Sproutbreak — big media cover up — 50 deaths, nearly 900 maimed with HUS and 4000 sick: sprouts guilty

posted in: Syndicated | 61

 “Those who cannot remember the past are condemned to repeat it.”(George Santayana). (Here’s *a reminder* for those who have forgotten or do not know.)

Main lessons to be taken from this short history:

The type of food label needed here ?- from Bill Marler

  1. Bean and various other seed sprouts are the suspects. Humans can carry and transmit the germ. The E. coli EHEC germ is spreading to other countries. Disease risks are severe. A serious global epidemic of a deadly disease is possible, even likely if immediate actions are not taken.
  2. Basic hygiene in all parts of fresh vegetable production and use in food needs to be given a thorough review everywhere and improvements communicated widely.
  3. Various special interests are likely to generate irrelevant noise that will obscure these messages getting through to potential victims: this noise should be ignored
  4. To avoid people being harmed,  efforts and comments should be focussed on spreading the first two messages .
To understand the crux of this topic people just need to read this single Bloomberg story
By Niklas Magnusson – Jun 9, 2011 11:53 AM ET
All else is detail.
But the main details of what we know now follow for the more curious reader.

Updates (latest 24-06-2011. Further updates on the outbreak after that will be made at the Barfblog hot with the latest gossip post)

Video interview with Dr Tribe about E. coli worries and how to react to them.

Later Pundit posts about the outbreak or highly relevant to its emergence:

More about how the EHEC germ may spread in seeds

The banning of irradiation of foods 11 years ago in Germany

Barfblog again hot with the latest

Other important  items:

Epidemic Profile of Shiga-Toxin–Producing Escherichia coli O104:H4 Outbreak in Germany — Preliminary Report
Christina Frank, Ph.D., Dirk Werber, D.V.M., Jakob P. Cramer, M.D., Mona Askar, M.D., Mirko Faber, M.D., Matthias an der Heiden, Ph.D., Helen Bernard, M.D., Angelika Fruth, Ph.D., Rita Prager, Ph.D., Anke Spode, M.D., Maria Wadl, D.V.M., Alexander Zoufaly, M.D., Sabine Jordan, M.D., Klaus Stark, M.D., Ph.D., and Gérard Krause, M.D., Ph.D. for the HUS Investigation Team
June 22, 2011 (10.1056/NEJMoa1106483)

Food Safety Network
More Details on the Mysterious German Microbe

Blast from the past:

Infections Associated with Eating Seed Sprouts: An International Concern
Peter J. Taormina, Larry R. Beuchat, and Laurence Slutsker†
Emerging Infectious Diseases Vol. 5, No. 5, September-–October 1999 page 626

Q&A: Dr. Robert Tauxe on the Outbreak in Germany

E. coli O104:H4 – 38 Dead, 824 with HUS, 3351 Ill – Massachusetts, Michigan, and Wisconsin with 5

Household transmission of haemolytic uraemic syndrome associated with Escherichia coli O104:H4 in the Netherlands, May 2011
23.jun.11 via Barfblog
Eurosurveillance, Volume 16, Issue 25
E J Kuijper, D Soonawala, C Vermont, J T van Dissel
Following the outbreak of haemolytic uraemic syndrome (HUS) and haemorrhagic colitis in Germany, two patients returning from a stay in Germany developed HUS due to Escherichia coli O104:H4 in the Netherlands. The index case developed symptoms eight days, and her child 15 days after their return. It is very likely that transmission resulted from secondary spread from mother to child. Recommendations should be made to prevent secondary transmission within households.

