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A novel strain of ''Escherichia coli'' O104:H4 bacteria caused a serious outbreak of foodborne illness focused in northern Germany in May through June 2011. The illness was characterized by bloody diarrhea, with a high frequency of serious complications, including hemolytic-uremic syndrome (HUS), a condition that requires urgent treatment. The outbreak was originally thought to have been caused by an enterohemorrhagic (EHEC) strain of ''E. coli'', but it was later shown to have been caused by an enteroaggregative E. coli (EAEC) strain that had acquired the genes to produce Shiga toxins, present in organic fenugreek sprouts. Epidemiological fieldwork suggested fresh vegetables were the source of infection. The agriculture minister of Lower Saxony identified an organic farm in Bienenbüttel, Lower Saxony, Germany, which produces a variety of sprouted foods, as the likely source of the ''E. coli'' outbreak. The farm was shut down.〔 Although laboratories in Lower Saxony did not detect the bacterium in produce, a laboratory in North Rhine-Westphalia later found the outbreak strain in a discarded package of sprouts from the suspect farm. A control investigation confirmed the farm as the source of the outbreak. On 30 June 2011, the German ''Bundesinstitut für Risikobewertung (BfR)'' (Federal Institute for Risk Assessment), an institute of the German Federal Ministry of Food, Agriculture and Consumer Protection, announced that seeds of organic〔(Outbreak of Shiga Toxin–Producing Escherichia coli O104:H4 Associated With Organic Fenugreek Sprouts, France, June 2011 ), Lisa A. King et al., Clinical Infectious Diseases Volume 54, Issue 11, pp. 1588-1594. Oxford Journals, 2012.〕 fenugreek imported from Egypt were likely the source of the outbreak. In all, 3,950 people were affected and 53 died, 51 of whom were in Germany. 800 people suffered hemolytic uremic syndrome (HUS), which can lead to kidney failure.〔(New insight from whole-genome sequencing of Europe's 2011 E. coli outbreaks ), Biotechnology, February 6, 2012.〕A handful of cases were reported in several other countries including Switzerland, Poland,〔 the Netherlands,〔 Sweden,〔 Denmark,〔 the UK,〔 Canada〔 and the USA.〔 Essentially all affected people had been in Germany or France shortly before becoming ill. Initially, German officials made incorrect statements on the likely origin and strain of ''Escherichia coli''.〔(【引用サイトリンク】title=EUROPEAN COMMISSION-Audio conference of the STEC OUTBREAK IN GERMANY )〕〔(RASFF Notification detail – 2011.0703 enterohaemorrhagic Escherichia coli in organic cucumbers from Spain )〕 The German health authorities, without results of ongoing tests, incorrectly linked the O104 serotype to cucumbers imported from Spain. Later, they recognised that Spanish greenhouses were not the source of the ''E. coli'' and cucumber samples did not contain the specific ''E. coli'' variant causing the outbreak.〔(【引用サイトリンク】title=EUROPEAN COMMISSION – HEALTH AND CONSUMERS DIRECTORATE GENERAL – 2 June 2011 )〕 Spain consequently expressed anger about having its produce linked with the deadly ''E. coli'' outbreak, which cost Spanish exporters US$200 million per week. Russia banned the import of all fresh vegetables from the European Union from early June until 22 June 2011. ==Origin== Beginning 2 May 2011, German health authorities reported the outbreak of bloody diarrhea accompanied by hemolytic-uremic syndrome (HUS). On 22 May 2011, German health authorities said, "Clearly, we are faced with an unusual situation", one day after the first death in Germany. ''Escherichia coli'' infection is common, infecting 800 to 1200 people a year in Germany, but is usually mild. Until 25 May it occurred in northwest Germany mostly. On 26 May, German health officials announced that cucumbers from Spain were identified as a source of the ''E. coli'' outbreak in Germany.〔(【引用サイトリンク】title=Deadly E. coli found in Spanish cucumbers – The Local )〕 On 27 May 2011, German officials issued an alert distributed to nearby countries, identifying organic cucumbers from Spain and withdrawing them from the market.〔 The European Commission on 27 May said the two Spanish greenhouses suspected to be the sources had been closed, and were being investigated.