EHEC Outbreak 2011

From May to July 2011 there were many occurrences of illness in Germany with hemolytic-uremic syndrome (HUS) and bloody diarrhoea linked to an infection with enterohemorrhagic Escherichia coli (EHEC) of the serotype O104:H4. The outbreak affected all federal laender, but mainly those in northern Germany.

According to information provided by the Robert Koch Institute, almost 4,000 people were infected with EHEC during the outbreak in 2011 and 53 of them died as a result. This makes it the largest outbreak of disease through EHEC infections in Germany to date and, as far as the number of HUS cases is concerned, the largest outbreak of this kind ever described anywhere in the world. Even though it was not possible to produce microbiological evidence, fenugreek seed imported from Egypt and used to producing sprouts and shoots in a horticultural farm in Lower Saxony as well as by private persons are regarded as the cause of the EHEC outbreak in 2011. Where and how the seeds came into contact with the pathogen that caused the outbreak could not be determined, however.

Investigation into the EHEC Outbreak 2011

The BfR has given its comprehensive support to the epidemiological and microbiological outbreak investigations conducted by the federal and laender authorities.

By evaluating and comparing the delivery lists and distribution channels of consumed foods from 41 well-characterized outbreak clusters, it was possible to establish a connection to sprouts and shoots delivered from a horticultural farm in Lower Saxony. After infections with EHEC O104:H4 also occurred in France in June 2011, it was possible to further restrict the suspect food “sprouts”. The persons who were taken ill near Bordeaux had eaten sprouts that were produced in a French children’s hostel from three different seed varieties. Only fenugreek sprouts were contained in the sprout mixture consumed in France as well as the sprout mixtures in the horticultural farm in Lower Saxony associated with the outbreak clusters examined in Germany. In addition to this, cases of illness also occurred in Germany within the scope of the 2011 EHEC outbreak after the consumption of sprouts self-cultivated from fenugreek seeds of the same batch.

Further investigations on EU level have shown that a fenugreek seed batch produced in Egypt as far back as the winter of 2008/2009 is the only connection between the outbreaks of illness in Germany and France. Partial quantities of this fenugreek seed batch were used for sprout production in the horticultural farm in Lower Saxony, as well as the hostel in France. For the protection of consumers, the European Commission then ordered the recall and safe disposal of certain fenugreek seed batches from Egypt and imposed an import ban on fenugreek seeds and other plant-based foods from Egypt for a limited time period.

The risk of consumers contracting an EHEC infection after consuming raw sprouts produced from fenugreek seeds was considerably reduced through the recall and import ban, thus helping to contain the EHEC outbreak in 2011.

Recommendations for the consumption of sprouts and shoots

Fenugreek seeds purchased before October 2011 which are still in storage in private households should not be allowed to sprout under any circumstances. They should be disposed of precautionary along with the household refuse. Anyone who still wishes to eat them should only do so once they have been prepared as hot foods.

It is known from the investigation into previous outbreaks that the consumption of raw sprouts can lead to diseases such as salmonellosis. The reason for this is that the seeds used can already be contaminated with pathogens and that the cultivation conditions for sprouts and shoots (warmth and moisture) then favour the propagation of these pathogens.

Thorough washing of the sprouts is not sufficient to safely eliminate the pathogens, but they can be killed off by boiling or frying the sprouts. For this reason, it is recommended by way of precaution that people whose immune system is weakened or not fully developed (young children, pregnant women, old and sick people) only eat sprouts and shoots after they have been sufficiently heated.

BfR Risk Assessment of the EHEC Outbreak 2011

The BfR has evaluated the results of the outbreak investigation in three risk assessments and published them in the internet in the form of statements and press releases on the EHEC Outbreak 2011.