GERMAN E. coli strain especially lethal, studies find
23.jun.11 via Barfblog
Steven Reinberg
(HealthDay News) — The strain of E. coli bacteria that this month killed dozens of people in Europe and sickened thousands more may be more deadly because of the way it has evolved, a new study suggests.
Scientists say this strain of E. coli produces a particularly noxious toxin and also has a tenacious ability to hold on to cells within the intestine. This, alongside the fact that it is also resistant to many antibiotics, has made the so-called O104:H4 strain both deadlier and easier to transmit, German researchers report.
“This strain of E. coli is much nastier than its [more common] cousin E. coli O157, which is nasty enough — about three times more virulent,” said Hugh Pennington, emeritus professor of bacteriology at the University of Aberdeen in Scotland and author of an accompanying editorial published online June 23 in The Lancet Infectious Diseases.
Another study, published the same day in the New England Journal of Medicine, concludes that, as of June 18, more than 3,200 people have fallen ill in Germany due to the outbreak, including 39 deaths.
In fact, the German strain — traced to sprouts raised at a German organic farm — “was responsible for the deadliest E. coli outbreak in history,” Pennington said. “It may well be so nasty because it combines the virulence factors of shiga toxin, produced by E. coli O157, and the mechanism for sticking to intestinal cells used by another strain of E. coli, enteroaggregative E. coli, which is known to be an important cause of diarrhea in poorer countries,” he said.
Shiga toxin can also help spur what doctors call “hemolytic uremic syndrome,” a potentially fatal form of kidney failure. In the New England Journal of Medicine study, German researchers say that 25 percent of outbreak cases involved this complication.
The bottom line, according to Pennington: “E. coli hasn’t gone away. It still springs surprises.”
To find out how this strain of the intestinal bug proved so lethal, researchers led by Dr. Helge Karch from the University of Munster studied 80 samples of the bacteria from affected patients. They tested the samples for shiga toxin-producing E. coli and also for virulence genes of other types of E. coli.
That’s when they uncovered the strain’s use of shiga toxin and its propensity to adhere tightly to cells in the digestive tract. This tight bond between the bacteria and the intestinal cells ” might facilitate systemic absorption of shiga toxin,” the authors wrote, upping the odds that a patient might progress to the sometimes deadly hemolytic uremic syndrome.
The strain was also resistant to common antibiotics, specifically penicillins and cephalosporins. Luckily, it was susceptible to another class of antibiotics called carbapenems.
According to the New England Journal of Medicine study, severe cases involving the hemolytic uremic syndrome have occurred mainly among adults, predominantly women. In one medical center in Hamburg, 12 of 59 patients infected with the O104:H4 strain went on to develop the sometimes form of deadly kidney failure, according to a team led by Christina Frank, of Berlin’s Robert Koch Institute.
For their part, the authors of the Lancet study believe that the emergence of the new strain “tragically shows ” how E. coli can change and “have serious consequences for infected people.”
One outside expert agreed. Infectious disease expert Dr. Marc Siegel, an associate professor of medicine at New York University in New York City, said that “in this case the bug itself is more virulent and more transmissible.”
This is just part of how the bacterium develops to survive, Siegel explained. And these changes may well affect other strains of E. coli. “These bugs are becoming more virulent,” he said.
One culprit, according to Siegel, is the overuse of antibiotics in livestock. Dosing animals with large quantities of antibiotics can make bacteria such as E. coli resistant to the drugs, he said.
These bacteria can then find their way into produce via water contaminated with animal waste, Seigel added. From there, the pathogen need only find its way into a salad or other food to infect people.
More information
For more information on food borne illness, visit the U.S. Centers for Disease Control and Prevention.
(SOURCES: Hugh Pennington, emeritus professor, bacteriology, University of Aberdeen, Scotland; Marc Siegel, M.D., associate professor, medicine, New York University, New York City, author of The Inner Pulse: Unlocking the Secret Code For Sickness and Health; June 23, 2011, The Lancet Infectious Diseases, online; June 23, 2011, online, New England Journal of Medicine )

WHO on EHEC outbreak: Update 16

Mounting evidence, new recommendations
On 10 June, authorities from the Robert Koch Institute (RKI), the Federal Institute for Risk Assessment (BfR) and the Federal Office of Consumer Protection and Food Safety (BVL) jointly stated that mounting epidemiological and food-chain evidence indicated that bean and seed sprouts (including fenugreek, mung beans, lentils, adzuki beans and alfalfa) are the vehicle of the outbreak in Germany caused by the unusual enteroaggregative verocytotoxin-producing Escherichia coli (EAggEC VTEC) O104:H4 bacterium.

