E. coli O104:H4 Serotype Outbreak in Germany in 2011

From the first of May until the 25th of July of 2011 at 10 a.m. 852 cases of HUS, 3469 EHEC cases including 426 asymptomatic EHEC infections were reported to the RKI. 32 HUS patients and 18 persons infected with EHEC died. The outbreak was mainly localized in the northern parts of Germany, in Hamburg, North Rhine-Westphalia, Lower Saxony, Schleswig- Holstein and Bremen, although few cases have been reported in the neighboring countries and the southern parts of Germany. The outbreak was declared to be ended on the 25th of July as there were no new cases reported to the RKI for three ongoing weeks. For the clarification of the responsible pathogen and the vehicle on which it was able to spread over such a great distance a Task Force was formed. The BGITech. discovered very quickly the serogroup O104 in an isolate from an stool sample. Further investigations were based on this important fact. During the primary examinations with the classical PCR the most important characteristic genetic information of the serotype were found out. This information was used to develop a Multiplex-PCR; therefore the time needed for the investigation of the sample decreased very rapidly. Simultaneously a very high amount of samples of non human stool had to be handled. No technology was available for a reliable isolation of the serotype in sample of ready-to-eat vegetables. So a faster and more reliable method for the detection of EHEC/STEC of plant origin was developed. With the help of these newly invented method they were able to isolate on a sprout of fenugreek the serotype O104:H4. The positive predicted result by the forward and backward tracing of fenugreek seeds could not be confirmed by microbiological methods. The forward and backward tracing resulted in an high amount of data. A high coordination level of reported new cases, analysis and visualization was needed to get a better overview. Paid and freely available software was used and structures and databases already in use of the different involved offices and organizations were employed. All these improved and new invented materials and methods, are now available for an hopefully never coming future events