〔(Rapid Alert System for Food and Feed )〕 The investigation included analyzing soil and water samples from the greenhouses in question, located in the Andalusia region, with results expected by 1 June. Cucumber samples from the Andalusian greenhouses did not show ''E. coli'' contamination,〔(【引用サイトリンク】title=Efforts intensify to identify source of ''''E. coli''' outbreak in Germany as final tests clear Spanish cucumbers )〕〔(【引用サイトリンク】title=Ministry of Health Spain )〕 but cross-contamination during transport in Germany and distribution in Hamburg are not discounted; in fact, the most probable cause is cross-contamination inside Germany. The Robert Koch Institute advises against eating raw tomatoes, cucumbers, and lettuces in Germany to prevent further cases.〔(【引用サイトリンク】title=New epidemiological data corroborate existing recommendation on consumption by BfR )〕 On 31 May, an EU official said the transport chain was so long, the cucumbers from Spain could have been contaminated at any point along the transit route. Spanish officials said before, there was no proof that the outbreak originated in Spain; Spanish Secretary of State for European Affairs Diego López Garrido said, "you can't attribute the origin of this sickness to Spain."〔 On Tuesday 31 May, lab tests showed two of the four cucumbers examined did contain toxin-producing ''E. coli'' strains, most likely because of cross-contamination in Germany according to experts,〔 but not the O104 strain found in patients. The bacteria in the other two cucumbers have not yet been identified. Genomic sequencing by BGI Shenzhen confirm a 2001 finding that the O104:H4 serotype has some enteroaggregative ''E. coli'' (EAEC or EAggEC) properties, presumably acquired by horizontal gene transfer. The only previous documented case of EHEC O104:H4 was in South Korea in 2005, and researchers pointed at contaminated hamburgers as a possible cause.〔("A Case of Hemolytic Uremic Syndrome Caused by Escherichia coli O104:H4" ), Yonsei Medical Journal, Vol. 47, No. 3, pp. 437 – 439, 2006〕 On 4 June, German and EU officials had allegedly been examining data that indicated an open catering event at a restaurant in Lübeck, Germany, was a possible starting point of the ongoing deadly ''E. coli'' outbreak in Europe. German hospitals were nearly overwhelmed by the number of ''E. coli'' victims. A spokesman for the agriculture ministry in Lower Saxony, warned people on 5 June to stop eating local bean sprouts, as they had become the latest suspected cause of the ''E. coli'' outbreak. A farm in Bienenbuettel, Lower Saxony, was announced as the probable source, but on 6 June, officials said this could not be substantiated by tests. Of the 40 samples from the farm that were being examined, 23 had tested negative. But on 10 June, the head of the Robert Koch Institute confirmed the sprouts were the source of the outbreak, and people who ate the sprouts were nine times more likely to have bloody diarrhea. The WHO have confirmed on 10 June this statement on the update 13 of the EHEC outbreak. According to the head of the national ''E. coli'' lab at the German Federal Institute for Risk Assessment, the strain responsible for the outbreak has been circulating in Germany for 10 years, and in humans not cattle. He said it is likely to have gotten into food via human feces. A joint risk-assessment by EFSA/ECDC, issued 29 June 2011, made a connection between the German outbreak and a HUS outbreak in the Bordeaux area of France, first reported on 24 June, in which infection with ''E. coli'' O104:H4 has been confirmed in several patients. The assessment implicated fenugreek seeds imported from Egypt in 2009 and 2010, from which sprouts were grown, as a common source of both outbreaks, but cautioned, "there is still much uncertainty about whether this is truly the common cause of the infections", as tests on the seeds had not yet found any ''E. coli'' bacteria of the O104:H4 strain. The potentially contaminated seeds were widely distributed in Europe. Egypt, for its part, steadfastly denied it may have been the source of deadly ''E. coli'' strain, with the Minister of Agriculture calling speculations to that effect "sheer lies". Using epidemiological methods the outbreaks in 2011 were traced to a shipment of seeds from Egypt that arrived in Germany in December 2009.〔〔 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「2011 Germany E. coli O104:H4 outbreak」の詳細全文を読む スポンサード リンク
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