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EHEC Outbreak in Germany:
      Lessons for Global Health

      One Health Summit
      Davos, Feb 21, 2012

      Alexander S. Kekulé, MD, PhD

IBS   Institute for Biosecurity Research, Halle
Northern Germany, May 2011:
      Mysterious Cases of Renal Failure

         15 cases of the rare
          "hemolytic-uremic
          syndrome" (HUS) in one
          week in a Hamburg
          hospital
         Caused by an unusual
          E. coli bacterium
         "Vegetables and salads"
          suspected as outbreak
          source


IBS
Panic in Germany


         Largest HUS/EHEC
          outbreak in history




                                                                   Source: Robert Koch Institute
         Mainly young adults,
           female > male
         Death count raises daily
         Source still unknown
         Sales for salads and
          vegetables plummeting

                                         HUS Incidence
                                     (cases per 100,000 persons)


IBS
"It's the Spanish Cucumbers!"




            Cornelia Prüfer-Storcks, Senator for Health,
                      Hamburg, May 26, 2011

IBS
Political and Economic
      Collateral Damage

         Russia bans EU
          vegetables
         Spain looses
          200 Mio. € in
          vegetable sales
         German Government
          under pressure by
          EU parliament

                              "Deadly germ comes from Spain!"



IBS
Some were amused…
      …others were not




      Spanish member of
           "Life or money!"
      EU parliament
      accuses German
      EHEC management
                              "Fits on every cucumber!"




IBS
"It's the sprouts!"



         Epidemiology
          pointed to a
          sprout producer
          in Lower Saxony
         But EHEC was
          never detected in
          that facility

                              Reinhard Burger, RKI
                                 June 10, 2011

IBS
The Bug: "EHEC O104:H4"


                              A mutated E. coli
      H                        of human origin
                              Shiga toxin
                               destroys kidneys
                               and brain
                              Adherence to
                               colon mucosa
                              Resistant to
           O                   many antibiotics


IBS
AAF/III

      A Deadly Mixture,
                                                                pAA
      Man-Made
                                                     EAEC Ec55989
                                                      (from Africa)
      Stx phage
                                       AAF/I



      stx2a                            pAA
                                                                 Inc-I
                                                              pEC_Bactec
                                             Inc-I

                                                             bla CTX-M15
                     STEC ("EHEC") O104:H4                    bla TEM-1
            Stx-2a


IBS
Food-borne Epidemic in the EU:
      Desperately Seeking the Source

       Unconnected
        cluster in
        Bordeaux
       EFSA, July 5:




                                                                       Data from ECDC, 2011
        It's Fenugreek
        seeds from
        Egypt!
       But the bug
        was never
        detected in       Bordeaux →
        seeds or
        sprouts
       It can happen
        again, any time
IBS                                    Cases (deaths) May 1 – July 4
How did we perform?

                 First alert




                                                               Data source: RKI
               Public + EWRS
                   (25.5.)
                                 EU expert
                               team in Berlin
                                   (6.6.)

                                                   EC import
                                                     stop on
                                      "It's the    fenugreek
                                      sprouts"    from Egypt
                                        (10.6.)     (6.7.)




IBS
Lessons for Global Health

       Even in the context of high medical standards,
        Germany and the EU were unable to stop a food-borne
        epidemic
       Infectious agents travel worldwide with people, animals,
        food and other goods
       Infections from remote parts of the world are
        particularly dangerous, since the population is
        immunologically naïve and doctors are clueless
       Unusual germs are also suitable for bioterrorist attacks
       The fight against diseases begins with health in the
        remotest and poorest regions of the world
       It is proposed to constitute a "Global Early Warning
        System for Infectious Diseases" under UN leadership
IBS
Thank you for your attention!

