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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