2011 Germany E. coli O104:H4 outbreak

2011 Germany E. coli O104:H4 outbreak
2011 German E. coli O104:H4 outbreak
Classification and external resources

Schistocytes seen in a person with hemolytic-uremic syndrome
The 2011 E. coli O104:H4 outbreak.
LEGEND No food restrictions or tests. Food and/or medical tests done. Food sale and/or trade restrictions.
No cases.
  
  
  
Suspected cases
  
  
  
Known non-native cases
  
  
  
Known native cases
  
  
  
Deaths
  
  
  
Exposure to the outbreak start from 21 April 2011 with permanent or temporary stay in Germany, consumption of a food acquired in Germany or close contact with a HUS case.[1]

A novel strain of Escherichia coli O104:H4 bacteria caused a serious outbreak of foodborne illness focused in northern Germany in May through June 2011. The illness was characterized by bloody diarrhea, with a high frequency of serious complications, including hemolytic-uremic syndrome (HUS), a condition that requires urgent treatment. The outbreak was originally thought to have been caused by an enterohemorrhagic (EHEC) strain of E. coli, but it was later shown to have been caused by an enteroaggregative E. coli (EAEC) strain that had acquired the genes to produce Shiga toxins.

Epidemiological fieldwork suggested fresh vegetables were the source of infection. The agriculture minister of Lower Saxony identified an organic farm[2] in Bienenbüttel, Lower Saxony, Germany, which produces a variety of sprouted foods, as the likely source of the E. coli outbreak.[3] The farm has since been shut down.[3] Although laboratories in Lower Saxony did not detect the bacterium in produce, a laboratory in North Rhine-Westphalia later found the outbreak strain in a discarded package of sprouts from the suspect farm.[4] A control investigation confirmed the farm as the source of the outbreak.[5] On 30 June 2011 the German Bundesinstitut für Risikobewertung (BfR) (Federal Institute for Risk Assessment), an institute of the German Federal Ministry of Food, Agriculture and Consumer Protection), announced that seeds of fenugreek imported from Egypt were likely the source of the outbreak.[6]

In addition to Germany, where 3,785 cases and 45 deaths had been reported as of 27 July,[7] a handful of cases were reported in several countries including Switzerland,[7] Poland,[7] the Netherlands,[7] Sweden,[7] Denmark,[7] the UK,[7][8] Canada[9] and the USA.[10][9] Essentially all affected people had been in Germany or France shortly before becoming ill.

Initially German officials made incorrect statements on the likely origin and strain of Escherichia coli.[11][12][13][14] The German health authorities, without results of ongoing tests, incorrectly linked the O104 serotype to cucumbers imported from Spain.[15] Later, they recognised that Spanish greenhouses were not the source of the E. coli and cucumber samples did not contain the specific E. coli variant causing the outbreak.[16][17] Spain consequently expressed anger about having its produce linked with the deadly E. coli outbreak, which cost Spanish exporters 200M USD per week.[18] Russia banned the import of all fresh vegetables from the European Union until June 22.[19]

Contents

Origin

Beginning 2 May 2011, German health authorities reported the outbreak of bloody diarrhea accompanied by hemolytic-uremic syndrome (HUS).[20] On 22 May 2011, German health authorities said “Clearly, we are faced with an unusual situation”, one day after the first death in Germany. Escherichia coli infection is common, infecting 800 to 1200 people a year in Germany, but is usually mild.[21][22] Until 25 May it occurred in northwest Germany mostly.[23]

On 26 May 2011, German health officials announced that cucumbers from Spain were identified as a source of the E. coli outbreak in Germany.[24] On 27 May 2011, German officials issued an alert distributed to nearby countries, identifying organic cucumbers from Spain and withdrawing them from the market.[13] The European Commission on 27 May said that two Spanish greenhouses that were suspected to be sources had been closed, and were being investigated.[25][26] The investigation included analyzing soil and water samples from the greenhouses in question, located in the Andalusia region, with results expected by 1 June.[27] Cucumber samples from the Andalusian greenhouses did not show E. coli contamination,[28][29][30] but a cross-contamination during transport in Germany or distribution in Hamburg are not discounted; in fact, the most probable cause is cross-contamination inside Germany.[31][32] The Robert Koch Institute advises against eating raw tomatoes, cucumbers and lettuces in Germany to prevent further cases.[33]

On 31 May 2011, an EU official said that the transport chain was so long that the cucumbers from Spain could have been contaminated at any point that occurred along the transit route. [34] Spanish officials, said before that there was no proof that the outbreak originated in Spain; Spanish Secretary of State for European Affairs Diego López Garrido said that "you can't attribute the origin of this sickness to Spain."[26]

On Tuesday 31 May, lab tests showed that two of the four cucumbers examined did contain toxin-producing E. coli strains, most likely because of cross-contamination in Germany according to experts,[32] but not the O104 strain that was found in patients. The bacteria in the other two cucumbers have not yet been identified.