      Kekule@IBS-Halle.de




IBS   Institute for Biosecurity Research, Halle
EHEC Outbreak in Germany:
      Lessons for Global Health
      Alexander S. Kekulé, MD, PhD

       In 2011, Germany underwent the largest EHEC
        outbreak in history. Lethal bacteria were imported with
        seeds from Egypt.
       Even in the context of high medical standards,
        Germany and the EU were unable to stop the epidemic
       Infectious agents travel worldwide with people,
        animals, food and other goods
       Infections from remote parts of the world are
        particularly dangerous, since the population is
        immunologically naïve and doctors are clueless
       The fight against diseases begins with health in the
        remotest and poorest regions of the world
       The author proposes a "Global Early Warning System
IBS     for Infectious Diseases" under UN leadership

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EHEC Outbreak in Germany: Lessons for Global Health

  • 1. EHEC Outbreak in Germany: Lessons for Global Health One Health Summit Davos, Feb 21, 2012 Alexander S. Kekulé, MD, PhD IBS Institute for Biosecurity Research, Halle
  • 2. Northern Germany, May 2011: Mysterious Cases of Renal Failure  15 cases of the rare "hemolytic-uremic syndrome" (HUS) in one week in a Hamburg hospital  Caused by an unusual E. coli bacterium  "Vegetables and salads" suspected as outbreak source IBS
  • 3. Panic in Germany  Largest HUS/EHEC outbreak in history Source: Robert Koch Institute  Mainly young adults, female > male  Death count raises daily  Source still unknown  Sales for salads and vegetables plummeting HUS Incidence (cases per 100,000 persons) IBS
  • 4. "It's the Spanish Cucumbers!" Cornelia Prüfer-Storcks, Senator for Health, Hamburg, May 26, 2011 IBS
  • 5. Political and Economic Collateral Damage  Russia bans EU vegetables  Spain looses 200 Mio. € in vegetable sales  German Government under pressure by EU parliament "Deadly germ comes from Spain!" IBS
  • 6. Some were amused… …others were not Spanish member of "Life or money!" EU parliament accuses German EHEC management "Fits on every cucumber!" IBS
  • 7. "It's the sprouts!"  Epidemiology pointed to a sprout producer in Lower Saxony  But EHEC was never detected in that facility Reinhard Burger, RKI June 10, 2011 IBS
  • 8. The Bug: "EHEC O104:H4"  A mutated E. coli H of human origin  Shiga toxin destroys kidneys and brain  Adherence to colon mucosa  Resistant to O many antibiotics IBS
  • 9. AAF/III A Deadly Mixture, pAA Man-Made EAEC Ec55989 (from Africa) Stx phage AAF/I stx2a pAA Inc-I pEC_Bactec Inc-I bla CTX-M15 STEC ("EHEC") O104:H4 bla TEM-1 Stx-2a IBS
  • 10. Food-borne Epidemic in the EU: Desperately Seeking the Source  Unconnected cluster in Bordeaux  EFSA, July 5: Data from ECDC, 2011 It's Fenugreek seeds from Egypt!  But the bug was never detected in Bordeaux → seeds or sprouts  It can happen again, any time IBS Cases (deaths) May 1 – July 4
  • 11. How did we perform? First alert Data source: RKI Public + EWRS (25.5.) EU expert team in Berlin (6.6.) EC import stop on "It's the fenugreek sprouts" from Egypt (10.6.) (6.7.) IBS
  • 12. Lessons for Global Health  Even in the context of high medical standards, Germany and the EU were unable to stop a food-borne epidemic  Infectious agents travel worldwide with people, animals, food and other goods  Infections from remote parts of the world are particularly dangerous, since the population is immunologically naïve and doctors are clueless  Unusual germs are also suitable for bioterrorist attacks  The fight against diseases begins with health in the remotest and poorest regions of the world  It is proposed to constitute a "Global Early Warning System for Infectious Diseases" under UN leadership IBS
  • 13. Thank you for your attention! Kekule@IBS-Halle.de IBS Institute for Biosecurity Research, Halle
  • 14. EHEC Outbreak in Germany: Lessons for Global Health Alexander S. Kekulé, MD, PhD  In 2011, Germany underwent the largest EHEC outbreak in history. Lethal bacteria were imported with seeds from Egypt.  Even in the context of high medical standards, Germany and the EU were unable to stop the epidemic  Infectious agents travel worldwide with people, animals, food and other goods  Infections from remote parts of the world are particularly dangerous, since the population is immunologically naïve and doctors are clueless  The fight against diseases begins with health in the remotest and poorest regions of the world  The author proposes a "Global Early Warning System IBS for Infectious Diseases" under UN leadership