Early doctors’ reports of E. coli poisoning in northern Germany took as long as 16 days to wend their way up the government system and alert national health authorities, seriously delaying the government’s response to the deadly outbreak.
That’s the conclusion of a report posted Thursday by a team of health authorities from the Robert Koch Institute (RKI) and other German health agencies, which declared that their routine surveillance system “was not sufficient for an adequate response.”
As of Thursday, 3,406 people, most of them adult Germans, had been sickened with the rare E. coli O104:H4 strain, 826 of them with a severe complication called hemolytic uremic syndrome (HUS). The death toll reached 39, already a record for known E. coli epidemics.
The staggering number of illnesses and deaths, now attributed to sprouts from a German farm, has confounded public health authorities in the U.S., who have openly questioned Germany’s response to the crisis.
“A lot of what I see coming out of Germany doesn’t make a lot of sense,” said Dr. John Kobayashi, a respected epidemiologist at the University of Washington in Seattle. “My impression has been that the German states are independent and the central government is very weak. It all seems backwards.”
That judgment appears to be borne out by the report released online on the Eurosurveillance website, which tracks issues in European epidemiology.
Although people began to get sick on May 1, it was May 19 before the RKI learned of a cluster of seriously ill HUS patients, the report says.
In the meantime, contaminated sprouts continued to be served and consumed across northern Germany, sickening thousands more people.
The report says German physicians and labs who diagnose E. coli and HUS illnesses are required to notify health authorities within 24 hours. However, it can be a week before that information is passed along to state officials, and potentially another week before it is reported to federal authorities at the RKI.
So “transferring information on a case from the local to the national health authority may take from a few days up to 16 days,” the report says.
The government reporting and response were slow despite an attempt in the late 1990s to improve Germany’s response to foodborne illness and other diseases. A report published by the U.S. Centers for Disease Control and Prevention in 2000 pointed out that the RKI had a strong tradition for dealing with infectious diseases during the 19th and early 20th centururies. But that tradition disappeared under the Nazis in the 1930s and 1940s.
In postwar decades, primary responsibility for public health resided with the 16 state governments and 420 local governments, while the federal RKI focused on basic research.
That began to change in the 1990s, when health authorities struggled to respond to the AIDS crisis. The CDC helped train German health officials in basic epidemiology, including response to foodborne illness outbreaks.
But the response to Germany’s horrendous E. coli outbreak suggests that public health agencies have a ways to go.
Slow reporting meant more people were sickened, while chances of tracking the source diminished as contaminated food was either consumed or discarded. Meanwhile, U.S. epidemiologists have speculated that the Germans, when they did respond, focused their efforts on high-tech genome sequencing of bacteria on suspect vegetables, rather than on more mundane tactics — especially interviews with patients and their families.
As a result, they wasted precious time pursuing a theory that the epidemic was caused by contaminated cucumbers, lettuce and tomatoes, critics have said.
“It sounded like: We think it’s cucumbers … Well, maybe it’s lettuce … Or, no, it’s cucumbers, or not cucumbers,” Dr. Kobayashi recalled. “I don’t know what they were doing.”
The Eurosurveillance report concludes that Germany’s shortcomings can be overcome with timely electronic notification of a central database, which would have alerted federal authorities far more quickly to Germany’s epidemic.
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