Genomic sequencing by BGI Shenzhen confirm a 2001 finding that the O104:H4 serotype has some enteroaggregative E. coli (EAEC or EAggEC) properties, presumably acquired by horizontal gene transfer.[35][36][37]

The only previous documented case of EHEC O104:H4 was in South Korea in 2005 and researchers pointed at contaminated hamburgers as a possible cause.[38]

On June 4, German and EU officials had allegedly been examining data that indicated that a open catering event at a restaurant in Lübeck, Germany, was a possible starting point of the on-going deadly E. coli outbreak in Europe.[39][40] German hospitals were nearly overwhelmed by the number of E. coli victims.[41]

A spokesman for the agriculture ministry in Lower Saxony, warned people on June 5 to stop eating local bean sprouts as they had become the latest suspected cause of the E. coli outbreak.[42] A farm in Bienenbuettel, Lower Saxony, was announced as the probable source,[43][44] but on June 6 officials said that this could not be substantiated by tests. Of the 40 samples from the farm that were being examined, 23 had tested negative.[45] But on June 10 it was confirmed by the head of the Robert Koch Institute that the bean sprouts are the source of the outbreak, and that people who ate the bean sprouts were nine times more likely to have bloody diarrhea.[46][47] The WHO have confirmed on June 10 this statement on the update 13 of the EHEC outbreak.[48]

According to the head of the national E. coli lab at the German Federal Institute for Risk Assessment, the strain responsible for the outbreak has been circulating in Germany for 10 years, and in humans not cattle. He said it is likely to have got into food via human feces.[49]

A joint risk-assessment by EFSA/ECDC, issued June 29, 2011, made a connection between the German outbreak and a HUS outbreak in the Bordeaux area of France, first reported on June 24, in which infection with E. coli O104:H4 has been confirmed in several patients.[50] The assessment implicated fenugreek seeds imported from Egypt in 2009 and 2010, from which sprouts were grown, as a common source of both outbreaks, but cautioned that "there is still much uncertainty about whether this is truly the common cause of the infections", as tests on the seeds had not yet found any E. coli bacteria of the O104:H4 strain.[51][52] The potentially contaminated seeds were widely distributed in Europe.[53] Egypt, for its part, steadfastly denied that it may have been the source of deadly E. coli strain, with the Minister of Agriculture calling speculations to that effect "sheer lies."[54]

Affected countries

Overview

Most or all victims as of 21 July 2011 (2011 -07-21) were believed to have become infected in Germany or France. Confirmed cases are listed below according to their location when diagnosed.

Number of cases reported to the WHO as for 21 July 2011[9]
Country Deaths HUS cases Non-HUS cases
 Austria &10000000000000000000000 0 &10000000000000001000000 1 &10000000000000004000000 4
 Canada &10000000000000000000000 0 &10000000000000000000000 0 &10000000000000001000000 1
 Czech Republic &10000000000000000000000 0 &10000000000000000000000 0 &10000000000000001000000 1
 Denmark &10000000000000000000000 0 &10000000000000010000000 10 &10000000000000016000000 15
 France &10000000000000000000000 0 &10000000000000007000000 7 &10000000000000004000000 10
 Germany &10000000000000048000000 48 &10000000000000733000000 857 &10000000000003078000000 3078
 Greece &10000000000000000000000 0 &10000000000000000000000 0 &10000000000000001000000 1
 Luxembourg &10000000000000000000000 0 &10000000000000001000000 1 &10000000000000001000000 1
 Netherlands &10000000000000000000000 0 &10000000000000004000000 4 &10000000000000007000000 7
 Norway &10000000000000000000000 0 &10000000000000000000000 0 &10000000000000001000000 1
 Poland &10000000000000000000000 0 &10000000000000002000000 2 &10000000000000001000000 1
 Spain &10000000000000000000000 0 &10000000000000001000000 1 &10000000000000001000000 1
 Sweden &10000000000000001000000 1 &10000000000000018000000 18 &10000000000000035000000 35
 Switzerland &10000000000000000000000 0 &10000000000000005000000 5 &10000000000000000000000 0
 United Kingdom &10000000000000000000000 0 &10000000000000003000000 3 &10000000000000004000000 4
 United States &10000000000000001000000 1 &10000000000000004000000 4 &10000000000000002000000 2
Total &09999999999999998999999 50 &09999999999999998999999 908 &09999999999999998999999 3,167

International response

European Union

On 22 May, Health Commissioner John Dalli of the European Commission declared the issue to be an 'absolute priority', saying that the Commission is working with member states, particularly Germany, to identify the source of the outbreak.[55] Speaking again on 1 June, Commissioner Dalli noted that the outbreaks have been limited in origin to the Greater Hamburg area and declared that any product ban would be disproportionate. He also said that he is working with Agriculture Commissioner Dacian Cioloş "to address the hardship faced by this group of our citizens that has also been hit hard by the E. coli outbreak".[56] He also said on June that "In future we need to see how the timing of the alerts can be closer to the actual scientific basis and proof." [57]

By June 7, EU Ministers held an emergency meeting in Luxembourg to discuss the growing crisis, which had left 23 people dead, more than 2,000 ill so far.[58][57] Germany's Federal Agriculture Minister, Ilse Aigner, repeated her warnings to EU consumers to avoid eating any bean sprouts, cucumbers, tomatoes and salads.[58]

The United States Center for Disease Control (CDC) and the United States Department of Agriculture has long been concerned regarding risks involving the E. coli risk in raw bean sprout production.[57]

EU member nations

Apart from the German government, which warned against the consumption of all raw cucumbers, tomatoes and lettuce,[59] several countries implemented restrictions or bans on the import of produce.