The authorities now recommend that people in Germany should not eat raw bean and seed sprouts of any origin. Households, caterers and restaurants should dispose of any bean and seed sprouts that they have, and any food items that might have been in contact with them, until further notice.
In addition, BfR advises against eating home-grown, uncooked sprouts and seedlings.
The recommendation not to eat cucumbers, tomatoes and leafy salads in northern Germany is cancelled.
The authorities recommend withdrawal from the market of all food products from a farm in Lower Saxony, where the implicated bean and seed sprouts originated.
Numerous investigations continue, including into delivery chains. So far, there is no evidence that bean and seed sprouts from the farm have been exported beyond Germany.
The authorities recommend strict adherence to general hygiene advice when handling food items, after using the toilet and when health professionals are in contact with patients.
BfR, BVL and RKI issued a joint press release on 10 June with more details. The press release was updated on 12 and 13 June. (continues)

Nature Editorial
Published online 15 June 2011
If it is to deal effectively with outbreaks of infectious diseases, Germany must streamline its convoluted systems for reporting and communication.
Some six weeks after the first cases of potential food poisoning were reported, diners in Germany are still contemplating their side salads nervously, spooked by the confused information and warnings that have been issued over the past few weeks. Which item of greenery might be home to the deadly Escherichia coli bacterium known as EHEC O104:H4? By 13 June, the microbe had infected 3,325 people and killed 36.
The German public has been traumatized. It took weeks for the probable source of the bacterium to be named as an organic-bean-sprout farm in Lower Saxony. And, inevitably, accusations of crisis mismanagement are starting to fly.
These critical fingers, rightly, are not pointed at the scientists in Germany (and elsewhere), who rose admirably to the challenge of identifying and analysing the culprit. Instead, they are directed, with some justification, at the bizarrely complicated system Germany uses to handle disease outbreaks and track their sources — and at an alarmingly outdated way of transmitting information between physicians and agencies…continues at link

Scheutz et al. provide convincing evidence that the STEC strain causing the outbreak in Germany is in fact not a typical virulent STEC strain, but instead is a much rarer hybrid pathotype that harbours the phage-mediated Shiga toxin determinant with an enteroaggregative E. coli (EAggEC) background, more precisely described as enteroaggregative, Shiga toxin/verotoxin-producing E. coli (EAggEC STEC/VTEC). Secondly, they also identify in this strain the presence of the receptor for iron-chelating aerobactin, known to be a virulence factor associated with the extra-intestinal E. coli pathotype. Thirdly, they provide new data attesting to a close genetic relatedness of the German outbreak strain to previously described similar EAggEC STEC/VTEC strains. These findings are relevant for identifying the ecological reservoir and evolutionary origin of the epidemic agent, gaining a better understanding of the biological determinants of unusual disease severity and clinical complications seen in outbreak cases and the design of specific diagnostic tools for detection and treatment of STEC cases, and identification of the epidemic strain for accurate outbreak monitoring.

