an organic farm in northern germany caused the e coli outbreak that has killed 31 people and infected thousands more, german. H4 caused the largest ever recorded ehec outbreak in germany in 2011, which in addition showed the so far highest incidence rate of ehecrelated hus. H4 outbreak of hemorrhagic diarrhea in germany is an example of the explosive cocktail of high virulence and resistance that can emerge in this species.
Timeliness of surveillance during outbreak of shiga toxin. To prospectively elucidate the unique characteristics of this strain in the. The illness was characterized by bloody diarrhea, with a high frequency of serious complications, including hemolyticuremic syndrome hus, a condition that requires urgent treatment. A maximumlikelihood phylogeny of the outbreak isolates fig. In may 2011, an outbreak of enterohemorrhagic escherichia coliehec occurred in. H21 was linked to consumption of milk contaminated postpasteurization. In the context of a large outbreak of shiga toxinproducing escherichia coli o104. A large number of cases with bloody diarrhea and haemolytic uraemic syndrome hus occurred. The 2011 german enterohemorrhagic escherichia coli o104. Why health authorities are so worried about europes mutant e. This toxin is dangerous as it can attack the body in several areas. An ongoing outbreak of exceptionally virulent shiga toxin stxproducing escherichia coli o104. Ruminants, in particular bovines, are the primary reservoir of shiga toxinproducing e.
H7in may 2011, disturbing reports of outbreaks of enterohemorrhagic. The outbreak started on may 8, peaked on may 22, and was. Apr 15, 2014 it differs essentially from typical ehec o104. H4 included diarrhea often bloody, abdominal cramps, vomiting, and occasionally a lowgrade fever. H4 in northern germany led to a high proportion of patients developing postenteritis haemolytic uraemic syndrome. H4 infection in germany and france is much diminished. H4, which caused in 2011 a massive ehec outbreak in germany shares highest genome sequence similarity with enteroaggregative e. H4, can make a potent shiga toxin, as can most strains in the serotype o157. H4 infection countries in the who european region have reported significant numbers of infections from verocytotoxinproducing escherichia coli o104. Genomes of ten outbreak isolates and a historical o104. Enterohemorrhagic escherichia coli ehec are shiga toxin stx producing bacteria causing a disease characterized by bloody or nonbloody diarrhea, which might progress to hemolytic uremic syndrome hus. H4 infection involves ingestion of fecally contaminated food. The current outbreak in germany involves a rare strain known as o104. Bean sprouts have been identified as the product that likely caused the outbreak, hahne said.
Background a large outbreak of the hemolyticuremic syndrome caused by shigatoxinproducing escherichia coli o104. Worlds largest e coli outbreak kills 14 in germany. Strains of the eaec pathotype are basically adapted to the human host. Major events relating to the outbreak epidemiology below arrow and those relating to genomic elucidation efforts above arrow are noted separately in the graph.
Jul 31, 2018 wieler lh, semmler t, eichhorn i et al 2011 no evidence of the shiga toxinproducing e. Phylogenetic analyses were performed using various approaches which either are not. The case of the european escherichia coli outbreak from. This large outbreak was caused by an unusual strain that is most similar to enteroaggregative e. Escherichia coli, diarrheagenic chapter 4 2020 yellow. H4 strain that was similar to the current outbreak strain. The germany outbreak strain contains another virulence factor referred to spates serine protease autotransporter toxins. The confirmation of the serotype o104 is still pending as of 10 june. H4 outbreak, 2011 distribution of fenugreek seeds from egypt batch 48088, 15 t weiser et al. In 2011, germany experienced the largest outbreak of stec cases ever recorded. In the summer of 2011 germany experienced one of the largest outbreaks of a foodborne infection caused by enterohaemorrhagic escherichia coli ehec with the serotype o104. H4 ty2482, lb226692 by comparing it to strain k12 dh10b at ion torrent sequencing data. A total of 46 deaths, 782 cases of hemolyticuremic syndrome hus, and 3,128 cases of acute gastroenteritis were officially attributed to this new clone of enterohemorrhagic e. A major outbreak caused by escherichia coli of serotype o104.
