EHEC O104:H4 in Germany 2011: Large outbreak of bloody diarrhea and haemolytic uraemic syndrome by shiga toxin-producing E. coli via contaminated food

Abstract

In the summer of 2011 Germany experienced one of the largest outbreaks of a food-borne infection caused by enterohaemorrhagic Escherichia coli (EHEC) with the serotype O104:H4. A large number of cases with bloody diarrhea and haemolytic uraemic syndrome (HUS) occurred. Never before was such a high rate of HUS cases observed in an outbreak caused by a food-borne pathogen. The events in Germany caused by EHEC O104:H4 in the summer of 2011 show dramatically how rapidly an infectious agent is able to develop into a major health threat for a whole country. The outbreak caused widespread concern among the population, turning soon into fear. People expecting safe and healthy food felt threatened. It changed the eating habits of the majority of the population, and it had enormous economic consequences, particularly for farmers producing salad ingredients. It resulted in a large number of seriously ill patients and in a substantial number of deaths. The burden of disease and the economic consequences have made it a tragedy for many. It is important to analyse this outbreak scientifically in order to learn from this unique event and to be prepared for comparable infections in the future. In particular, all the steps regarding detection of cases, diagnostic procedures, identification of vehicle and origin, and infection control measures, all the way to therapy, should be reflected carefully. Usually, even experienced physicians encounter only a few cases of EHEC-induced HUS in adults in their whole career. Therefore, the large number of cases in Germany represents a valuable source of information for future epidemics. This manuscript summarises the work of the HUS investigation team of the Robert Koch Institute (RKI) and gives an overview of the work done by the colleagues in the Department of Infectious Disease Epidemiology at the RKI (G. Krause, C. Frank, D. Werber, K. Stark, and U. Buchholz), the Department for Infectious Diseases (M. Mielke and A. Fruth), and the RKI-Consultant Laboratory for HUS/EHEC at the University of Münster (H. Karch). Many additional colleagues were involved.