Non-EU European nations

Many European other countries took restrictive actions or lost sales of produce, including Albania, Croatia,[60] and Russia.

The ban on EU vegetables was lifted on June 10, but stiff safety mesures remained in place.[61]

Middle East

Many countries took restrictive action. Egypt was a focus of the epidemiological investigation because the fenugreek seeds were imported into Germany from Egypt.

Egypt’s Minister of Health Ashraf Hatem denied his nation had any patients infected with the new E. coli strain, due to the strict precautions brought in to test over-seas tourists entering the country on June 2.[62][63]

Responding to claims that Egyptian fenugreek seeds were the cause of the E. coli outbreak, Egyptian Minister of Agriculture Ayman Abu-Hadid told the Egyptian press the problem had nothing to do with Egypt and instead asserted, "Israel is waging a commercial war against Egyptian exports."[64]

North America

Canada and the United States reported cases of E. coli infection that had been acquire in Europe.

On June 2 Canada brought in stricter anti E. coli related food inspections [65] and by June 3 the Public Health Agency of Canada said that no Canadians had been reported sick with the strain as of that date. The Canadian Government also brought in heavier import and hygiene restrictions on EU cucumbers, lettuces and tomatoes.[66]

The United States Department of Agriculture (USDA) and the Food and Drug Administration (FDA) stated that emerging strains of E. coli are a significant problem, but regulatry bodies in the USA have concentrated on the more infamous E. coli O157 serotype.[67][68]

FDA noted that nearly all of America's fresh produce is grown in the U.S. and areas of Central America, and the EU has not been a significant source of fresh produce for the US.[69]

Other countries

Other countries, including Nigeria, Hong Kong, Thailand expressed concern regarding imported produce.

Economics

By June 1 both Italian, Austrian, and French cucumber sales had begun to decline sharply, but the Austrian Health Ministry official Dr. Pamela Rendi-Wagner, claimed Austrian customers were still safe.[70]

On 3 June, the governments of Spain, Portugal and Germany said that they would formally request EU agricultural aid for farmers affected by the outbreak.[71] That day also saw Russia set up plans for new imports of cucumbers from Ukraine, Azerbaijan, Egypt and Turkey.[72][73]

By June 7, the EU’s farmers had reported they had lost millions of dollars in exports during the outbreak, with Fepex, Spain's fruit and vegetable industry group, saying its growers had $256,000,000 in turnover.[58] French, Swiss, Bulgarian, German, Dutch, Belgian and Portuguese producers have also been similarly affected.[58]

That day, the EU proposed issuing £135,000,000 in agricultural compensation to its farmers. The EU agriculture commissioner said the EU’s farmers could get back up to 30% of the cost of vegetables they were unable to sell.[74] The EU's health commissioner, John Dalli, had formally criticised earlier that day Germany for rushing out "premature conclusions" about the source of an outbreak, and only helped to spread alarm among the public and farmers and untimely leading to the damaging the EU’s agriculture sector.[75] John Dalli also told the EU parliament in Strasbourg that claims had to be scientifically sound, unbiased and fool-proof in nature before it was publicised in future.[76]

Spain then rejected a €150,000,000/£135,000,000 the European Commission’s compensation deal for there for farmers who were hit by the E. coli outbreak, on June 8, saying it was too small.[77] France, European Union’s largest agricultural grower, said it would support the plan to compensate producers hurt by the outbreak, according to the French Agriculture Minister Bruno Le Maire.[44]

Ministers from both EU and Russian were scheduled to meet on June 8 over Russian's earlier decision to ban all its vegetable imports from the EU.[78]

On June 8, it was reckoned that the EU’s E. coli O104:H4 outbreak cost $2,840,000,000 in human losses (such as sick leave), regardless of material losses (such as dumped cucumbers).[79]

Consumers across Europe were shunning fruit and vegetables on mass by June 8, as the German government‘s against eating raw cucumbers, tomatoes, lettuce and sprouts remained on. EU farmers claimed to have losses up to C$417,000,000 ($611,000,000) a week as ripe vegetables produce rotted in their fields and warehouses.[80] On June 8, The EU Farm Commissioner Dacian Ciolos said that the EU had increased its offer of compensation to farmers for the losses caused by E. coli outbreak to C$210,000,000 ($306,000,000).[80]

Specific countries

On June 8, Dacian Cioloş, the European Commissioner for Agriculture & Rural Development, increased the compensation offer to €210 million ($306.2 million) for farmers who lost money due to the outbreak.[81][82]

Several countries reported economic losses, particulaly Spain. By June 7, the EU’s Farmers had reported that they had lost millions of dollars in exports during the outbreak, with Fepex, Spain's fruit and vegetable industry group, saying its growers had lost $256,000,000m in turnover.[58] Spain rejected the European Commission’s €150,000,000/£135,000,000 compensation deal for their farmers who were hit by the E. coli outbreak, on June 8, saying it was too small.[77]

Other countries reporting losses included Bulgaria,[83] Croatia,[60] and Switzerland,[84][85] Russia requested further Turkish and Azerbaijani cucumber imports to replace banned EU imports.[73][86]

