HAMBURG, Germany — The E. coli outbreak in northern Germany that has taken the lives of 14 people — and captured the attention of health officials around the world — does not appear to be causing concern everywhere in Europe.
Cucumbers were still a regular part of the fresh vegetable selection on French food stands this weekend, despite an announcement Saturday from the ministries of economy, health and agriculture that 3 cases of E. coli infection are being investigated in France.
These investigations come as cucumbers and other fresh produce have been recalled in Germany and elsewhere in Europe following an epidemic of E. coli illnesses. The European Union has warned that contaminated vegetables– thought to originate on two farms in Spain and possibly from the Netherlands or Denmark — may have been sent to other European countries, including the Czech Republic, Denmark, Austria, Luxembourg and Hungary.
Food Safety News snapped this shot of a curbside grocery stand in Nice, France, where the two remaining cucumbers suggested people weren’t shying away from this vegetable.
But while cucumbers remain bountiful in France, they are noticeably absent in Hamburg.
One waitress told me her restaurant used to offer cucumbers on its green salad, but the raw vegetable has been removed from the dinner options, along with a cucumber salad normally served with the veal dish.
The only cucumbers still on the menu were boiled ones, which are not considered a threat because high heats kill E. coli bacteria.
“We’re supposed to post notifications warning about cucumbers,” the waitress told me, although signs had not yet been put up.
Indeed, even in this city, ground zero of the outbreak, the possibility of contaminated cucumbers worries some, but not others.
A couple at the same restaurant told me the wife had been served cucumbers with her salad, and that she sent the dish back. “She calls them the ‘killer cucumbers,’ ” the husband, an American, told me.
Although his German wife is concerned about her health — a legitimate fear considering that the majority of hemolytic uremic syndrome (HUS) victims have been women — she says her friend in the UK doesn’t even know about the disease and its dangers.
Anyone who reads the newspaper in Germany, however, cannot help but know what’s going on. Welt am Sonntag carried a two-page spread with the headline — “Die EHEC – Epedimie halt Deutschland in Atem,” in other words, “Germany is holding its breath.”
For an outbreak that has caused more devastation than the infamous 1993 Jack in the Box E. Coli outbreak in the U.S., and whose victim count is still on the rise, however, the reaction to this news on the continent seems mixed thus far.
“Is it really that much of a danger?” asked the first person I encountered in Hamburg when I told her I had come to learn more about the outbreak.
Another man suggested I find out whether everything being reported about how dangerous the outbreak is is really true.
While there are indeed many facts still unknown, including whether the outbreak was caused by cucumbers, how the cucumbers became contaminated or why the pathogen is predominantly affecting women, there’s no question about the level of devastation.
As German health authorities try to get a handle on the size, scope and source of the outbreak, here’s what is being reported so far:
Numbers: As many as 1,200 people have been sickened in Germany, and E. coli infections linked to the outbreak have been reported in Austria, France, Sweden, Denmark, Britain, Switzerland and the Netherlands; but nearly all of the case patients outside Germany seem to have visited the country recently, and fell ill after returning home. There have been no reports of infections linked to the outbreak in Spain.
The European Centre for Disease Prevention and Control’s May 27 update said exposure to the outbreak has, so far, been limited to Germany. The ECDC said it continues to monitor the outbreak in collaboration with the member states, the European Food Safety Authority (EFSA), the European Commission and World Health Organization (WHO).
Of those who have become infected, 329 in Germany have developed HUS, a severe, life-threatening complication of E. coli infection that can cause kidney failure. This is the largest number of HUS ever associated with an outbreak in Germany and possibly a record number worldwide, according to the online journal Eurosurveillance.
The strain: HUS disease in Germany and elsewhere is generally associated with E. coli O157 strains, so the identification of this serotype O104 “is highly unusual,” according to WHO. E. coli O104 has previously been described only once before — as the cause of an outbreak in Helena, Montana in 1994.
A three-day old Eurosurveillance report acknowledges that whether E. coli O104 is to blame for the entire outbreak in Germany still needs to be confirmed by analysis of a greater number of isolates.
Hospitals: Many patients with severe abdominal cramping and bloody diarrhea, toxic E. coli’s classic symptoms, need to be admitted to hospital for intravenous rehydration and pain control. If they develop HUS, they typically require intensive care with dialysis and/or plasmapheresis.
Hospital staffs and resources are said to be overwhelmed, especially in northern Germany. Hospitals in Hamburg, where more than 467 people are believed to have been infected with E, coli, are said to be so taxed they are sending patients elsewhere. A spokesman for the university hospital in nearby Luebeck, where some 20 suspected HUS cases were being treated, told one newspaper that staff there were “close to exhaustion.”
Death toll: The first two deaths linked to the outbreak were a woman in her 80s and one in her 20s. But eight other fatalities are suspected to be caused by HUS. The latest victims: three women in their 80s, a fourth in her 30s and a 91-year-old woman.
Food source: On Friday, the European Commission said organic cucumbers from Almeria and Malaga in Spain were confirmed as one source of the outbreak of enterohemorrhagic E. coli (EHEC). But the commission also said a batch of cucumbers origninating in the Netherland or Denmark, and shipped to Germany, was under suspicion.
The government is still recommending that people avoid eating raw tomatoes, cucumbers and leafy salads, especially in northern Germany, until further notice. ”Until experts in Germany and Spain are able to positively identify the source of the pathogen, general warnings about vegetables remain valid,” Consumer Minister Ilse Aiger told the Bild am Sonntag newspaper.
Recalls: Austria has ordered the recall of organic cucumbers, tomatoes and eggplant grown in Spain and shipped through Germany. The Czech Republic ordered a recall of cucumbers grown in Spain. Denmark told two wholesalers, including the big Mango Frugt company, to recall cucumbers from Spain. A report in the Fyns Times said 1,500 school children attending a festival last week ate cucumbers supplied by Mango Frugt, which sells both Danish-grown and imported cucumbers. Tests on cukes sold by the Funen-based company should be available Tuesday, according to the