The E. coli outbreak that has sickened thousands in Europe has become the deadliest on record, killing at least 18 people.
Another 1,823 cases have been reported, according to the World Health Organization in Geneva. The number of reported cases is based on hospital records, and the actual number may be 10 or more times higher.
The strain circulating in Germany and 10 other European countries produces a toxin not usually seen in E. coli that can damage the kidneys and other organs. Germany alone has reported 520 cases of the kidney ailment, and officials advised against eating raw tomatoes, cucumbers and leafy salads.
The following questions and answers are from Bloomberg News interviews with experts in public health, infectious disease and emerging diseases, and from official websites of the World Health Organization, the U.S. Centers for Disease Control and Prevention in Atlanta, the European Center for Disease Control and Prevention, the U.S. National Institutes of Health in Bethesda, and the Robert Koch Institute, the German health authority.
Q: What is E. coli? What is EHEC? What is HUS?
A: Escherichia coli is a type of bacteria that normally lives in the intestines. Most varieties are harmless. A few strains can cause bloody diarrhea, abdominal cramps and kidney failure. Symptoms vary, and may be mild.
The type of E. coli that causes bloody diarrhea is called enterohemorrhagic E. coli, or EHEC. That can develop into a life-threatening disease, hemolytic uremic syndrome, or HUS, which causes kidney damage. The death rate from HUS is about 3 percent to 5 percent.
The strain causing the German outbreak has caused sporadic disease in the past, but hasn’t been known previously to cause outbreaks.
Q: When was the last outbreak?
A: There are outbreaks every year around the world. The world’s biggest recorded outbreak occurred in 1996 in Japan, where over 10,000 people were infected.
Q: How many countries are involved?
A: So far, 11 in addition to Germany. They are Austria, the Czech Republic, Denmark, France, the Netherlands, Norway, Spain, Sweden, Switzerland, the United Kingdom and the United States of America. Most of these are people who have recently visited northern Germany. One case was in a person who had contact with a visitor from northern Germany who had an EHEC case.
Q: Can E. coli transmit from person to person?
A: Sometimes there is person-to-person transmission. Usually E. coli is transmitted when feces, often from an animal source, are ingested. Person-to-person transmission can occur when people with diarrhea don’t wash their hands properly, and come into contact with others who don’t wash their hands before eating.
Q: How many people are sick?
A: We don’t know. The U.S. Centers for Disease Control and Prevention says the number of HUS cases suggest the outbreak is “very large.” It’s too early to know why so many are sick, although a popular food item may be contaminated, or the strain may be especially likely to cause complications.
As of June 3, 520 people had HUS, and 11 died; 1,215 people had EHEC, and 6 died in Germany. That’s a total of 1,733 cases, with 17 dead. Globally, 552 cases of HUS have occurred, and 12 have died and 1,271 people have been sickened, with 6 who’ve died.
In addition, symptoms don’t appear until 3 to 4 days after infection.
Q: If E. coli comes from meat, how does it get into vegetables?
A: In a 2006 California outbreak, spinach was contaminated with E. coli, killing 3 people and sickening 200. Cow feces had contaminated the water where the vegetables were growing.
Q: Why are women and children severely sick more often?
A: Children under the age of 5 years old and the elderly are most likely to have serious complications. An unusual number of healthy adults have been seriously sick as well.
Women seem to be getting sick more often because they eat more vegetables, and are more likely to be exposed.
Q: What is the treatment for E. coli infection?
A: Antibiotic therapy isn’t helpful and may even make E. coli worse. Patients are given fluids. Anti-diarrheal agents aren’t recommended as they may also worsen the disease.
Q. How do you prevent infection?
A: The source of the contamination is still unknown. German officials and the U.K.’s Health Protection Agency are telling people to avoid eating raw tomatoes, cucumbers and leafy salads until further notice.
To prevent E. coli, avoid raw meat. Cook meat to at least 160 degrees Fahrenheit (71 Celsius) at its thickest point. Stay clear of unpasteurized milk, juice and cider, and wash produce thoroughly. Follow any government recommendations to shun certain foods. To avoid contamination, wash utensils before and after they come in contact with food, and keep raw foods separate. People should wash their hands after preparing food, eating, using the bathroom and changing diapers.
Q: How did WHO learn about the outbreak? What is being done?
A: All countries are requested to inform WHO of any public health event “of international concern,” and Germany notified WHO on May 22.
Germany and other affected countries are investigating the outbreak by interviewing patients about what foods they’ve eaten, analyzing the food and analyzing the microbe. WHO is monitoring the situation and working to assist the German health authorities. WHO doesn’t recommend restrictions on travel or trade with Germany.