See also

  • Health crisis
  • Crisis situations and protests in Europe since 2000
  • List of foodborne illness outbreaks

References

  1. ^ "Case definition for HUS-cases associated with the outbreak in Germany" (PDF). http://www.rki.de/cln_116/nn_217400/EN/Home/HUS__Case__definition,templateId=raw,property=publicationFile.pdf/HUS_Case_definition.pdf. Retrieved 2011-06-04. 
  2. ^ "Gärtnerhof Bienenbüttel". http://www.gaertnerhof.org/. Retrieved 13 June 2011. 
  3. ^ a b "German-grown food named likely culprit in deadly outbreak". CNN.com. 2010-06-05. http://www.cnn.com/2011/WORLD/europe/06/05/europe.e.coli/index.html?hpt=hp_t2. Retrieved 2011-06-05. 
  4. ^ "Deadly E. coli found on bean sprouts". www.thelocal.de. 2010-06-11. http://www.thelocal.de/national/20110610-35583.html. Retrieved 2011-06-11. 
  5. ^ "Bundesinstitut bestätigt Sprossen als Ehec-Quelle". sueddeutsche.de. 2010-06-11. http://www.sueddeutsche.de/wissen/ehec-epidemie-bahr-befuerchtet-weitere-todesfaelle-1.1107576. Retrieved 2011-06-13. 
  6. ^ "Samen von Bockshornklee mit hoher Wahrscheinlichkeit für EHEC O104:H4 Ausbruch verantwortlich in English: Fenugreek seeds with high probability for EHEC O104: H4 responsible outbreak" (in German) (PDF). Bundesinstitut für Risikobewertung (BfR) in English: Federal Institute for Risk Assessment. 30 June 2011. http://www.bfr.bund.de/cm/343/samen_von_bockshornklee_mit_hoher_wahrscheinlichkeit_fuer_ehec_o104_h4_ausbruch_verantwortlich.pdf. Retrieved 17 July 2011. 
  7. ^ a b c d e f g "Shiga toxin-producing E. coli (STEC): Update on outbreak in the EU (27 July 2011, 11:00)". ECDC. 27 July 2011. http://ecdc.europa.eu/en/activities/sciadvice/Lists/ECDC%20Reviews/ECDC_DispForm.aspx?List=512ff74f%2D77d4%2D4ad8%2Db6d6%2Dbf0f23083f30&ID=1166&RootFolder=%2Fen%2Factivities%2Fsciadvice%2FLists%2FECDC%20Reviews. Retrieved 27 August 2011. 
  8. ^ "E. coli cucumber scare: Russia announces import ban". BBC News Online. 30 May 2011. Archived from the original on 30 May 2011. http://www.webcitation.org/5z4jXeT1m. Retrieved 30 May 2011. 
  9. ^ a b c WHO, EHEC outbreak: Update 30 (22 July 2011) This and previous updates are available at: [1]
  10. ^ "E. Two in U.S. infected in German E. coli outbreak". MSNBC Online. 31 May 2011. http://www.msnbc.msn.com/id/43227702/ns/health-infectious_diseases/. Retrieved 2 June 2011. 
  11. ^ "/ Europe - Cucumber crisis widens European rift". Ft.com. http://www.ft.com/cms/s/0/46118688-8c76-11e0-883f-00144feab49a.html?ftcamp=rss#axzz1OIkFWAJy. Retrieved 2011-06-04. 
  12. ^ "EUROPEAN COMMISSION-Audio conference of the STEC OUTBREAK IN GERMANY" (PDF). http://ec.europa.eu/food/food/docs/stec_outbreak_flash_report_27052011_en.pdf. Retrieved 2011-06-04. 
  13. ^ a b RASFF Notification detail - 2011.0703 enterohaemorrhagic Escherichia coli in organic cucumbers from Spain
  14. ^ "E. coli outbreak sickens European diplomatic relations". The Periscope Post. http://www.periscopepost.com/2011/06/e-coli-outbreak-sickens-european-diplomatic-relations/. Retrieved 2011-06-04. 
  15. ^ "Toll climbs in European E. coli outbreak". Toronto: The Globe and Mail. 30 May 2011. Archived from the original on 30 May 2011. http://www.theglobeandmail.com/news/world/europe/toll-climbs-in-european-e-coli-outbreak/article2040566/. Retrieved 31 May 2011. 
  16. ^ "EUROPEAN COMMISSION - HEALTH AND CONSUMERS DIRECTORATE GENERAL - 2 June 2011" (PDF). http://ec.europa.eu/food/food/docs/stec_summary_note_audioconference_02062011_en.pdf. Retrieved 2011-06-04. 
  17. ^ "Germany now say Spanish cucumbers not source of E. coli". Euskal Irrati Telebista. 31 May 2011. http://www.eitb.com/news/life/detail/671223/germany-now-say-spanish-cucumbers-not-source-ecoli/. Retrieved 31 May 2011. 
  18. ^ "E. coli cucumber scare: Spain angry at German claims". BBC. 31 May 2011. http://www.bbc.co.uk/news/world-europe-13605910. Retrieved 31 May 2011. 
  19. ^ Chelsom-Pill, Charlotte (2011-06-22). "Russia lifts ban on EU vegetables". Deutsche Welle. http://www.dw-world.de/dw/article/0,,15182434,00.html. Retrieved 26 June 2011. 
  20. ^ "CDC - germany outbreak". C.cdc.gov. http://wwwnc.cdc.gov/travel/notices/outbreak-notice/2011-germany-europe-e-coli.htm. Retrieved 2011-06-04. 
  21. ^ "Scientists hunt source of life-threatening stomach bug". Thelocal.de. 2011-05-18. http://www.thelocal.de/society/20110523-35185.html. Retrieved 2011-06-04. 
