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EHEC O104:H4 Outbreak in Germany, 2011

EHEC O104:H4. Source: Gudrun Holland, Michael Laue/RKI

From May to July 2011, primarily in northern Germany, there was a large outbreak of illnesses characterized by haemolytic-uremic syndrome (HUS) and bloody diarrhoea caused by enterohemorrhagic Escherichia coli (EHEC) of the serotype O104:H4. Fenugreek sprouts were identified as most likely vehicle of infection.

A total of 855 cases of HUS and 2,987 cases of acute gastroenteritis were attributed to the outbreak (as of 16 August, 2011). The majority of cases were adults. This is in stark contrast to the cases of EHEC gastroenteritis and HUS reported in previous years, when children were predominantly affected. Overall, 53 fatalities occurred, 35 (4.1 %) among HUS patients and 18 (0.6 %) among patients with EHEC gastroenteritis.

The Robert Koch Institute has published a detailed final report on the outbreak (see link below).

Date: 05.06.2012


  • Buchholz U, Bernard H, Werber D, Böhmer MM, Remschmidt C, Wilking H, Deleré Y, an der Heiden M, Adlhoch C, Dreesman J, Ehlers J, Ethelberg S, Faber M, Frank C, Fricke G, Greiner M, Höhle M, Ivarsson S, Jark U, Kirchner M, Koch J, Krause G, Luber P, Rosner BM, Stark K, Kühne M; RKI HUS investigation team (2011): German Outbreak of Escherichia coli O104:H4 Associated with Sprouts
    N. Engl. J. Med. 365 (19): 1763-1770. Epub Oct 26. doi: 10.1056/NEJMoa1106482. more

  • Bielaszewska M, Mellmann M, Zhang W, Köck R, Fruth A, Bauwens A, Peters G, Karch H (2011): Characterisation of the Escherichia coli strain associated with an outbreak of haemolytic uraemic syndrome in Germany, 2011: a microbiological study
    Lancet Infect. Dis. 11 (9): 671-676. Epub Jun 22. doi:10.1016/S1473-3099(11)70165-7. more

  • Frank C, Werber D, Cramer JP, Askar M, Faber M, an der Heiden M, Bernard H, Fruth A, Prager R, Spode A, Wadl M, Zoufaly A, Jordan S, Stark K, Krause G for the HUS Investigation Team (2011): Epidemic Profile of Shiga-Toxin–Producing Escherichia coli O104:H4 Outbreak in Germany — Preliminary Report
    N. Engl. J. Med. 365 (19): 1771-1780. Epub June 22. doi: 10.1056/NEJMoa1106483. more

  • Wadl M, Rieck T, Nachtnebel M, Greutélaers B, an der Heiden M, Altmann D, Hellenbrand W, Faber M, Frank C, Schweickert B, Krause G, Benzler J, Eckmanns T on behalf of the HUS surveillance and laboratory team (2011): Enhanced surveillance during a large outbreak of bloody diarrhoea and haemolytic uraemic syndrome caused by Shiga toxin/verotoxin-producing Escherichia coli in Germany, May to June 2011
    Euro Surveill. 16 (24): pii=19893. more

  • Askar M, Faber M, Frank C, Bernard H, Gilsdorf A, Fruth A, Prager R, Höhle M, Suess T, Wadl M, Krause G, Stark K, Werber D (2011): Update on the ongoing outbreak of haemolytic uraemic syndrome due to Shiga toxin-producing Escherichia coli (STEC) serotype O104, Germany, May 2011
    Euro Surveill. 16 (22): pii=19883. more

  • Frank C, Faber M, Askar M, Bernard H, Fruth A, Gilsdorf A, Höhle M, Karch H, Krause G, Prager R, Spode A, Stark K, Werber D on behalf of the HUS investigation team (2011): Large and ongoing outbreak of haemolytic uraemic syndrome, Germany, May 2011
    Euro Surveill. 16 (21): pii=19878. more