The Chemical and Veterinary Investigation Office of Rhine-Ruhr-Wupper has found E. coli O104 in an opened package of sprouts retrieved from the trash of a household in Rhein-Sieg-Kreis. Two of the three family members in the household ate the sprouts and were infected with the outbreak pathogen.

The sprouts came from Gärtnerhoff Bienenbüttel GmbH, the Lower Saxony grower whose sprouts had been implicated as the source of the E. coli O104:H4 outbreak that has sickened more than 3,000 people and killed 30 since the beginning of May.

John Remmel, Consumer Protection Minister for North Rhine-Westphalia, cautions that the new finding is not definitive, as the package of sprouts had already been opened. Additional studies are still in progress.

Following is the complete German text of the Press Release, kindly provided to me by Kirsten Reinhardt of foodwatch e.v.

Pressemitteilung

Gefährlicher EHEC Serotyp O 104 auf Sprossen in NRW gefunden – Zwei Familienmitglieder erkrankt

In Nordrhein-Westfalen hat das Chemische und Veterinäruntersuchungsamt Rhein-Ruhr-Wupper EHEC-Bakterien in einer Packung Sprossen nachgewiesen. Es handelt sich um den aggressiven Serotyp O 104. Allerdings war die Packung geöffnet und befand sich bereits in der Mülltonne eines Haushalts im Rhein-Sieg-Kreis. Zwei der drei in diesem Haushalt lebenden Familienmitglieder haben Sprossen verzehrt und sind Mitte Mai an den EHEC-Bakterien erkrankt. Die Sprossen stammen nach den bisherigen Erkenntnissen aus dem Betrieb im niedersächsischen Bienenbüttel. Damit ist erstmalig eine ununterbrochene Kette mit dem Erreger O 104 infizierten Sprossen aus dem Betrieb in Bienenbüttel und erkrankten Personen hergestellt.

NRW-Verbraucherschutzminister Johannes Remmel: „Der Fund bestätigt unsere aktuelleWarnung vor dem Verzehr von Sprossen. Es wird damit immer wahrscheinlicher, dass Sprossen die Ursache der EHECErkrankungen sind.“ Da aber nur eine geöffnete und keine geschlossene Packung untersucht wurde, verbleibt ein Rest an Unsicherheit. „Auch deshalb rufen wir weiterhin zur Einhaltung strenger Hygiene und besonderer Vorsicht im Umgang mit rohen Lebensmitteln auf“, so Remmel. Ergänzende Untersuchungen werden derzeit durch das Bundesinstitut für Risikobewertung durchgeführt.

Minister Remmel steht heute um 17.00 Uhr für Interviews zur Verfügung.

 

After vacillating from Spanish cucumbers to Germany sprouts and back to cucumbers, Germany’s outbreak task force has settled on sprouts.

According to information released earlier today (June 10th), epidemiological and traceback studies of disease clusters in five affected provinces point conclusively to bean and/or seed sprouts produced by Gärtnerhoff Bienenbüttel GmbH, an organic grower in Lower Saxony. The official government news release did not name the grower.

Although lab tests have not yet revealed the presence of the outbreak strain in samples of sprouts produced by the grower, all of Gärtnerhoff Bienenbüttel’s produce – including fenugreek, mung bean, lentil, adzuki bean, and alfalfa sprouts – has been recalled, and the grower has suspended operations. Federal and State inspectors are working to determine how the sprouts became contaminated – possibly through the water supply, a human source, or the seeds themselves.

The Germany government has rescinded its warning against consuming raw tomatoes, cucumbers and salad greens.

As of June 9th, Germany has recorded 759 cases of hemolytic uremic syndrome (HUS), with 21 deaths, and 2,229 cases of non-HUS E. coli O104:H4 infections (with 9 deaths), for a total of 2,988 documented illnesses and 30 deaths. Thirteen other European countries, Canada and the USA have reported outbreak-related illnesses, as follows:

• Austria: 4 cases, including 1 HUS
• Canada: 1 case
• Czech Republic: 1 case involving a tourist from the USA who had travelled in Germany
• Denmark: 20 cases, including 8 HUS
• France: 2 confirmed cases + 7 cases of bloody diarrhea not yet lab-confirmed
• Greece: 1 case involving a German tourist
• Luxembourg: 1 case
• Netherlands: 8 cases, including 4 HUS
• Norway: 1 case, involving contact with a German in Norway
• Poland: 2 cases of HUS
• Spain: 2 cases, including 1 HUS
• Sweden: 47 cases, including 17 HUS (one fatal HUS case)
• Switzerland: 5 cases
• United Kingdom: 5 cases, including 3 HUS
• USA: 4 cases, including 3 HUS. One of the HUS cases is confirmed; the other 2 HUS cases and the EHEC case are awaiting lab confirmation.

Including all European and North American cases, there are a total of 3092 reported outbreak cases – 798 HUS and 2,294 non-HUS EHEC. All but 2 of the 3092 outbreak victims either travelled to or lived in Germany during the incubation period for the infection.

