More than three months after a higher-than-usual occurrence of hemolytic uremic syndrome (HUS) in Germany provided the first clues, the details of the deadliest Escherichia coli outbreak in modern history are well known.
Now, we’re left with the questions: Why did middle-aged adults—particularly women—make up the majority of victims, not children and the elderly? Why did investigation into the rare 0104:H4 strain appear so confused—resulting in millions of dollars in lost sales for European Union (EU) farmers and retailers? Most of all, what steps can and will be taken to improve the speed, reliability, and effectiveness with which future outbreaks of this magnitude are handled?
German and European authorities have endured withering criticism over what many say is an outdated food safety investigation system hindered by decentralization and miscommunication. Germany’s initial assertion that produce from Spain was the culprit caused a diplomatic furor, protests, and eventual agreement to compensate farmers for crops destroyed in the ensuing wave of consumer fear.
The toll of dead and seriously injured in more than a dozen nations is sobering: The official death toll is more than 40 or 50, depending on the source. More than 4,000 are ill—more than 800 of the stricken suffering from HUS, enduring brain and kidney complications that will likely afflict them for the rest of their lives. Blame for the outbreak veered from Spanish cucumbers to sprouts from an organic farm in Germany and briefly back to cucumbers found in the trash of a German family, before officials settled on Egyptian fenugreek seeds—many of which might still be on the market.
At the core of this confusing case is the 0104:H4 strain responsible, an unusually virulent Shiga toxin-producing variant documented in research published by The Lancet Infectious Diseases and The New England Journal of Medicine in June. The Lancet paper, by Helge Karch, PhD, and colleagues, characterized the strain as a hybrid of enterohemorraghic and enteroaggregative E. coli strains, with a corollary traced back to an HUS case in Germany in 2001, as well as an occurrence in Korea in the 1990s. Dr. Karch, head of the Robert Koch Institute’s EHEC [enterohemorrhagic E. coli] consulting lab at the University of Münster Hospital, led a team that spent two intensive days deciphering the bacteria.
Backlash and speculation continue. Food industry pundits called for all manner of investigatory reform, even as Congress wrangled over funding the E. coli-detecting Microbiological Data Program.
Time will tell if, as happened with the 1993 Jack in the Box outbreak, significant regulatory improvements emerge from this latest food safety crisis.
Geoff Giordano, veteran editor of numerous newspapers and magazines, has been acting editor of Food Quality since February. Contact him at [email protected].
The ECDC’s Role and What We Learned
By Marc Sprenger, MD, PhD
Since the beginning of May, Europe has seen more than 40 deaths and more than 4,000 people hospitalized with an aggressive new strain of the E. coli bacterium. This has happened in the heart of Europe, in rich countries with well-resourced public health systems. Even worse, people hit by this outbreak were mostly women and men in their prime who thought they were eating healthy food. Hundreds of them have been damaged for the rest of their lives, suffering kidney failure, brain damage, and other long-term disabilities.