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Hamburg Grapples with Lethal E. coli Outbreak

HAMBURG, Germany — Here at the epicenter of an E. coli earthquake that has sent tremors through this country, as well as the rest of Europe, confusion is rampant as locals struggle to understand the nature of the pathogen, and just how dangerous it is.

GiveBlood - featured.jpgAlready, the numbers in this outbreak of enterohaemorrhagic E.coli, also known as EHEC, are staggering, and expected to get worse. On Monday Deutsche Presse Agentur said the outbreak had claimed 14 people’s lives. By Tuesday, press reports put the toll at 16, although German authorities have confirmed only six deaths.

As many as 1,200 are said to be sickened, with 373 in critical condition because of kidney-damaging hemolytic uremic syndrome (HUS).

“KillerBacteria: Chief of University Hamburg-Eppendorf University Hospital (UKE) warns of more deaths!” read the headline on Monday’s front page of Bild Hamburg, a tabloid-style newspaper with a wide following here. “E. coli Rages in Germany,” the article begins.

“We will lose young people,” another paper’s headline warned, quoting the Head of UKE, Jorg Debaten, although Debaten’s quote predicted only that Germany would lose more people, and did not specify age.

German authorities initially said some organic cucumbers from Spain were preliminarily found to be contaminated with the outbreak strain of E. coli O104, a rare serotype, and that a batch of cucumbers from either the Netherlands or Denmark was also under suspicion. But no one was able to explain how the implicated cucumbers, which were repacked in Germany, might have become contaminated.

On Tuesday, however, Hamburg’s health minister announced that Spanish cucumbers were likely not the cause of the outbreak after all, because bacteria found on the vegetables did not match the bacteria found in patients’ stool specimens.

Denmark health officials were saying tests they conducted on cucumbers found no evidence of E. coli, while Russia, Austria, Italy and other countries were nevertheless imposing various import restrictions on cucumbers as well other fresh vegetables.

Messages like these, including the German Health Ministry’s continued warning to avoid uncooked cucumbers, tomatoes or lettuce, prove confusing when juxtaposed with what’s being offered around Hamburg — lots of these verboten vegetables.

In my first full day here, I was served cucumbers twice — sliced into an omelet at breakfast, and then again boiled in a vegetable medley at dinner. While cooked cucumbers should be safe — heat kills bacteria — the ones served with my eggs had not been peeled and it wasn’t clear whether they had actually been cooked or tossed in at the end, raw.

When I asked the waiter (with the help of a translator) about the safety of the cucumbers, he replied that these were local and organic — and therefore not dangerous. While this might have been true, it didn’t persuade me to eat them.

Although many restaurants continue to put cucumbers on the table, grocery stores are a different matter.

At a large supermarket, cucumbers were noticeably absent from the produce section; however tomatoes and lettuce were available in every variety.

SmallHamburgGrocerStillSellingCukes-featured.jpgA smaller grocer was gamely trying to sell his local cucumbers, perching a smiley-faced, stuffed cartoon tomato near the cucumber box, but the vegetables were shriveling with age. Only one customer had bought cukes since the outbreak began, he told me, and most of his tomatoes and lettuces were also going untouched, much to his dismay.

“Everybody asks about these vegetables, and I tell them a lot about the product, but nobody buys,” he said. A survey published this weekend in the newspaper Bild am Sonntag validated that notion: 58 percent of Germans say they are not eating fresh cucumbers, raw tomatoes or salad.

This region is home to some of Europe’s most productive farms, and the produce business is being severely damaged by the E. coli outbreak and the lack of demand. “This is the time for fresh vegetables you don’t have to cook,” the greengrocer says. This season, however, it looks like stoves will see more action than salad bowls.

If the German public was somewhat slow to see the country’s worst-ever outbreak of EHEC as a pressing threat, Dr. Michael Straubaum, a local cardiologist, thinks that has changed. He says people are starting to understand how much of a danger the disease poses.

He says his own concern over the gravity of the outbreak is also rising.

“In the beginning, I was not so afraid. I said OK, so you get a disease. But now I see the inference for the kidney [HUS]. Now you better understand what’s behind it. I’m careful now,” he says.

Indeed it seems that many here are just now learning about E. coli and the risk it poses.

Before this outbreak, E. coli in Europe was relatively rare, and typically limited to smaller outbreaks, perhaps due in part to smaller scale, decentralized farming. But this extent of infection is wholly unfamiliar and its source still largely undetermined.

“Nobody knows what it is, where it comes from, or how to end it,” said the owner of the small grocery stand. This, he added, is what sets this scare apart from recent food safety issues in Europe, including earlier this year when feed contaminated with dioxin halted the sale of eggs, poultry and pork. But that scandal, as big as it was, posed no immediate threat to human health.

Now, as Germany struggles with the rapid spread and severity of the E. coli illnesses, hospitals are overwhelmed and no one knows if the outbreak has peaked. In a press release Sunday, the UKE hospital stated that it has enough blood for transfusions needed to treating HUS patients to last another few weeks, but is calling for people to donate blood to restore its depleted reserves.

EHECSchool1-featured.jpg

On Monday, a school in Hamburg shut down one of its classrooms after four of its 10th graders were confirmed to be infected with the outbreak strain of E. coli.

The school administrator at Gymnasium Othmarschen said officials closed only the affected students’ classroom, and would sanitize it thoroughly as they attempted to keep the rest of the school running normally, a task that proved extremely difficult with members of the press hovering around the school grounds with cameras.

The school’s news was noteworthy because it was one of the signs that in this outbreak, which so far has primarily affected adults, young people are vulnerable as well.

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Photos by Gretchen Goetz

© Food Safety News
  • Gene Grabowski

    Bill:
    Glad to see you made it to Germany. From your blog post, it sounds like the German people have put the E-coli scare in perspective and are addressing it without too much anxiety. In your view, is that because German society has a more sophisticated outlook or is the media much more restrained – or perhaps even naive – there?
    Cheers,
    Gene

  • Justice Plus

    Excerpted for the article: “Before this outbreak, E. coli in Europe was relatively rare, and typically limited to smaller outbreaks, perhaps due in part to smaller scale, decentralized farming.”
    Do the “smaller outbreaks from smaller scale decentralized farming” mean less people are sickened in Europe from food as compared to our industrial system or does it just mean a multiplicity of small scale outbreaks? Does anyone have the data?
    I’ve seen some data that would suggest that France’s hospitalization rate for food-borne illness rate per 1000 is about ¼ that of USA.

  • “We are disappointed by the way Germany handles the situation,” Aguilar said, citing in particular “very unfortunate” declarations of German public health authorities “which pointed at Spanish cucumber and Spain as the origin of this infection without having reliable data”.

  • Bacteria are mutating, keeping one step ahead of us. The necessity for vaccines for live animals becomes more pronounced, and must be pursued. We also need to develop other interventions for use at slaughter plants, if we want to stay ahead of the mutating bugs. FSIS should place low dose/low penetration “irradiation” of carcasses towards the top of its list. Such treatment does NOT use radioactive isotopes, but a mere electronic treatment which admittedly is not a kill step, but will lower the numbers of microbes. All our other existing interventions also lack a kill step, but are authorized because they act in tandem with each other to lower the numbers of pathogens.