  22. ^ "First death in German E. coli outbreak; up to 200 sick | barfblog". Barfblog.foodsafety.ksu.edu. 2011-05-24. http://barfblog.foodsafety.ksu.edu/blog/148448/11/05/24/first-death-german-e-coli-outbreak-200-sick. Retrieved 2011-06-04. 
  23. ^ "Potentially deadly E. coli bug spreads in Germany". Swiss Tribune. 2011-05-24. http://www.swisstribune.com/inhalt/1164-potentially-deadly-e-coli-bug-spreads-germany. Retrieved 2011-06-09. 
  24. ^ "Deadly E. coli found in Spanish cucumbers - The Local". Thelocal.de. http://www.thelocal.de/national/20110526-35261.html. Retrieved 2011-06-05. 
  25. ^ Rapid Alert System for Food and Feed[dead link]
  26. ^ a b "E. coli cucumber scare: Germany seeks source of outbreak". BBC News Online. 30 May 2011. Archived from the original on 30 May 2011. http://www.webcitation.org/5z4s65O8X. Retrieved 30 May 2011. 
  27. ^ Govan, Fiona (30 May 2011). "'Killer cucumbers' row breaks out between Spain and Germany". London: The Telegraph. Archived from the original on 30 May 2011. http://www.webcitation.org/5z4sR1sDs. Retrieved 30 May 2011. 
  28. ^ "Efforts intensify to identify source of ''E. coli' outbreak in Germany as final tests clear Spanish cucumbers". Europa.eu. http://europa.eu/rapid/pressReleasesAction.do?reference=MEMO/11/366. Retrieved 2011-06-04. 
  29. ^ "Europe lifts cucumber warning". The Irish Times. 1 June 2011. http://www.irishtimes.com/newspaper/breaking/2011/0601/breaking34.html. Retrieved 2011-06-04. 
  30. ^ "Ministry of Health Spain". Msps.es. http://www.msps.es/gabinetePrensa/notaPrensa/desarrolloNotaPrensa.jsp?id=2120. Retrieved 2011-06-04. 
  31. ^ "E.coli outbreak kills Swedish woman as death toll hits 16 but cucumbers are NOT to blame". London: Dailymail.co.uk. 1 June 2011. http://www.dailymail.co.uk/news/article-1392665/E-coli-outbreak-kills-Swedish-woman-death-toll-hits-16-cucumbers-NOT-blame.html. Retrieved 2011-06-04. 
  32. ^ a b Brown, Jonathan (1 June 2011). "Cucumbers in clear – so what is causing deadly E.coli outbreak?". London: The Independent. http://www.independent.co.uk/life-style/health-and-families/health-news/cucumbers-in-clear-ndash-so-what-is-causing-deadly-ecoli-outbreak-2291600.html. Retrieved 2011-06-04. 
  33. ^ "New epidemiological data corroborate existing recommendation on consumption by BfR". Bundesinstitut für Risikobewertung. http://www.bfr.bund.de/en/press_information/2011/14/new_epidemiological_data_corroborate_existing_recommendation_on_consumption_by_bfr-70992.html. Retrieved 2011-06-27. 
  34. ^ "Europeans trade blame over E.coli outbreak, Belgium Health". Maktoob News. http://en.news.maktoob.com/20090000774696/Europeans_trade_blame_over_E_coli_outbreak/Article.htm. Retrieved 2011-06-05. 
  35. ^ "BGI Sequences Genome of the Deadly E. coli in Germany and Reveals New Super-Toxic Strain". BGI. 2011-06-02. http://www.genomics.cn/en/news_show.php?type=show&id=644. Retrieved 2011-06-02. 
  36. ^ David Tribe (2011-06-02). "BGI Sequencing news: German EHEC strain is a chimera created by horizontal gene transfer". http://www.biofortified.org/2011/06/german-ehec-strain-is-a-chimera/. Retrieved 2011-06-02. 
  37. ^ Maev Kennedy and agencies (2 June 2011). "E. coli outbreak: WHO says bacterium is a new strain". London: guardian.co.uk. http://www.guardian.co.uk/world/2011/jun/02/e-coli-outbreak-who-bacterium-new-strain. Retrieved 2011-06-04. 
  38. ^ "A Case of Hemolytic Uremic Syndrome Caused by Escherichia coli O104:H4", Yonsei Medical Journal, Vol. 47, No. 3, pp. 437 - 439, 2006
  39. ^ "E. coli Outbreak Started from German Restaurant - Sofia News Agency". Novinite.com. 2011-06-04. http://www.novinite.com/view_news.php?id=128960. Retrieved 2011-06-04. 
  40. ^ Marco Krefting (June 6, 2011). "Focus shifts to German restaurant in hunt for outbreak source". The Sydney Morning Herald. http://www.smh.com.au/world/focus-shifts-to-german-restaurant-in-hunt-for-outbreak-source-20110605-1fnb8.html#ixzz1OPYauQbo. 
  41. ^ "Germany 'Struggling To Cope' With E.coli". SkyNews. June 5, 2011. http://news.sky.com/skynews/Home/World-News/Ecoli-Outbreak-Germany-Hospitals-Struggle-To-Cope-As-One-Survivor-Speaks-Out-About-The-Problems/Article/201106116005708?lpos=World_News_First_Home_Article_Teaser_Region_3&lid=ARTICLE_16005708_E.coli_Outbreak%3A_Germany_Hospitals_Struggle_To_Cope_As_One_Survivor_Speaks_Out_About_The_Problems. 
  42. ^ "E coli outbreak: German officials identify bean sprouts as likely source | World news | guardian.co.uk". London: Guardian. 5 June 2011. http://www.guardian.co.uk/world/2011/jun/05/ecoli-beansprouts-identified-likely-source. Retrieved 2011-06-06. 
