Deadly E. coli outbreak hits Germany

Behind the Headlines

Friday June 10 2011

Wash all raw fruit and vegetables carefully before eating them

Last updated June 10 2011

German authorities say that bean sprouts are likely to be behind the European E. coli outbreak. Although laboratory tests on bean sprouts had come back negative, German health ministers say the diets of infected people show a clear link between eating bean sprouts and having the infection, with people who ate them nine times more likely to have symptoms of bloody diarrhoea.

In Germany, the number of infections continues to rise, with a total of 2,808 people affected since the outbreak began in early may. The outbreak, which has caused 26 deaths in Germany, has spread in only a very limited way in the rest of Europe, causing 91 confirmed cases and a single death. These have largely been in people who had recently travelled from Germany.

Although there is no evidence that the infection has spread within the UK, the outbreak is serious and highlights the importance of taking simple food hygiene precautions to prevent the spread of illness.

It is recommended that all fresh fruit and vegetables are washed carefully before being eaten. If you handle unwashed fruit or vegetables, wash your hands carefully afterwards to prevent the possibility of any bacteria on your hands spreading.

The Health Protection Agency (HPA) advises that anyone returning from Germany with illness including bloody diarrhoea should seek urgent medical attention and make sure they mention their recent travel history. People who are travelling to Germany should follow the advice of the authorities and avoid eating raw tomatoes, cucumbers and leafy salad including lettuce, especially in the north of the country, until further notice.

E. coli is a type of bacteria that causes food poisoning and is normally spread through traces of animal waste. There are different strains of E. coli, and some are more toxic than others. The strain of E. coli currently circulating in Europe is thought to be new and is proving particularly dangerous.

The best way to protect yourself against food poisoning is to practise good food hygiene, such as washing your hands carefully before and after handling food.

 

What problems can E. coli cause?

Escherichia coli (commonly referred to as E. coli) is a type of bacteria that can be found in the intestines of many animals. Some strains can cause illness in people. Usually, people have diarrhoea that settles within seven days without treatment.

For general food poisoning (from any type of bacteria), you should see a doctor if:

  • vomiting lasts for more than two days
  • it is not possible to keep liquids down for more than a day
  • diarrhoea lasts for more than three days
  • there is blood in your vomit or stools
  • you experience seizures, fits, slurred speech or double vision
  • you are dehydrated (symptoms include dry mouth, sunken eyes and being unable to pass urine)

However, E. coli can also cause more serious illness. The strain involved in the German outbreak has caused cases of haemolytic uraemic syndrome (HUS). HUS is a serious complication caused when bacteria produce a toxic substance called verocytotoxin. This can affect the blood, kidneys and, in some cases, the nervous system. It requires hospital treatment and, although most people make a full recovery, it can be fatal.

According to the latest figures from the European Centre for Disease Prevention and Control, there have been 2,808 E. coli cases in Germany, and a further 91 confirmed cases in people from other European countries who had recently travelled from Germany. Among those affected, there have been 757 cases of HUS and 27 deaths.

 

Has the outbreak reached the UK?

There have been a few isolated reports of illness due to this strain of E. coli in the UK. These have all been in people who have travelled from Germany and fallen ill after arriving in the UK. Nobody else has become infected after coming into contact with these people or contracted the illness from any other source in the UK.

In recent weeks, German authorities have tested various types of produce, including bean sprouts and Spanish cucumbers. While these laboratory tests have found no evidence of E. coli in bean sprouts, German authorities strongly suspect they are the cause as a high proportion of people affected had recently consumed them.

The HPA says that there is no evidence that any suspected produce has been distributed to the UK, and that it is continuing to monitor the situation.

 

How can food become contaminated?

People carry harmless strains of E. coli in their intestines, but can acquire harmful strains if they eat food that has been in contact with animal or human faeces. These harmful strains of E. coli may be transferred to other people if an infected person prepares food after going to the toilet and not washing their hands adequately.

Protect yourself:

  • Wash fruits and vegetables before you eat them.
  • Peeling or cooking fruit and vegetables can also remove these germs.
  • Good hygiene is very important in preventing person-to-person spread.
  • Supervise small children to make sure they wash their hands after using the toilet and before eating.
  • Read more advice on food safety.

In this particular case, it is unclear how the suspected produce may have became contaminated, but it may be the result of animal manure products being used as fertilisers or the presence of animals on the farms where produce has been grown.

 

Who has been affected?

According to the European Centre for Disease Prevention and Control (ECDC), the outbreak in Germany has mainly affected adults, and around two-thirds of affected adults have been female. The number of severe cases of HUS is unusual and the affected age groups are not typical – HUS as a complication of E. coli infection is generally more common in children. The rare strain of E. coli in this outbreak is called O104 and is not often seen in the UK.

 

What are the symptoms of food poisoning?

The most common symptoms of food poisoning are nausea, vomiting and diarrhoea. People may also experience stomach cramps and abdominal pain, loss of appetite, fever, muscle pains and chills.

In the German outbreak, bloody diarrhoea was a symptom and the HPA has recommended that any UK tourists returning from Germany with illness including bloody diarrhoea should seek urgent medical treatment and mention where they have travelled.

For general food poisoning (from any type of bacteria), you should see a doctor if:

  • vomiting lasts for more than two days
  • it is not possible to keep liquids down for more than a day
  • diarrhoea lasts for more than three days
  • there is blood in your vomit or stools
  • you experience seizures, fits, slurred speech or double vision
  • you are dehydrated (symptoms include dry mouth, sunken eyes and being unable to pass urine)

 

How can I avoid food poisoning?

It is important to wash your hands before preparing food and after handling raw meat. The German outbreak highlights the importance of washing all vegetables. Peeling and cooking fruit and vegetables can also remove these germs.

Chopping boards and work surfaces can harbour germs, and it is especially important to use separate chopping boards and utensils for raw and ready-to-eat foods and to wash them well between uses.

It is important to cook food thoroughly, particularly meat. If you are reheating food, make sure it is piping hot all the way through and do not reheat food more than once.

Cooked leftovers should be cooled quickly, ideally within one or two hours, and then put in the fridge or freezer once cooled.

 

Where can I get more information?

Further updates on the German E. coli outbreak are available from the Health Protection Agency and the Food Standards Agency.

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Edited by NHS Choices