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Epidemic profile of Shiga-toxin-producing Escherichia coli O104:H4 outbreak in Germany.
N Engl J Med. 2011 Nov 10; 365(19):1771-80.NEJM

Abstract

BACKGROUND

We describe an outbreak of gastroenteritis and the hemolytic-uremic syndrome caused by Shiga-toxin-producing Escherichia coli in Germany in May, June, and July, 2011. The consumption of sprouts was identified as the most likely vehicle of infection.

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 (HUMC). 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 during the period from May 1 through July 4, 2011, in Germany.

RESULTS

A total of 3816 cases (including 54 deaths) were reported in Germany, 845 of which (22%) involved the hemolytic-uremic syndrome. The outbreak was centered in northern Germany and peaked around May 21 to 22. Most of the patients in whom the hemolytic-uremic syndrome developed were adults (88%; median age, 42 years), and women were overrepresented (68%). The estimated median incubation period was 8 days, with a median of 5 days from the onset of diarrhea to the development of the hemolytic-uremic syndrome. Among 59 patients prospectively followed at HUMC, the hemolytic-uremic syndrome developed in 12 (20%), with no significant differences according 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 outbreak, caused by an unusual E. coli strain, cases of the hemolytic-uremic syndrome occurred predominantly in adults, with a preponderance of cases occurring in women. The hemolytic-uremic syndrome developed in more than 20% of the identified cases.

Authors+Show Affiliations

Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21696328

Citation

Frank, Christina, et al. "Epidemic Profile of Shiga-toxin-producing Escherichia Coli O104:H4 Outbreak in Germany." The New England Journal of Medicine, vol. 365, no. 19, 2011, pp. 1771-80.
Frank C, Werber D, Cramer JP, et al. Epidemic profile of Shiga-toxin-producing Escherichia coli O104:H4 outbreak in Germany. N Engl J Med. 2011;365(19):1771-80.
Frank, C., Werber, D., Cramer, J. P., Askar, M., Faber, M., an der Heiden, M., Bernard, H., Fruth, A., Prager, R., Spode, A., Wadl, M., Zoufaly, A., Jordan, S., Kemper, M. J., Follin, P., Müller, L., King, L. A., Rosner, B., Buchholz, U., ... Krause, G. (2011). Epidemic profile of Shiga-toxin-producing Escherichia coli O104:H4 outbreak in Germany. The New England Journal of Medicine, 365(19), 1771-80. https://doi.org/10.1056/NEJMoa1106483
Frank C, et al. Epidemic Profile of Shiga-toxin-producing Escherichia Coli O104:H4 Outbreak in Germany. N Engl J Med. 2011 Nov 10;365(19):1771-80. PubMed PMID: 21696328.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Epidemic profile of Shiga-toxin-producing Escherichia coli O104:H4 outbreak in Germany. AU - Frank,Christina, AU - Werber,Dirk, AU - Cramer,Jakob P, AU - Askar,Mona, AU - Faber,Mirko, AU - an der Heiden,Matthias, AU - Bernard,Helen, AU - Fruth,Angelika, AU - Prager,Rita, AU - Spode,Anke, AU - Wadl,Maria, AU - Zoufaly,Alexander, AU - Jordan,Sabine, AU - Kemper,Markus J, AU - Follin,Per, AU - Müller,Luise, AU - King,Lisa A, AU - Rosner,Bettina, AU - Buchholz,Udo, AU - Stark,Klaus, AU - Krause,Gérard, AU - ,, Y1 - 2011/06/22/ PY - 2011/6/24/entrez PY - 2011/6/24/pubmed PY - 2011/12/13/medline SP - 1771 EP - 80 JF - The New England journal of medicine JO - N Engl J Med VL - 365 IS - 19 N2 - BACKGROUND: We describe an outbreak of gastroenteritis and the hemolytic-uremic syndrome caused by Shiga-toxin-producing Escherichia coli in Germany in May, June, and July, 2011. The consumption of sprouts was identified as the most likely vehicle of infection. 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 (HUMC). 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 during the period from May 1 through July 4, 2011, in Germany. RESULTS: A total of 3816 cases (including 54 deaths) were reported in Germany, 845 of which (22%) involved the hemolytic-uremic syndrome. The outbreak was centered in northern Germany and peaked around May 21 to 22. Most of the patients in whom the hemolytic-uremic syndrome developed were adults (88%; median age, 42 years), and women were overrepresented (68%). The estimated median incubation period was 8 days, with a median of 5 days from the onset of diarrhea to the development of the hemolytic-uremic syndrome. Among 59 patients prospectively followed at HUMC, the hemolytic-uremic syndrome developed in 12 (20%), with no significant differences according 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 outbreak, caused by an unusual E. coli strain, cases of the hemolytic-uremic syndrome occurred predominantly in adults, with a preponderance of cases occurring in women. The hemolytic-uremic syndrome developed in more than 20% of the identified cases. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/21696328/full_citation L2 - https://www.nejm.org/doi/10.1056/NEJMoa1106483?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -