Saturday, May 28, 2011

Large outbreak of haemolytic uraemic syndrome caused by E. coli in Germany – important advice for travellers

Large outbreak of haemolytic uraemic syndrome caused by E. coli in Germany – important advice for travellers
26 May 2011

The Health Protection Agency (HPA) is aware that Germany is currently experiencing a large outbreak of haemolytic uraemic syndrome (HUS), which is a serious complication from verocytotoxin-producing E. coli (VTEC) infection that requires hospitalisation. Since the second week of May, there have been reports of approximately 214 cases of HUS and two people are reported to have died.

The outbreak is mainly affecting adults - almost 70 per cent of who are female. The cases are occurring mainly in northern Germany, but there are also reports from southern and eastern Germany.

This strain of VTEC infection suspected in this outbreak is O104 which is a rare strain of the infection and seldom seen in the UK.

England has so far seen two cases in German nationals with compatible symptoms. Other European countries have also seen cases of HUS and bloody diarrhoea among returning travellers.

The German authorities believe that a food source of infection is likely, and, early studies implicate raw tomatoes, cucumbers and lettuce. Although it is not clear whether one or more of these food items are associated with the outbreak, as a precaution they are advising people in Germany against eating raw tomatoes, cucumbers and lettuce, especially in the north of the country, until further notice.

The HPA and the National Travel Health Network and Centre (NaTHNaC) advises anyone travelling to Germany to follow the advice from the German authorities. In addition, returning travellers with illness including bloody diarrhoea should seek urgent medical attention and make sure they mention any recent travel history.

The public health organisation in Germany investigating the outbreak also recommend following the standard food and water hygiene advice.

Dr Dilys Morgan, head of the gastrointestinal, emerging and zoonotic infections department at the HPA, said: "The HPA is actively monitoring the situation very carefully and liaising with the authorities in Germany, the European Centre for Disease Control (ECDC) and the World Health Organization (WHO) as to the cause of the outbreak.

"We are keeping a close watch for potential cases reported in England and are working with colleagues in the devolved administrations to recommend they do the same. In addition we are in the process of alerting health professionals to the situation and advising them to urgently investigate potential cases with a travel history to Germany."

The HPA is also working closely with the Department of Health and the Food Standards Agency. The FSA is monitoring the situation closely and if there are any implications for food distributed in the UK they will provide an update.


Notes to editors:

1. In this outbreak many more people are suspected to have bloody diarrhoea, which can be serious, or milder forms of the infection which are usually self limiting and clears within seven days. The public health organisation investigating the outbreak in Germany is the Robert Koch Institute

2. Haemolytic Uraemic Syndrome (HUS) is a serious complication from verocytotoxin-producing E. coli (VTEC) infection that affects the blood, kidneys and in severe cases, the central nervous system. It is a serious illness that requires treatment in hospital and can be fatal.

3. The number of severe cases of HUS in a short period is very unusual and the affected age groups in this outbreak are not typical – HUS is a more common complication from E. coli infection in children.

4. Escherichia coli (commonly referred to as E coli) bacteria usually cause diarrhoea which settles within seven days without treatment. There are many strains of the infection. Occasionally, serious kidney and blood complications can occur, such as HUS.

5. Most people normally carry harmless strains of E. coli in their intestine. Both the harmless strains and the strains that cause diarrhoea are acquired primarily through ingestion of contaminated food or water. Person-to-person and animal-to-human transmission is through the oral-faecal route.

6. Good hygiene is very important in preventing person-to person spread and small children should be supervised with hand washing after using the toilet and before eating. Advice on food safety can be found on the NHS Choices website:

7. Verocytotoxin- producing E. coli (VTEC) O104 is a rare serogroup and further testing of samples is needed to confirm this as the cause of the outbreak. Reports from Germany refer to the VTEC cases as cases of Shiga-toxin producing E. coli (STEC). VTEC is also sometimes called Entrohaemorrhagic E. coli (EHEC).

8. Healthcare professionals and members of the public can find more information about travel health (including country specific advice) by logging onto the National Travel Health Network and Centre (NaTHNaC) website

9. The Health Protection Agency is an independent UK organisation that was set up by the government in 2003 to protect the public from threats to their health from infectious diseases and environmental hazards. It does this by providing advice and information to the general public, to health professionals such as doctors and nurses, and to national and local government. In 2012 the HPA will become part of Public Health England. To find out more, visit our website:

10. For media enquiries please contact the national HPA press office at Colindale on 020 8327 7901 or email Out of hours the duty press office can be contacted on 020 8200 4400