Epidemic Profile of Shiga-Toxin–Producing Escherichia coli O104:H4 Outbreak in Germany — Preliminary Report
The New England Journal of Medicine
June 22, 2011 (10.1056/NEJMoa1106483)
Background
In this report, we provide a preliminary description of an ongoing large outbreak of gastroenteritis and the hemolytic–uremic syndrome caused by Shiga-toxin–producing Escherichia coli in Germany in May and June 2011.
Methods
We analyzed data from reports in Germany of Shiga-toxin–producing E. coli gastroenteritis and the hemolytic–uremic syndrome and clinical information on patients presenting to Hamburg University Medical Center. An outbreak case was defined as a reported case of the hemolytic–uremic syndrome or of gastroenteritis in a patient infected by Shiga-toxin–producing E. coli, serogroup O104 or serogroup unknown, with an onset of disease on or after May 1, 2011, in Germany.
Results
As of June 18, 2011, a total of 3222 outbreak cases (including 39 deaths) have been reported in Germany, 810 of which (25%) involved the hemolytic–uremic syndrome. The outbreak is centered in northern Germany and peaked around May 21 to 23. Most of the patients in whom the hemolytic–uremic syndrome has developed are adults (89%; median age, 43 years), and women are overrepresented (68%). The estimated median incubation period is 8 days, with a median of 5 days from the onset of diarrhea to the development of the hemolytic–uremic syndrome. Among 59 patients infected with the outbreak strain who were prospectively followed at Hamburg University Medical Center, the hemolytic–uremic syndrome developed in 12 (20%), with no significant difference between patients in whom the syndrome developed and those in whom it did not with respect to sex or reported initial symptoms and signs. The outbreak strain was typed as an enteroaggregative Shiga-toxin–producing E. coli O104:H4, producing extended-spectrum beta-lactamase.
Conclusions
In this large outbreak of the hemolytic–uremic syndrome, caused by an unusual strain of Shiga-toxin–producing E. coli, cases have occurred predominantly in adults, with a preponderance of cases occurring in women. The hemolytic–uremic syndrome has developed in a quarter of the symptomatic outbreak cases that have been ascertained thus far.
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