  43. ^ "German-grown sprouts named likely culprit in deadly outbreak - CNN News International Edition". CNN.com. 2011-06-05. http://www.cnn.com/2011/WORLD/europe/06/05/europe.e.coli/. Retrieved 2011-06-05. 
  44. ^ a b Connolly, Allison (2008-07-19). "E. Coli Outbreak Kills One More Patient as Source Eludes Investigators". Bloomberg. http://www.bloomberg.com/news/2011-06-07/e-coli-deaths-at-23-after-another-fatality-as-source-eludes-investigators.html. Retrieved 2011-06-09. 
  45. ^ James Gallagher (2011-06-05). "BBC News - E. coli outbreak: First German sprout tests negative". Bbc.co.uk. http://www.bbc.co.uk/news/world-europe-13672161. Retrieved 2011-06-09. 
  46. ^ "Germany says sprouts are most likely source of E.coli". The Jerusalem Post. June 10, 2011. http://www.jpost.com/Headlines/Article.aspx?id=224434. Retrieved June 10, 2011. 
  47. ^ "German tests link bean sprouts to deadly E. coli". BBC News. June 10, 2011. http://www.bbc.co.uk/news/world-europe-13725953. Retrieved June 10, 2011. 
  48. ^ "EHEC outbreak: update 13". WHO News. June 10, 2011. http://www.euro.who.int/en/what-we-do/health-topics/emergencies/international-health-regulations/news/news/2011/06/ehec-outbreak-update-13. Retrieved June 10, 2011. 
  49. ^ MacKenzie, Debra. "Bean sprouts to blame for 'decade-old' E. coli". New Scientist. http://www.newscientist.com/article/dn20562-bean-sprouts-to-blame-for-decadeold-e-coli.html. Retrieved June 11, 2011. 
  50. ^ "Cluster of haemolytic uremic syndrome (HUS) in Bordeaux, France" (EFSA/ECDC joint risk-assessment). European Centre for Disease Prevention and Control. June 29, 2011. 
  51. ^ William Neuman and Scott Sayare (June 29, 2011). "Egyptian Seeds Are Linked to E. Coli in Germany and France". The New York Times. http://www.nytimes.com/2011/06/30/world/middleeast/30ecoli.html. Retrieved June 30, 2011. 
  52. ^ James Gallagher (30 June 2011). "E. coli outbreaks linked to Egypt". BBC News. http://www.bbc.co.uk/news/health-13973002. Retrieved 30 June 2011. 
  53. ^ Maryn McKenna (July 7, 2011). "E. coli: A Risk for 3 More Years From Who Knows Where". Wired (magazine). http://www.wired.com/wiredscience/2011/07/e-coli-3-years/. Retrieved July 12, 2011. 
  54. ^ "Egypt denies fenugreek-German E coli link". Monsters and Critics. Deutsche Presse-Agentur (Cairo/Berlin). 1 July 2011. http://www.monstersandcritics.com/news/health/news/article_1648784.php/Egypt-denies-fenugreek-German-E-coli-link. Retrieved 2 July 2011. "Egypt on Friday dismissed as untrue European reports that fenugreek seeds from Egypt were a suspected source of a deadly E coli outbreak." 
  55. ^ Escherichia coli outbreak in Germany: Shiga toxin-Producing Escherichia coli (STEC) – European Commission
  56. ^ Statement by Commissioner Dalli on the E. coli outbreak – European Commission
  57. ^ a b c "Germany and Spain talk cucumbers amid E. coli outbreak | Europe | Deutsche Welle | 08.06.2011". Dw-world.de. http://www.dw-world.de/dw/article/0,,15136009,00.html. Retrieved 2011-06-09. 
  58. ^ a b c d e "EU ministers to meet on E.coli outbreak - Europe". Al Jazeera English. http://english.aljazeera.net/news/europe/2011/06/20116771510528902.html. Retrieved 2011-06-09. 
  59. ^ "E-coli cucumber deaths reach 14". Financial Times. 30 May 2011. Archived from the original on 30 May 2011. http://www.webcitation.org/5z4y5vaEX. Retrieved 31 May 2011. 
  60. ^ a b "Croatian greengrocers complain of drop in sales due to E. coli panic - Business News - Croatian Times Online News - English Newspaper". Croatiantimes.com. http://www.croatiantimes.com/news/Business/2011-06-01/19689/Croatian_greengrocers_complain_of_drop_in_sales_due_to_E.coli_panic. Retrieved 2011-06-05. 
  61. ^ Germany blames bean sprouts for E coli, clears cucumbers - Monsters and Critics
  62. ^ "No E. coli bacteria in Egypt: Ministry of Health - Politics - Egypt - Ahram Online". English.ahram.org.eg. http://english.ahram.org.eg/~/NewsContent/1/64/13507/Egypt/Politics-/No-E-coli-bacteria-in-Egypt-Ministry-of-Health-.aspx. Retrieved 2011-06-05. 
  63. ^ "Egypt.com News - Egypt News - No E. coli bacteria in Egypt: Ministry of Health". News.egypt.com. http://news.egypt.com/english/permalink/7824.html. Retrieved 2011-06-09. 
  64. ^ David E. Miller (20 July 2011). "In new Egypt, old conspiracies live on". The Jerusalem Post. http://www.jpost.com/MiddleEast/Article.aspx?id=230235. Retrieved 20 July 2011. 