In 2011, germany experienced the largest outbreak with a shiga toxinproducing escherichia coli stec strain ever recorded. H4 outbreak, germany 2011 2 abstract from may to july 2011, primarily in northern germany, there was a large outbreak of illnesses characterized by haemolyticuremic syndrome hus and bloody diarrhoea assoc iated with infections by enterohemorrhagic escherichia coli ehec of the serotype o104. The case of the european escherichia coli outbreak from sprouts. There are more than 700 infectious serotypes closely related though distinguishable forms of e. An outbreak caused by the pathogenic shigatoxinproducing e. The pathogen involved was a unique strain of escherichia coli, o104. H4 that occurred in germany and france during the summer of 2011 and discusses its implications. Pdf in 2011, germany was hit by one of its largest outbreaks of acute gastroenteritis and haemolytic uraemic syndrome caused by a new emerging. From the start of the outbreak, fresh produce had been suspected as the cause. H4, which has not been detected in animals, has rarely been associated with hus in the past. What was the source of the 2011 outbreak of escherichia coli. In late april a small number of people in germany were hospitalized with hus, the cause of which was determined to be a strain of e. In the summer of 2011 germany experienced one of the largest outbreaks of a foodborne infection caused by enterohaemorrhagic escherichia coli ehec with. The figures reflect some delayed reporting, and the evidence indicates that the outbreak, which took 50 lives in germany alone, is nearly over.
He did not elaborate but planned a news conference later sunday. Bacteria can flourish in the warm, humid conditions in which sprouts are. The year 2011 witnessed the deadliest and second largest e. Though limited primarily to germany, the episode raised fears in other countries and caused some 4,321 cases of illness and 50 deaths, nearly all of which were associated with hemolytic uremic syndrome hus, in.
Update on the ongoing outbreak of haemolyticuraemicsyndrome due to shiga toxinproducing escherichia coli stec serotype o104, germany, may 2011. H4 occurred in germany, causing the highest reported cases of haemolyticuremic syndrome in humans associated with a single outbreak. One snp, at location 1568661, distinguishes the historical 2004 and 2009 isolates and all. Prospective genomic characterization of the german. H4 strain that caused an outbreak in germany in 2011. Oct 03, 2011 on 21 may 2011, germany reported an ongoing outbreak of shigatoxin producing escherichia coli stec, serotype o104. From may to july 2011, primarily in northern germany, there was a large outbreak of illnesses characterized by haemolyticuremic syndrome hus and bloody diarrhoea caused by enterohemorrhagic escherichia coli ehec of the serotype o104. In may 2011, an outbreak caused by escherichia coli of serotype o104. Coli outbreak linked to sprouts from a german farm. Although reporting occurred faster than required by law, potential for improvement exists at all levels of the information chain. This case study summarizes the epidemiologic and laboratory investigations of the largest outbreak of e. H4 centered in germany, has caused over 830 cases of hemolytic uremic syndrome hus and 46 deaths since may 2011. Hahne said the sprouts were grown on a farm in lower saxony in northern germany. The outbreak in germany was caused by a relatively rare strain of e.
From an initial case control study, the outbreak was associated with the consumption of fresh salad vegetables. H4 in germany, we are nearly returned to the preantibiotic era. Epidemic profile of shigatoxinproducing escherichia coli o104. For example, in 2009 in the republic of georgia, culture of specimens from two patients who were part of a cluster of diarrheal illness yielded an e. H4 strains because it comprises a hybrid virulence profile that combines typical molecular and phenotypic characteristics of shiga toxin e. Bacteria can flourish in the warm, humid conditions in which sprouts are grown, according to a report by the centers for. H4 outbreak 2011 in germany and generic concepts for future outbreak situations, foodborne pathog dis. Since the start of these outbreaks, there were a large number of patients with bloody diarrhoea caused by stec and an unusually high proportion of these. The genome sequences of the pathogen revealed a clonal outbreak with enteroaggregative e. Background a large outbreak of diarrhea and the hemolyticuremic syndrome caused by an unusual serotype of shigatoxinproducing escherichia coli o104.