"BfR Scientific Journal 03/2012 "EHEC outbreak - Investigation of the Outbreak along the Food Chain" summarizes the results." PDF-File (6.3 MB)

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Opinion

 (11)
Date Title Size
23.11.2011
BfR Opinion No. 049/2011
EHEC Outbreak 2011: Updated Analysis as a Basis for Recommended Measures 166.6 KB
PDF-File
26.07.2011
Updated BfR Opinion No. 031/2011
Relevance of EHEC O104:H4 in fenugreek seeds which are processed into other foods than sprouts and germ buds 114.4 KB
PDF-File
05.07.2011
Updated BfR Opinion No. 023/2011
Relevance of sprouts and germ buds as well as seeds for sprouts production in the current EHEC O104:H4 outbreak event in May and June 2011 433.4 KB
PDF-File
01.07.2011
BfR Opinion No. 022/2011
High probability of responsibility of fenugreek seeds for EHEC O104:H4 outbreak 37.0 KB
PDF-File
18.06.2011
Opinion No. 021/2011 of BfR
EHEC: Observance of general hygiene rules is particularly important for the protection against infections 43.3 KB
PDF-File
07.06.2011
Opinion No. 019/2011 of BfR
Enterohaemorrhagic Escherichia coli (EHEC) O104:H4: a brief bacteriological intro-ductory profile 25.5 KB
PDF-File
06.06.2011
Opinion No. 018/2011 of BfR
Sprouts and germ buds as possible cause for the EHEC infections: BfR supports Lower Saxony at the clarification 36.5 KB
PDF-File
06.06.2011
Opinion No. 020/2011 of BfR
EHEC: What is the role of BfR in the current EHEC outbreak event? 42.6 KB
PDF-File
31.05.2011
Opinion No. 016/2011 of BfR
EHEC pathogen not yet typed: tomatoes, cucumbers and salads should nonetheless continue not to be consumed raw 29.2 KB
PDF-File
28.05.2011
BfR Opinion No. 015/2011, 26 May 2011
EHEC: Consumers to continue to refrain from eating tomatoes, cucumbers and green salads raw 29.1 KB
PDF-File
25.05.2011
Joint Opinion No. 014/2011 of BfR and RKI
Preliminary results of the EHEC/HUS Study 27.1 KB
PDF-File

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FAQ

 (2)
Date Title Size
15.06.2011
Updated BfR FAQ
Frequently Asked Questions on EHEC infections caused by vegetable foods 50.2 KB
PDF-File
31.08.2007
BfR FAQs
Frequently Asked Questions about EHEC 40.6 KB
PDF-File

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Press releases

 (12)
Date Title Keywords
07.08.2015
20/2015
Civil courts assess the recommendations made by the BfR in the EHEC crisis in 2011 as lawful EHEC - enterohemorrhagic Escherichia coli, zoonoses
23.12.2011
45/2011
EHEC outbreak 2011: summary from a risk assessment perspective EHEC - enterohemorrhagic Escherichia coli, zoonoses
29.11.2011
41/2011
EHEC outbreak 2011: Recommendations on the handling of sprouts EHEC - enterohemorrhagic Escherichia coli, zoonoses
21.07.2011
23/2011
EHEC: BfR, BVL and RKI issue specified consumption recommendations for uncooked sprouts and shoots (germ buds) EHEC - enterohemorrhagic Escherichia coli, zoonoses
05.07.2011
21/2011
EHEC O104:H4 outbreak event in Germany clarified: sprouts of fenugreek seeds imported from Egypt as underlying cause EHEC - enterohemorrhagic Escherichia coli, zoonoses
12.06.2011
18/2011
EHEC outbreak: BfR also advises against the consumption of home-grown raw sprouts and germ buds EHEC - enterohemorrhagic Escherichia coli, zoonoses
11.06.2011
17/2011
EHEC outbreak: BfR confirms contamination of sprouts with O104:H4 EHEC - enterohemorrhagic Escherichia coli, zoonoses
10.06.2011
16/2011
EHEC: Current State of Knowledge Concerning Illnesses in Humans EHEC - enterohemorrhagic Escherichia coli, zoonoses
09.06.2011
15/2011
Consumption Recommendations to protect consumers from EHEC EHEC - enterohemorrhagic Escherichia coli, zoonoses
03.06.2011
14/2011
New epidemiological data corroborate existing recommendation on consumption by BfR
01.06.2011
13/2011
EHEC germs on Spanish cucumbers do not correspond to the pathogen type of the patients concerned EHEC - enterohemorrhagic Escherichia coli, zoonoses
31.05.2011
12/2011
BfR and ANSES develop test system for the identification of EHEC contaminations in foods EHEC - enterohemorrhagic Escherichia coli, zoonoses

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Publikationen - BfR-Wissenschaft

 (1)
Date Title Size
15.05.2012
BfR-Wissenschaft 03/2012
EHEC Outbreak 2011 - Investigation of the Outbreak Along the Food Chain 6.3 MB
PDF-File

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