  65. ^ "E. coli outbreak sparks beefed up Canadian food import inspections". Healthzone.ca. 2011-06-02. http://www.healthzone.ca/health/newsfeatures/article/1001705--canadian-experts-alarmed-at-spread-of-mutant-e-coli-in-europe?bn=1. Retrieved 2011-06-06. 
  66. ^ "Canadian inspectors testing Europe veggies for E. coli - CTV News". Ctv.ca. http://www.ctv.ca/CTVNews/Health/20110603/canada-eurole-vegetables-coli-110603/. Retrieved 2011-06-06. 
  67. ^ "''E. coli'' O104:H4 responses from the USA". Ecolio104h4.com. 1999-02-22. http://ecolio104h4.com/e-coli-o104h4-responses-usa/. Retrieved 2011-06-05. 
  68. ^ "William Marler: ''E. coli'' Outbreak: Exporting Bill Marler to Germany or Japan". Huffingtonpost.com. http://www.huffingtonpost.com/william-marler/e-coli-outbreak-exporting_b_867819.html. Retrieved 2011-06-05. 
  69. ^ "FDA STATEMENT ON E. COLI 0104 OUTBREAK IN EUROPE". East County Magazine. http://eastcountymagazine.org/node/6365. Retrieved 2011-06-09. 
  70. ^ "Cucumber sales plummet in Europe". News.xinhuanet.com. 2011-06-01. http://news.xinhuanet.com/english2010/video/2011-06/01/c_13905346.htm. Retrieved 2011-06-05. 
  71. ^ Stevens, Laura (4 June 2011). "Europe's E. coli Cases Rise - WSJ.com". Online.wsj.com. http://online.wsj.com/article/SB10001424052702303657404576362821286583788.html. Retrieved 2011-06-04. 
  72. ^ "Azerbaijan Business Center - Azerbaijan gets chance to increase sharply export of vegetables to Russia". Abc.az. http://abc.az/eng/news/main/54726.html. Retrieved 2011-06-04. 
  73. ^ a b "Russian ban may support Turkish exports - Hurriyet Daily News and Economic Review". Hurriyetdailynews.com. http://www.hurriyetdailynews.com/n.php?n=russian-ban-may-support-turkish-exports-2011-06-02. Retrieved 2011-06-04. 
  74. ^ Peter Walker, Adam Gabbatt and agencies (7 June 2011). "E coli: European commissioner suggests £135m payout for farmers | World news". London: guardian.co.uk. http://www.guardian.co.uk/world/2011/jun/07/ecoli-outbreak-farmers-compensation. Retrieved 2011-06-09. 
  75. ^ Janicek, Karel (2011-05-29). "E. coli cucumbers may be in Austria, Hungary". MSNBC. http://www.msnbc.msn.com/id/43210195/ns/health-food_safety/t/e-coli-cucumbers-may-be-austria-hungary/. Retrieved 2011-06-05. 
  76. ^ "Germany criticised by EU health chief over 'premature' E. coli claims". London: Telegraph. 2011-06-05. http://www.telegraph.co.uk/health/healthnews/8561406/Germany-criticised-by-EU-health-chief-over-premature-E.coli-claims.html. Retrieved 2011-06-09. 
  77. ^ a b Driver, Alistair. "Spain rejects €150m e. coli compensation | News". Farmers Guardian. http://www.farmersguardian.com/home/business/business-news/spain-rejects-%E2%82%AC150m-e-coli-compensation/39517.article. Retrieved 2011-06-09. 
  78. ^ "EU increases E coli compensation offer - RTÉ News". Rte.ie. 2010-10-20. http://www.rte.ie/news/2011/0608/russia.html. Retrieved 2011-06-09. 
  79. ^ "German E. coli O104:H4 Outbreak - $2.84 Billion in Human Damage : Food Poison Journal : Food Poisoning Lawyer & Attorney : Bill Marler : Marler Clark". Food Poison Journal. 2011-05-31. http://www.foodpoisonjournal.com/foodborne-illness-outbreaks/german-e-coli-o104h4-outbreak---284-billion-in-human-damage/. Retrieved 2011-06-09. 
  80. ^ a b CTV Edmonton - Cucumbers suspected again in European E. coli outbreak - CTV News
  81. ^ "EU ups farmers compensation offer to 210 mln euros". Yahoo News. http://old.news.yahoo.com/s/afp/20110608/bs_afp/germanyfooddiseasehealtheucompensation. Retrieved June 10, 2011. 
  82. ^ "EU boosts E. coli compensation offer for farmers". Deutsche Welle. http://www.dw-world.de/dw/article/0,,15141284,00.html. Retrieved June 10, 2011. 
  83. ^ "E. coli outbreak threatens Bulgarian agriculture - Bulgaria". The Sofia Echo. http://www.sofiaecho.com/2011/06/03/1100229_ecoli-outbreak-threatens-bulgarian-agriculture. Retrieved 2011-06-05. 
  84. ^ "Swiss record third E.coli case - swissinfo". Swissinfo.ch. http://www.swissinfo.ch/eng/swiss_news/Swiss_record_third_E.coli_case.html?cid=30382868. Retrieved 2011-06-09. 
  85. ^ "Swiss farmers destroy cucumbers over E. coli fears - swissinfo". Swissinfo.ch. http://www.swissinfo.ch/eng/swiss_news/Farmers_destroy_cucumbers_over_E.coli_fears.html?cid=30380670. Retrieved 2011-06-09. 
  86. ^ "Switzerland confirms third case of rare E. coli strain < German news | Expatica Germany". Expatica.com. http://www.expatica.com/de/news/german-news/switzerland-confirms-third-case-of-rare-e-coli-strain_154074.html. Retrieved 2011-06-09. 

