GERMANY (eTN) – The results of the outbreak of the EHEC bacteria is keeping Europe in its hold. In the meantime, more than one thousand cases are known, while normally speaking, about nine hundred people are infected during an entire year.
Twelve people have died, but the German authorities are sure that more fatalities will occur. As the number of patients still increases, the German Robert Koch Institute is convinced that there are one or more additional seats of infection. The incubation period till falling ill is 10 days. In Berlin, a crisis meeting will be held today about the outbreak of the intestinal bacteria EHEC. Among others, the federal government, the state governments and authorities in the area of public health and agriculture will be present.
Some two weeks after the outbreak was first reported in the north of the country, the number of people contaminated or suspected of having been poisoned by the potentially deadly enterohaemorrhagic E. coli (EHEC) has reached 12,00, according to media reports. There was no immediate official confirmation of the figure, but the Stockholm-based European Centre for Disease Prevention and Control has described the outbreak as “one of the largest worldwide and the largest ever reported in Germany.” EHEC can result in full-blown haemolytic uraemic syndrome (HUS), a disease that causes bloody stools and serious liver damage and which can result in death. The Robert Koch Institute (RKI), Germany’s national disease institute, reported 329 HUS cases nationwide and three confirmed deaths.
Also in the Netherlands, a crisis team is with representatives from the entire chain. “The impact of the outbreak on the sale of vegetables is very large. Therefore, it is important that the German authorities are clear quickly about the source of the EHEC-bacteria,” Nico van Ruiten said, who is present on behalf of the crisis team at the PT. The new Food and Drug Authority (nVWA) mentioned on Friday that contrary to earlier rumors, not a single Dutch person has been involved with contagious Spanish cucumbers.
There is a rumor that a Dutch company had done business with Spanish companies, where the EHEC bacteria was found. The new Food and Drug Authority inspected the company as a preventative measure, but no Spanish cucumbers were found. Also no business transactions took place between the companies. “A sigh of relief at the growers, because there was nothing wrong, and at the same time a confirmation that the quality systems in our country work well. Even the semblance of being involved is out of the world for our sector. Our products are good and entirely safe for the consumer,” Nico concluded.
“Our most important task is to reassure the consumers about the consumption of Dutch vegetables. Also we think about an action plan for the arisen stocks and try and prevent wrong information being published, as happened last week,” Nico continued. The Glaskracht foreman refers to the article in a Dutch newspaper last Saturday, in which in large letters was mentioned that Dutch cucumbers were contaminated. In the meantime, this article has been rectified.
Source not yet confirmed
Germany thinks that polluted cucumbers from Spanish cultivation companies are the source of the EHEC outbreak, but this has not as yet been confirmed by laboratories. The European Commission confirmed earlier that two companies in Almeria and Malaga were closed temporarily, because they could possible be responsible for spreading the cucumbers. But the Ministry of Health in Sevilla now denies this. According to the ministry, only a sample of their cucumbers was requested for laboratory tests. According to the Spanish government, no EHEC infections had been linked to the outbreak in Germany.
German shop chains cancel orders
Many German shop chains have already canceled orders of Dutch cucumbers this week. That occurred after German advice not to eat cucumbers for the time being. According to agricultural organizations, the Germans hardly buy lettuce any more and sales of strawberries have halved. The Dutch cucumber growers together produce 1.65 billion cucumbers annually. About 780 million are for the German market. Only 20% is consumed in the Netherlands.
Vegetable industry confused
“The global vegetable industry is confused. You can conclude that the total cucumber sales has been reduced to 30% of the normal sales,” approved Eric van Gentevoort from EMT/Witkamp, Holland. He calls the panic nonsense. “When the news came out Thursday morning, we tested our cucumbers on the bacteria by Groen Agro Control. All our 28 growers were approved. There hasn’t been found any devastating bacteria. Our only problem is the politics.”
Albert Heijn said, happily for the growers, not to doubt Dutch cucumbers. “We still have them on the shelves,” assured a spokesperson.
Symptoms of the diseases caused by EHEC include abdominal cramps and diarrhea that may in some cases progress to bloody diarrhea (haemorrhagic colitis). Fever and vomiting may also occur. The incubation period can range from three to eight days, with a median of three to four days. Most patients recover within ten days, but in a small proportion of patients (particularly young children and the elderly), the infection may lead to a life-threatening disease, such as haemolytic uraemic syndrome (HUS). HUS is characterized by acute renal failure, haemolytic anaemia, and thrombocytopenia. It is estimated that up to 10% of patients with EHEC infection may develop HUS, with a case-fatality rate ranging from 3% to 5%. Overall, HUS is the most common cause of acute renal failure in young children. It can cause neurological complications (such as seizure, stroke, and coma) in 25% of HUS patients and chronic renal sequelae, usually mild, in around 50% of survivors.
The incidence of EHEC infections varies by age group, with the highest incidence of reported cases occurring in children aged under 15 years (0.7 cases per 100,000 in the United States). Sixty-three to 85% of cases are a result of exposure to the pathogen through food. The percentage of EHEC infections, which progress to HUS varies between sporadic cases (3%-7%) and those associated with outbreaks (20% or more). In epidemiological terms, there is generally a background of sporadic cases, with occasional outbreaks.
Sources of infection
Most available information relates to serotype O157:H7, since it is easily differentiated biochemically from other E. coli strains. The reservoir of this pathogen appears to be mainly cattle and other ruminants such as camels. It is transmitted to humans primarily through consumption of contaminated foods, such as raw or undercooked ground meat products and raw milk. Fecal contamination of water and other foods, as well as cross-contamination during food preparation (with beef and other meat products, contaminated surfaces, and kitchen utensils), will also lead to infection.
Examples of foods implicated in outbreaks of E. coli O157:H7 include undercooked hamburgers, dried cured salami, unpasteurized fresh-pressed apple cider, yogurt, cheese, and milk. An increasing number of outbreaks are associated with the consumption of fruits and vegetables (sprouts, lettuce, coleslaw, salad) whereby contamination may be due to contact with feces from domestic or wild animals at some stage during cultivation or handling. EHEC has also been isolated from bodies of water (ponds, streams), wells, and water troughs, and has been found to survive for months in manure and water-trough sediments. Waterborne transmission has been reported, both from contaminated drinking-water and from recreational waters.
Person-to-person contact is an important mode of transmission through the oral-fecal route. An asymptomatic carrier state has been reported, where individuals show no clinical signs of disease but are capable of infecting others. The duration of excretion of EHEC is about one week or less in adults, but can be longer in children. Visiting farms and other venues where the general public might come into direct contact with farm animals has also been identified as an important risk factor for EHEC infection.