Foodborne Illness Outbreak Database

This database provides summaries of significant food and water related outbreaks occurring since 1984 caused by E. coli, Salmonella, Hepatitis A, Campylobacter and other pathogens. Read more »

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2011 Outbreak of E. coli O104:H4 Linked to Fenugreek Sprouts

Beginning in May, an outbreak of E. coli O104:H4, an enterohemorrhagic E. coli, spread rapidly throughout northern Germany affecting mostly adults and females. On May 25, the Robert Koch Institut, Germany's disease control authority, advised the public to stop eating tomatoes, cucumbers, and lettuce as these were first suspected as the cause of the outbreak. On May 26, scientists at Hamburg's Institute for Hygiene and Environment identified enterohemorrhagic E. coli in three, imported, organic, cucumbers from Spain and one cucumber of unclear origin. On May 31, it was revealed that the enterohemorragic E. coli isolated from the cucumbers was different from the enterohemorrhagic E. coli isolated from infected persons. The results suggested that the cucumbers did not cause the outbreak, but posed a health risk. On May 31, it was announced that German vegetables may have been contaminated by at least two strains of enterohemorrhagic E. coli. On June 6, the Lower Saxony Agricultural Minister revealed that sprouts (i.e., bean, broccoli, pea, chickpea, garlic lentil, mungo bean, and radish) grown in northern Germany were the likely outbreak vehicle. One organic farm in the greater Uelzen area, Gartnerhoff Bienenbuttel GmbH, could be traced to infected persons in five German states. Many restaurants where cases had eaten served these sprouts. The farm was shut down and its produce was recalled. The German government announced on June 10 that lettuce, tomatoes, and cucumbers were again safe to eat, however sprouts and other vegetables produced by the organic farm were still suspect. The Chemical and Veterinary Investigation Office of Rhine-Ruhr-Wupper reportedly found the outbreak strain of E. coli O104:H4 in an opened package of sprouts retrieved from the trash of a household in Rhein-Sieg-Kreis. Two of the three family members in this household had eaten the sprouts and were infected. Secondary spread of the outbreak was first confirmed on June 17, when it was revealed that an infected food handler contaminated food served at a restaurant. On June 29, the possibility was announced that fenugreek sprouts made from Egyptian fenugreek seed could have been responsible for this outbreak and for a concurrent outbreak of E. coli O104:H4, in France (See France Sprouts Made From Egyptian Seed 2011). The Egyptian fenugreek seeds were imported to Europe in 2009 and/or 2010 by AGA SAAT GMBH, a German seed importer. On July 1, German food safety authorities withdrew suspicious lots of fenugreek seed from the German market. On July 5, the European Union officially withdrew from the market, and temporarily banned the import, of certain types of seeds from Egypt. On June 2, the World Health Organization acknowledged that E. coli O104:H4 had been linked previously to a single human case (Korea, 2004), but that the E. coli O104:H4 from Korea did not match the current, 2011, outbreak strain. This 2011 outbreak strain was novel in that it was highly resistant to antibiotics and lacked a gene which had been thought key in causing kidney damage. It had the ability to gather on the surface of an intestinal wall in a dense pattern, possibly enhancing the bacteria’s ability to pump the toxin into the body. On July 6, the World Health Organization reported outbreak related cases from Denmark, the United Kingdom, United States, Sweden, France, Austria, Switzerland, Czech Republic, Norway, Canada, Luxembourg, Greece, Poland, Spain, and the Netherlands. Most of these cases had traveled to Germany prior to their illness onset. By July 22, there had been 4075 outbreak related cases; 908 of the cases developed hemolytic uremic syndrome (HUS). HUS is a complication of E. coli infection that destroys red blood cells and leads to kidney damage. Fifty deaths were attributed to the outbreak. On July 8, the Centers for Disease Control and Prevention confirmed at least six outbreak related cases in the United States. Five of the U.S. cases had recent travel to Germany, where they were likely exposed. The outbreak strain was confirmed by bacterial culture from four HUS cases in Arizona (1), Massachusetts (1), Michigan (1) and Wisconsin (1), and two cases with diarrheal illness in Michigan (1) and North Carolina (1). The Arizona case with HUS died. The Michigan resident with diarrheal illness had traveled to Germany, but likely acquired infection through close contact with the Michigan resident with HUS. In October, 2011, it was revealed that a child who had been hospitalized in 2009, in Italy, was confirmed to have been infected with an identical strain of E. coli O104:H4. This child had traveled to Tunisia one week prior to illness onset. The investigation was hampered because sprouts were not recalled as an ingredient to salads or other dishes.

  • Outbreak began:
  • May 2011
  • Affected Country:
  • International
  • Affected States/Territories:
  • Arizona, Not Applicable
  • Organism(s):
  • Non-O157 STEC
  • Vehicle(s):
  • Vegetables, Sprouts, Fenugreek
  • Molecular Results Available:
  • Yes
  • Test Results:
  • Unknown
  • Location(s):
  • Festival, Restaurants, Private Homes
  • Brand Name(s):
  • Product Subject to Recall:
  • Yes
  • Total ill:
  • 4321
  • Number ill by Case Definition Known:
  • Unknown
  • Number Laboratory Confirmed Cases:
  • N/A
  • Number Probable Cases:
  • N/A
  • Number Possible Cases:
  • N/A
  • Anyone Hospitalized:
  • Yes
  • Number Hospitalized:
  • Unknown
  • Any Deaths:
  • Yes
  • Number Dead:
  • 50
  • Any References:
  • Yes

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