E. coli Outbreak May Be a New Strain

Germany, U.K. Are Hit Hard as E. coli Cases Spread Across Europe and Possibly Enter U.S.

By Peter Russell
WebMD Health News

Reviewed by Farah Ahmed, MD

June 2, 2011 -- The E. coli outbreak that has left several dead and hundreds ill across Europe -- and may now have caused two U.S. travelers to become ill -- is a new strain that has never been seen before, according to an official at the World Health Organization (WHO).

According to a statement yesterday from the CDC, there are no confirmed cases of this strain in U.S. travelers to Europe. But media reports citing the CDC say that the two U.S. illnesses with E. coli-like symptoms are associated with recent travel to Germany and the agency is waiting for test results to see if it is the same strain. Both travelers are expected to survive.

In Europe, Germany and the U.K. have been hardest hit, but there has been one death in Sweden and reported cases in Spain, the Netherlands, Austria, Denmark, Norway, Switzerland, and the Czech Republic, according to U.K.'s Mail Online.

The Health Protection Agency in the U.K. says seven people in the U.K. have been infected with the strain of E. coli linked to the outbreak in Germany.

Hilde Kruse, a food safety expert at the WHO, is quoted by the Associated Press as saying, "This is a unique strain that has never been isolated from patients before."

She says the new strain has "various characteristics that make it more virulent and toxin-producing" than the many E. coli strains people naturally carry in their intestines.

Kruse says it's not unusual for bacteria to mutate, evolve, and swap genes.

U.K. Cases

The latest cases in the U.K. involve three people with bloody diarrhea and one person who has developed the potentially fatal form of the condition known as hemolytic uremic syndrome (HUS).

Three of the four new cases are in U.K. residents who have recently returned from Germany, and the other involves a person from Germany who is on vacation in England.

In total, three people in the U.K. have been diagnosed with HUS and four with bloody diarrhea.

Cases in Germany

The Health Protection Agency says that there have been 470 cases of HUS in Germany, with nine reported deaths. German authorities have also reported 1,064 cases of bloody diarrhea related to the outbreak with four deaths, bringing the total number of official reported deaths in Germany to 13. German media have put the death toll higher, reporting that at least 17 people have died.

The Food Standards Agency in the U.K. says it has found no evidence that produce from possible sources identified with the outbreak has found its way into U.K. food outlets. It says that the European Commission has not been able to identify the exact source of the contamination.

The outbreak was caused by a rare organism called verocytotoxin-producing E. coli (VTEC) O104. Reports from Germany refer to the VTEC cases as cases of Shiga-toxin producing E. coli (STEC). VTEC is also sometimes called Enterohaemorrhagic E. coli (EHEC).

Cucumbers Initially Blamed

Initial reports in Germany blamed Spanish cucumbers for the outbreak. These have not been confirmed and investigations are continuing.

The Health Protection Agency says that until the sources are found, anyone visiting Germany should avoid raw tomatoes, cucumbers, and leafy salad including lettuce, especially in the north of the country.

The Health Protection Agency is working with the authorities in Germany, the European Centre for Disease Control, and the WHO.

Hemolytic Uremic Syndrome

Hemolytic uremic syndrome is a serious complication from VTEC infection that affects the blood, kidneys, and in severe cases, the central nervous system. It requires hospitalization and can be fatal.

Most people normally carry harmless strains of E. coli in their intestines. The harmless strains and the type causing illness are usually contracted by eating or drinking contaminated food or water. It can also spread from other people or animals through contact with feces.

Dilys Morgan, head of the gastrointestinal, emerging, and zoonotic infections department at the Health Protection Agency, says in a statement, "The HPA continues to actively monitor the situation very carefully and we are working with the authorities in Germany and with our counterparts across Europe as to the cause of the outbreak.

"We have alerted health professionals to the situation and advised them to urgently investigate and report suspected cases with a travel history to Germany."

Russia has banned the import of fresh vegetables from the European Union. Gennady Onishchenko, the head of Russia's consumer protection agency, was quoted by the Russian news agency Interfax as saying: "Fresh vegetables produced in these counties will be withdrawn from circulation on the territory of Russia."

Spanish authorities have threatened legal action because of lost vegetable sales.

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SOURCES: U.K. Health Protection Agency.U.K. Food Standards Agency.Associated Press.Deutsche Welle.Financial Times.CDC.Mail Online.ABC News. ©2011 WebMD, LLC. All Rights Reserved.

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