Coli outbreak the strain of escherischia coli wreaking havoc in germany is resistant to 14 kinds of antibiotics. H4 in germany, we quantified the timeliness of the german surveillance system for hemolytic uremic syndrome and shiga toxinproducing e. Traceback and traceforward tools developed ad hoc and used during the stec o104. Caco2 and ht29 german collection of microorganisms and cell. In may 2011, an outbreak of shiga toxinproducing enterohaemorrhagic e coli o104. H4 outbreak centered in germany has become the most deadly e. Never before was such a high rate of hus cases observed in an outbreak caused by a foodborne pathogen. Between the beginning of may and the end of july 2011, there was an outbreak of shigatoxin producing escherichia coli stec in germany. Jun 06, 2011 the current outbreak in germany involves a rare strain known as o104. Jun 10, 2011 bean sprouts from an organic farm in northern germany caused the e coli outbreak that has killed 31 people and infected thousands more, german officials said on friday health inspectors have. H4 outbreak strain of sequence type st 678 showed this strain to be highly similar to enteroaggregative e. Of the ill, at least 878 contracted hemolytic uremic syndrome hus, a severe, lifethreatening complication of e.
On 24 june 2011, french authorities also reported an e. H4 bacteria caused a serious outbreak of foodborne illness focused in northern germany in may through june 2011. On 21 may 2011, germany reported an ongoing outbreak of shigatoxin producing escherichia coli stec, serotype o104. In 2011, germany was hit by one of its largest outbreaks of acute gastroenteritis and haemolytic uraemic syndrome caused by a new emerging enterohaemorrhagic escherichia coli o104. A large bacterial infection outbreak hit central europe in the spring of 2011karch et al, 2012. A significant difference, however, is the presence of a prophage encoding the shiga toxin, which is characteristic of enterohemorrhagic e. H4, resulting in a large number of cases of bloody diarrhoea and haemolytic uraemic syndrome hus in germany, and in 15 other countries in europe and north america. A total of 46 deaths, 782 cases of hemolyticuremic syndrome, and 3,128 cases of acute gastroenteritis were attributed to this new clone of eaecehec.
The next month, france also reported a cluster of e. H4 contains a toxinencoding phage that is similar to 933w phage found in ehec 2 but with one nucleotide change in each of the subunits stx2a and stx2b 4. This chapter describes an investigation into the european escherichia coli outbreak in mayjune 2011. The entire wikipedia with video and photo galleries for each article. H4 strain isolated in 2001 were sequenced using different new generation sequencing platforms. The german haemolytic uraemic syndromeenterohaemorrhagic e. The serotypes are classified based on the antigens proteins that stimulate antibody production in animals on their surfaces, with the o cell wall and h flagellar antigens being of primary importance.
H4, although some cases have been reported globally in the past. Events span from early may 2011 to early june 2011. H4 strain in germany was spread mostly by contaminated sprouts, and in just a few cases, from close contact with a sick person. Shiga toxinproducing escherichia coli escherichia coli escherichiacoli o104. H4 isolates from 2004 and 2009 that we had also sequenced, showed that the limited diversity seen in the samples from the large german outbreak was nested within the greater diversity of french isolates. Coli outbreak to date, there have never been any confirmed cases of infection in the u. Killer cucumbers death toll rises to 10 and 1,000 have deadly e. The figures reflect some delayed reporting, and the evidence indicates that the outbreak, which. Jun 07, 2011 the outbreak in germany was caused by a relatively rare strain of e. On may 19, 2011, the robert koch institute in germany was notified of a. What was the source of the 2011 outbreak of escherichia. As of june 27, the outbreak had killed 48 people and sickened 3917. It appears that the escherichia coli abbreviated as e.
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