So what do the findings tell us about the reservoir and origin of the pathogen causing this outbreak? EAggEC is a common pathogen causing diarrhoea in travellers and persistent diarrhoea in infants and young children living in countries with poor sanitation [6,7]. In contrast to STEC strains that have an animal reservoir, mostly ruminants, EaggEC strains have a human reservoir. Little is known about the pathogenic role and epidemiological features of infections caused by strains of the hybrid EAggEC STEC/VTEC pathotype. One HUS outbreak caused by a strain of this mixed pathotype, but associated with a distinct serotype, had been previously reported from France in 1998 [8]. Scheutz et al. report that seven previously reported cases of diarrhoea or HUS worldwide caused by EAggEC O104:H4 have been identified: from Germany in 2001, France in 2004, South Korea in 2005, Georgia in 2009 and Finland in 2010 [9,10]. By PFGE analysis of EAggEC O104:H4 strains that are positive and negative for the Shiga toxin (stx) gene, the authors further demonstrate that, in contrast to the diversity seen within this serotype, isolates from the 2011 German outbreak cases exhibit a level of genetic similarity, which is also seen in the EAggEC STEC/VTEC O104:H4 strain from an unpublished outbreak of HUS in Georgia, which was investigated jointly by the United States Centers for Disease Control and Prevention (CDC) and Georgian public health authorities in 2009. However, no epidemiological link between these two outbreaks has been reported as yet and therefore the meaning of this finding remains elusive. Additional comparison of genomic relatedness of the German 2011 epidemic strain with other previously detected STEC O104:H4 strains causing sporadic HUS cases in other parts of the world should provide a more complete understanding of the potential reservoir and possible origin of the 2011 epidemic strain. 

Another fascinating development stems from comparative genomics, available in real time, to elucidate the ancestral origin of the 2011 outbreak strain. On 2 June, further information on the nature of the hybrid EAggEC STEC/VTEC pathotype of this strain came from whole genome sequence information generated by two groups of German academic investigators [11]. Sequence information from a third isolate from a patient was subsequently generated at the Health Protection Agency, United Kingdom.  The data sets from these sequencing initiatives were instantly released for public access, resulting in data analysis among bioinformaticians and other researchers around the world. Results from these preliminary analyses have been rapidly communicated via blogs, Twitter and private web pages, outside the standard peer-reviewed scientific publication route. These initiatives have confirmed the microbiological characterisation of the outbreak strain made in the public health laboratories by targeted genotyping and phenotyping of facultative E. coli virulence genes. Most importantly, among compared E. coli genome sequences, the genome of the 2011 outbreak strain clustered closest to an EAggEC strain isolated in 2002, with the addition of stx2 and antibiotic resistance genes.

From Eurosurveillance, Volume 16, Issue 24, 16 June 2011
M J Struelens , D Palm, J Takkinen
Microbiology Coordination Section, Resource Management and Coordination Unit, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
Food- and Waterborne Diseases and Zoonoses Programme, Office of the Chief Scientist, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
Citation style for this article: Struelens MJ, Palm D, Takkinen J. Enteroaggregative, Shiga toxin-producing Escherichia coli O104:H4 outbreak: new microbiological findings boost coordinated investigations by European public health laboratories . Euro Surveill. 2011;16(24):pii=19890. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19890
Date of submission: 14 June 2011

 Death Toll Reaches 37
Two-Year-Old Boy Dies in German E. Coli Outbreak 

Spiegel on line

Nature News Blog: Beansprouts: guilty

June 10, 2011, Nature News Blog
“It’s the bean sprouts,” said Reinhard Burger, head of the Robert Koch Institute (RKI), the German federal agency for disease surveillance in Berlin. The verdict, delivered earlier today, finally settles weeks of speculation about the source of the Escherichia coli outbreak which has swept across Europe over the past month (see ‘Microbe outbreak panics Europe’)…
…Now, investigators have linked people who have fallen ill with 26 restaurants which received produce from the farm. According to an Associated Press report, Andreas Hensel, the head of the country’s risk assessment agency, said: “They even studied the menus, the ingredients, looked at bills and took pictures of the different meals, which they then showed to those who had fallen ill.”
Health authorities in Germany have finally been able to show that the pathogens which caused the deadly EHEC outbreak came from sprouts at an organic farm in the Uelzen district. According to SPIEGEL ONLINE information, the breakthrough was made by scientists in the state of North Rhine-Westphalia. Final verification, however, is still pending.