Germany explains its delay in identifying sprouts as the source of the second largest – and the most deadly – E. coli outbreak ever recorded as follows (copy-edited* Google translation of relevant portion of the official news release):

A range of animal and vegetable foods, including sprouts, were taken into account during the first intensive survey of of patients from Hamburg (20.5./21.5). In this exploratory survey, only 3 of 12 patients reported having eaten sprouts. The patients who were interviewed were very clear and deliberate about their eating habits; it seemed unlikely that they would have under-reported eating sprouts. It is a methodological requirement and standard practice to include only those possible exposures that are potentially able to explain most of the epidemiological outbreak events. Including a large number of exposures increases the risk of false positive correlations. Therefore, sprouts were not immediately pursued. Sprouts were taken into account in subsequent detailed RKI surveys. In total, 16 (30%) of the 54 patients who were interviewed in-depth reported having consumed sprouts during the assumed infectious period.

An in-depth raw food case-control study, which included 26 HUS patients from Lubeck, Bremerhaven and Bremen, was begun on 05/29/2011 to differentiate more accurately between various vegetable foods. In this study, 6 out of 24 (25%) case-patients reported having sprouts, compared with 7 out of 80 (9%) control patients. The statistical significance of this difference was limited – significant in the unvariate analysis, but not in the multivariable analysis. The consumption of other plant foods – tomato, cucumber or lettuce – could not readily be differentiated, as these vegetables are so often consumed together.

Bottom line – the German investigators took at face value the initial questionnaire responses, instead of probing further to jog the memories of the interviewees.

It’s fortunate that sprouts have a relatively short shelf life. Between the exhaustion of the existing supply, the recall of sprouts from the market, and the suspension of production by Gärtnerhof Bienenbüttel, this outbreak should be on the wane.

Cold comfort to European growers of tomatoes, cucumbers and salad greens.

And very cold comfort to the more than 3,000 outbreak victims and their families, and to the families and friends of the 31 people who died as a result of “healthy” eating habits.

*I took the liberty of editing the Google translation for improved comprehension.

Bean sprouts grown in Lower Saxony (that’s in Germany, not Spain) are the latest suspects in the month-long German E. coli O104:H4 outbreak.

BBC Europe reports today that the epidemiological spotlight has landed on a plant nursery in Uelzen, south of Hamburg.

The German Ministry of Health is waiting for the results of lab tests before committing to this latest theory. For now, authorities are maintaining a warning against eating tomatoes, cucumbers or lettuce.

Nevertheless, the nursery has been closed.

While the outbreak strain of E. coli O104:H4 is a novel strain, sprouts of various kinds – beans, alfalfa, broccoli, et cetera – have been the source of numerous documented outbreaks of Salmonella and E. coli in Europe, North America and Japan.

The conditions used to produce sprouts – a warm and moist environment – are ideal for the growth of bacteria such as Salmonella and E. coli. In many cases, the seeds used for sprouting are already contaminated with the microbes. And washing either the seeds or the raw sprouts will not remove the pathogens.

The German outbreak ranks as the deadliest recorded outbreak of enterohemorrhagic E. coli (EHEC)- and one of the largest. As of today (June 5th), 627 cases of hemolytic uremic syndrome (HUS), and a further 1,536 cases of “simple” EHEC infections have been reported from Germany. HUS is a life-threatening complication that is associated with EHEC infections.

Fifteen HUS patients have died in Germany, as have 6 of the outbreak victims who suffered from EHEC without HUS – an overall death rate of 0.97% (21 dead out of 2163 confirmed illnesses).

The outbreak has spread beyond the borders of Germany, with 31 cases of HUS (one death) and 71 non-HUS cases of EHEC (102 cases in all) reported from eleven European countries, including:

• Austria.- 2 EHEC
• Czech Republic.- 1 EHEC
• Denmark.- 7 HUS; 11 EHEC
• France.- 10 EHEC
• Netherlands.- 4 HUS; 4 EHEC
• Norway.- 1 EHEC
• Poland.- 1 HUS
• Spain.- 1 HUS
• Sweden.- 15 HUS (1 death); 31 EHEC
• Switzerland.- 3 EHEC
• United Kingdom.- 3 HUS; 8 EHEC

All but one of the victims from these eleven countries reported having traveled to or from Germany during the typical incubation period for infection.

In addition to the European cases, the US CDC reports four suspect cases in the US – three of them suffering from HUS, and two suspect cases among US military service personnel in Germany.

Finding the source of the E. coli O104:H4 – if, indeed, the source has been found – won’t prevent the case count from continuing to rise. The incubation period, combined with the lab time required to complete a diagnosis, ensures that additional new cases will be reported. But the torrent should slow to a trickle over the next several days.

Even after the outbreak is over, this incident will fertilize numerous research projects. Still unanswered, for example, is why a disproportionate number of healthy women were stricken by HUS – a complication that more typically affects children. Questions about how this strain came into being, and why it is so deadly, also beg to be investigated.

Finally, expect the German people to question – rightly or wrongly – the competence of the epidemiologists and scientists at the Robert Koch Institute and the Federal Institute for Risk Assessment.