HAMBURG, Germany — To those hoping to know the cause of Europe’s mysterious E. coli epidemic, Tuesday brought only baffling news as German health officials announced that Spanish cucumbers were not the source of the outbreak. 

A few days ago, epidemiologists thought they had a promising lead when most of those sickened by enterohemorrhagic E. coli (EHEC ) had reported eating raw vegetables in the days preceding their illnesses. Suspicions were confirmed after four cucumbers, out of a random sample of vegetables from Hamburg markets, tested positive for E. coli; three of the cucumbers had been shipped from Spain. In fact, researchers were even able to pinpoint Almeria and Malaga as the regions of origin for the contaminated veggies.

But on Tuesday Hamburg’s health minister, Cornelia Prüfer-Storcks, revealed that bacteria found on two of the four cucumbers did not match the unusual O104:H4 outbreak strain that has claimed 17 lives and sickened more than 1,500 Europeans. Test results were still pending on the other two cucumbers.

In the meantime, while the investigation continues, German officials are continuing to warn consumers to avoid raw cucumbers, lettuce and tomatoes, in an attempt to stem the tide of infections until they can determine a source. Ideally, a specific food from a farm or company would be recalled, but right now public health authorities say they have no other option than to cast a wide net.

“The disturbing point here is that we still have not found the source,” said Stefan Willich, Head of the Institute for Social Medicine and Epidemiology at Hamburg University’s Medical Center, in an interview with Food Safety News. “That is usually the first task and the most important task, because if you have the source you can prevent effectively.”

Many fruit and vegetable vendors in Hamburg say that they know where their produce comes from — their own farms, or farms nearby — and that this local factor makes their food safe to eat, something they desperately try to convey to shoppers as fruit and vegetable sales plummet.

However, Prüfer-Storcks told Food Safety News she doesn’t think people should eat any red-flagged vegetables, even if they were grown locally.

“The protection of human life must be more important than economic interests,” Prüfer-Storcks said during a meeting with reporters.

Farmers are not convinced. Their stands are still brimming with cucumbers, tomatoes and lettuce from Germany, Italy and the Netherlands, vegetables they can’t sell.

“This is a catastrophe,” said one seller at Hamburg’s biggest outdoor market, which features only organic produce. The one-kilometer stretch of stands is usually bustling with buyers, residents say, but only a handful of stands had customers on Tuesday.

No vendors are even attempting to sell produce from Spain, whose vegetables have been shunned ever since the finger was first pointed at Spanish cucumbers as a possible cause of the outbreak.

“They were very fast to say, ‘Oh, it’s from Spain, Malaga,’ ” said David Salvatierra Martin, a Malagan resident vacationing in Hamburg. “I think they didn’t know [where the EHEC came from].” he told Food Safety News.

“There was no proof of this and so we will demand explanations from who has attributed this matter to Spain,” said Diego Lopez Garrido, Secretary of State for the European Union.

Many theories have arisen about how vegetables could have become contaminated, wherever they came from. Some think bacteria came from cow manure used as fertilizer. Others say cucumbers were accidentally dropped on the ground during transit.

“Every day, a new theory,” said Rico Schmidt of the Hamburg Health Ministry in an interview with Food Safety News. “But everyone is searching for someone so they can say, ‘Oh, it was not me,’ ” he said.

He says some have speculated about intentional poisoning, but neither Schmidt nor Prüfer-Storcks give credence to the possibility of bioterrorism.

Researchers at Germany’s Robert Koch Institute, who are leading the investigation, have not ruled out cucumbers as a possible source of the epidemic and are working quickly to find a definitive explanation for the outbreak as the situation grows more urgent.

From Monday to Tuesday morning alone, 80 more cases were confirmed to be part of the outbreak, according to Prüfer-Storcks. Hamburg is treating 110 patients critically ill with hemolytic uremic syndrome (HUS), 82 of whom are women. The European Centre for Disease Prevention and Control reported a total of 373 HUS patients, two thirds of them women. 

Why so many women are ill remains a puzzle. If the source is fresh produce, were they more likely to have eaten the vegetables or chopped and prepared them?

“We don’t know why women, particularly younger women, seem to be most vulnerable,” Willich said. “Maybe that has something to do with exposure. Maybe those women just tend to eat more salad than others.”

The aggressiveness of the pathogen is also shocking, he says.

“The case fatality is surprisingly high. Hospitals are loaded with hundreds and hundreds of patients, and that’s frightening.”

Schmidt says this is by far the most terrible event of his career.

“We had a lot more people with influenza two years ago,” he said, “but that was nothing compared to this. We have a lot of people dying.” 

“Five of these days take 15 years off my life,” he said, as the phone on his desk rang, rang again, and then again.

——————————

Photos by Gretchen Goetz