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HPA - Update on E. coli O104 outbreak in Germany and cluster of cases in France

New cases of Haemolytic Uraemic Syndrome (HUS) and bloody diarrhoea (VTEC or EHEC infection, caused by E. coli O104) in Germany are continuing to decrease this week.

Since our last update on Thursday 23 June, the German authorities have reported 18 new cases of HUS, bringing the total to 841. A further 245 new cases of bloody diarrhoea were reported, bringing the total to 3,110. Five more deaths have been reported in Germany since last Thursday – one from HUS and four from bloody diarrhoea. The total number of deaths from the outbreak now stands at 48 – 31 from HUS (30 in Germany, one in Sweden) and 17 from bloody diarrhoea (all in Germany).

No new cases of bloody diarrhoea in the UK, potentially linked to the outbreak in Germany, have been reported to the HPA in the past two weeks. The total number of cases in the UK therefore remains at 17 – three HUS (all in England) and 14 bloody diarrhoea (13 cases in England, one in Scotland). To date, six of these have been microbiologically confirmed. All 17 cases are related to travel to Germany.

The German authorities reported that a mix of locally grown sprouted seeds containing were implicated as the cause of infection.

As reported by the HPA on Monday 27 June, a cluster of cases of E. coli O104 have been reported in France, with no recent travel to Germany. To date the French authorities have reported eight cases of HUS and eight cases of bloody diarrhoea, with no deaths. Four of these cases are confirmed E.coli O104 – the same strain that was seen in the outbreak in Germany. Nine of the cases reported having eaten sprouted seeds (fenugreek, mustard and rocket) at an event in the commune of Bègles near Bordeaux on 8 June. The seeds, which were sprouted for the event, had been purchased from a local garden centre, which had sourced them from a British company.

A joint statement between the European Food Safety Authority (EFSA) and the European Centre for Disease Prevention and Control (ECDC) states that preliminary information on the French HUS cluster and detailed information from the German outbreak investigations suggest that the consumption of sprouting seeds is the source of infection of E. coli O104 in Germany and France.

The Food Standards Agency is working with EFSA who is coordinating trace-back and trace-forward investigations at national and EU level to identify what commonalities exist between the sprouting seed production chains (distributor chains, distributors, retail outlets and suppliers) in Germany and France, So far, the consumption of sprouted fenugreek seeds has been implicated as a possible source of the outbreaks in Germany and France.

Until the investigation has been finalised, the FSA has advised that as a precaution, all sprouted seeds – such as alfalfa, mung beans (usually known as beansprouts) and fenugreek – should only be eaten if they have been cooked thoroughly until steaming hot throughout; they should not be eaten raw.

In addition, ECDC and EFSA strongly recommend consumers across Europe should not grow sprouted seeds for their own consumption.

The FSA has also advised that there is no evidence that seeds contaminated with this strain of E. coli which caused the outbreak in France or Germany are on sale in the UK.

To avoid infection with E. coli, the HPA recommends that, as always, people should follow normal hand hygiene procedures and anyone suffering from symptoms of bloody diarrhoea and vomiting should immediately contact their GP.

Notes to editors:
For information on food safety, visit the Food Standards Agency website:

To view the joint rapid risk assessment on the E. coli outbreak, visit: http://www.ecdc.europa.eu/en/publications/Publications/2011June29_RA_JOINT_

The HPA carries out surveillance of E. coli in England. Its guidance on avoiding E. coli infections is as follows:

  • Wash your hand thoroughly after using the toilet (or helping others including changing nappies), handling raw meat, before meals and after contact with animals.
  • Cooking all minced meat products (i.e. burgers, meatloaf, meat balls etc.) thoroughly, until the colour is the same all the way through, and no blood runs from them;
  • Ensure that refrigerators are working correctly, bacteria grow more quickly at temperatures over 4°C;
  • Only leave cooked foods, meat and dairy products out at room temperature for a short time;
  • Store uncooked meats below cooked meats and salad vegetables to avoid dripping juices onto ready to eat food;
  • Store uncooked and cooked meats on different plates, avoid all contact between raw and cooked meats;
  • Thoroughly wash all salad vegetables that will be eaten raw, do not prepare them with utensils that have also been used for raw meat;
  • Children and the elderly who are particularly susceptible to the severe effects of VTEC should avoid eating or drinking unpasteurised dairy products;
  • People who have been ill should not prepare food for others for at least 48 hours after they have recovered;
  • Boil any drinking water if you are unsure of it's source;
  • Do not swim in water that you think may be contaminated by cattle and sheep in nearby fields.

The National Travel Health Network and Centre (NaTHNaC) is funded by the HPA and healthcare professionals and members of the public can find more information about travel health, including country specific advice, by logging onto their website: www.nathnac.org

For more information about the situation in Germany, visit the Robert Koch Institute's website http://www.rki.de

For an updated Q&A on this topic, visit: http://www.hpa.org.uk/web/HPAweb&Page&HPAwebAutoListName/Page/1296687744200

For media enquiries please contact the national HPA press office at Colindale on 020 8327 7901 or email colindale-pressoffice@hpa.org.uk.. Out of hours the duty press office can be contacted on 020 8200 4400.