Wikimedia Foundation. 2010.

Игры ⚽ Нужна курсовая?

Look at other dictionaries:

  • Escherichia coli O104:H4 — is a rare enterohemorrhagic strain of the bacterium Escherichia coli, and the cause of the 2011 Escherichia coli O104:H4 outbreak.[1] The O in the serological classification identifies the cell wall lipopolysaccharide antigen, and the H… …   Wikipedia

  • Escherichia coli O104:H4 — est une souche entérohémorragique rare de la bactérie Shiga Toxine Escherichia Coli, connue pour être la cause de l’épidémie de syndrome hémolytique et urémique de 2011 en Europe[1]. Le « O » de la classification sérologique sert à… …   Wikipédia en Français

  • Escherichia coli O104:H4 — Escherichia coli EHEC O104:H4 ist ein seltener Hybrid Stamm des Bakteriums Escherichia coli aus dem enteroaggregativen Escherichia coli EAEC O104:H4 sowie einem EHEC Stamm.[1] Als Erreger steht er im Zusammenhang mit der HUS Epidemie 2011. Das O… …   Deutsch Wikipedia

  • Escherichia coli O104:H4 — Кишечная палочка O104:H4 (Escherichia coli O104:H4) до 2011 г. редкий в Европе, высоко патогенный энтерогеморрагический штамм кишечной палочки. Инфицирование этим штаммом вызывает гемолитико уремический синдром. В мае июне 2011 года штамм вызвал… …   Википедия

  • Escherichia coli — E. coli redirects here. For the protozoan parasite, see Entamoeba coli. For the 2011 E.coli outbreak, see 2011 E. coli O104:H4 outbreak. For a specific strain, see Escherichia coli (disambiguation). For Escherichia coli in molecular biology, see… …   Wikipedia

  • Verotoxin-producing Escherichia coli — Verotoxin producing E. coli Classification and external resources ICD 10 A04.3 ICD 9 008.04 Verotoxin produ …   Wikipedia

  • HUS-Epidemie 2011 — Die HUS Epidemie 2011 (auch EHEC Epidemie) ist eine im Mai 2011 zuerst in Deutschland beobachtete Häufung und Ausbreitung einer bis dahin nicht bekannten, schweren Verlaufsform eines hämolytisch urämischen Syndroms (HUS) mit Durchfall. Nahezu… …   Deutsch Wikipedia

  • List of foodborne illness outbreaks by death toll — List of foodborne illness outbreaks caused by an infectious disease. Year Event Agent Vector Company Infected Deaths Notes 1985 1985 California listeriosis outbreak in cheese Listeria queso fresco Jalisco Cheese 00086 !>86 [1] …   Wikipedia

  • Эпидемия кишечной палочки в Европе (2011) — Карта заболеваний, вызванных штаммом Escherichia coli O104:H4 (на 3 июня 2011) Серый цвет: не обнаружено Зелёный: подозрительные случаи Жёлтый: ? Оранжевы …   Википедия

  • Food irradiation — The Radura logo, used to show a food has been treated with ionizing radiation. Food irradiation is the process of exposing food to ionizing radiation[1] to destroy microorganisms, bacteria, viruses, or ins …   Wikipedia

Share the article and excerpts

Direct link
… Do a right-click on the link above
and select “Copy Link”