Abstract
During the recent outbreak of Shiga toxin-producing Escherichia coli (STEC) O104:H4 in Germany most cases notified in the State of Hesse (6 million inhabitants) were linked to satellite clusters or had travelled to the outbreak area in northern Germany. Intensified surveillance was introduced to rapidly identify cases not linked to known clusters or cases and thus to obtain timely information on possible further contaminated vehicles distributed in Hesse, as well to describe the risk of secondary transmission among known cases. As of 2 August 2011* [corrected], 56 cases of haemolytic uraemic syndrome (HUS) including two fatal cases, and 124 cases of STEC gastroenteritis meeting the national case definitions have been reported in Hesse. Among the 55 HUS and 81 STEC gastroenteritis cases thatmet the outbreak case definition, one HUS case and eight STEC gastroenteritis cases may have acquired their infection through secondary transmission. They include six possible transmissions within the family, two possible nosocomial and one possible laboratory transmission. Our results do not suggest an increased transmissibility of the outbreak strain compared to what is already known about E. coli O157 and other STEC serotypes.
Highlights
On 19 May 2011, the public health authority of Frankfurt, Hesse, and the Robert Koch Institute (RKI), Germanys national public health authority, were informed about clusters of cases of haemolytic-uraemic syndrome (HUS) in Frankfurt and Hamburg [1,2]
As of 2 August 2011*, 56 HUS cases, including two fatal cases, and 124 Shiga toxinproducing Escherichia coli (STEC) gastroenteritis cases meeting the national case definitions were reported in Hesse, with onset dates of 1 May or later (Figures 2 and 3)
Among 81 STEC gastroenteritis outbreak cases, 72 were epidemiologically linked to the outbreak: 27 cases linked to Company A, no case at Party A, eight cases at Party B, 29 cases with travel history and eight cases with possible secondary transmissions
Summary
On 19 May 2011, the public health authority of Frankfurt, Hesse, and the Robert Koch Institute (RKI), Germanys national public health authority, were informed about clusters of cases of haemolytic-uraemic syndrome (HUS) in Frankfurt and Hamburg [1,2]. These were the first notified cases of an outbreak of Shiga toxinproducing Escherichia coli (STEC) serotype O104:H4. Trace back studies carried out by the German Enterohaemorrhagic E. coli Task Force and authorities of Lower Saxony identified one sprout-producing farm in Lower Saxony (Establishment A) as being the most likely source of sprouts contaminated with STEC O104. Forward tracing established that all 41 case clusters identified at that time in Germany were linked to consumption of sprouts originating from Establishment A [4]
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