As of Friday it remained unclear how the dangerous bacteria came to be present at the farm.
Even before this latest discovery, all the evidence had pointed to the farm in the state of Lower Saxony as the probable cause of the epidemic which has so far killed 29 people. Authorities had warned against eating raw sprouts. “It’s the sprouts”, the president of the Robert Koch Institute (RKI), Reinhard Burger, said in a press conference convened in Berlin on Friday.

Quoting comments at Nature news blog
I think that other important explanation to why this (O104:H4) and other E. coli strains (i.e., O157:H7) are becoming more present in organic products, is that the extended use of organic agriculture where manure is used as fertilizer it is been selecting for strains with the ability to invade and grow inside the plant vascular tissues thus reaching fruits and leaves. At least, E. coli O157:H7 has been reported growing inside plants. I wonder if the routine microbiological tests are taking into consideration that contamination may be inside the vegetable product and not only external surfaces. Likewise, I regret that most media are trying to hide the relationships between this terrible EHEC-HUS outbreak and organic agriculture.
Posted by: Marcel Gutierrez-Correa | June 10, 2011 06:25 PM

EHEC: A detective story

Today (June 10) the Robert Koch Institute published an Information update on EHEC outbreak. It’s a long document, with one passage of special interest: How the experts narrowed the culprit down to the sprouts. Excerpt:
Recipe-based restaurant cohort study 
With a high probability, the results of the “recipe-based restaurant cohort study” finally permit narrowing down the source of the infection to the consumption of sprouts. It was possible to apply this methodological approach only after a sufficient number of restaurant customers could be identified to ensure adequate statistical power of this analysis.

For an explanation of how they did it, and how difficult finding the culprit in this case was, go to:
Category: Food
Posted on: June 10, 2011 5:26 PM, by Liz Borkowski

This  is nasty:
FINLAND: EHEC infection discovered in Helsinki kindergarten
10.jun.11 via Doug Powell/ Barfblog
Helsingin Sanomat

A case of the EHEC infection that has caused havoc in Germany was found in a Helsinki kindergarten on Thursday. Health officials were notified of the matter at around noon, according to infectious diseases specialist and Helsinki city epidemiologist Hannele Kotilainen.
The daycare centre is now attempting to determine if there is more than one case to the outbreak.
“The matter is being examined according to the usual channels. We are charting the group and anyone with symptoms, and running tests on them”, reports Kotilainen.
She did not specify whether the infected party was a child or one of the kindergarten’s adult staff.

So is this 
SWEDEN reports first domestic EHEC case
The Local
For the first time, a Swede with no connections to Germany has been infected with the virulent enterohaemorrhagic E. coli (EHEC) bacteria that has claimed dozens of lives across Europe, Swedish health authorities reported on Tuesday.
“This means that the source of the infection is in Sweden, which is a lot worse, because it might mean that there is some form of infected food product in circulation that we haven’t yet identified, “ said Sofie Ivarsson, epidemiologist at the institute to news agency TT.
The infected Swede comes from Skåne, in southern Sweden, and has not been traveling in Germany. Neither does he have any other known connections to anyone else who have been taken ill after visiting Germany.
“All previous Swedish cases had a connection to Germany, but not this. This is a completely new case, which we identified this morning. We have not left any stones unturned and yet we have not been able to find any connection,” Ivarsson told TT.
The patient fell ill in the middle of June but is now reported to be feeling better, according to the institute.
There is an ongoing investigation to find the source of the infection, but it is not yet known if it originated in Sweden or if a connection to the German outbreak will be revealed.
According to the head of the institute, Johan Carlson, there are now only two alternatives. Either the Swedish man has been infected indirectly, or the source of the infection is in Sweden.
“And then we have more of a problem,” he told TT.

Thanks to Nick Loman for sproutbreak.

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David Tribe is an applied geneticist, teaching graduate/undergrad courses in food science, food safety, biotechnology and microbiology at the University of Melbourne.