HAMBURG, Germany — Officials at the University Hospital in Gronigen, Netherlands got a call Tuesday from the Bremen hospital — just over the border in Germany — asking if they’d be willing to take on extra patients in the event Bremen cannot accommodate its growing number of hemolytic uremic syndrome (HUS) patients, those suffering the most serious effects of E. coli illness.  

“I said yes, of course,” Dr. Alex Friedrich, head of the Department of Medical Microbiology and Infection Control in Gronigen, told Food Safety News. “We are preparing ourselves because we are the largest hospital close to the German border.”

The fact that German hospitals — among the best-equipped on the continent — are putting international backup plans in place is a sign of how severe the E. coli O1404:H4 outbreak in Germany has become. And Bremen isn’t sure it will have enough dialysis machines if the number of HUS cases continues to rise.  

Friedrich says many of his colleagues are somewhat wary of the prospect of accepting outbreak victims from Germany. The EU has permitted inter-state patient transfer since January, but the current outbreak is testing this open-hospital-door policy, he says.

So far, 7 Dutch citizens are suspected to be part of the outbreak of this virulent strain of E. coli. Like the cases reported from outside Germany in Sweden, Denmark, France, the United Kingdom, Austria, Switzerland and Spain, all are thought to have contracted the bacteria in Northern Germany.

In the United States, the Centers for Disease Control and Prevention reported two HUS cases in people who had recently returned from Hamburg, but said it has no confirmed cases of the outbreak strain and “is working with state health departments to learn more about these two cases and identify others.”

While press reports Wednesday put the total number of those sickened in the outbreak at about 1,500 and the death toll at 17, Germany’s Robert Koch Institute (RKI) was only confirming 9 deaths. 

Friedrich is worried that next week those numbers will rise. Thursday is a holiday in the Netherlands, and many people will travel over this weekend, some to neighboring Germany. Although German authorities are advising against eating any lettuce, tomatoes or cucumbers, the source of infection still has not been identified. 

According to Friedrich, the startling statistics in this outbreak should serve as a wake-up call to routinely screen for shiga toxins, not only for E. coli O157:H7 but other poisonous strains of the bacteria such as O104:H4, the serotype identified in this outbreak. 

“You have to look at countries, and I think the U.S. is part of that, who strictly look in their routine diagnostics at the O157,” Friedrich said. “If you do that, you miss [non-O157s], and that means you are not prepared.” 

“It can happen. It will happen again in the future,” he says. “This is not the last story [E. coli O104] writes. He will come again. The question is, is Europe and is the world prepared for that? Have we done everything so that we can prevent as many outbreaks as possible?”

Friedrich applauded the RKI for posting on its website the Pulsed Field Gel Electrophoresis (PFGE) pattern of E. coli O104:H4, which makes it possible to distinguish this specific strain from other poisonous Shiga-toxin producing E. coli (STEC). This could help laboratories around the world more quickly identify the pathogen and stop its spread.

“Now we have the possibility to find the source, I believe,” Friedrich says.

The CDC says E. coli O104:H4 has never been seen before in the United States, and that it is aware of only a few reports of the strain from other countries. (There was a 1994 outbreak in Helena, Montana of serotype O104:H21, not O104:H4).

“Although it is rare, the United States’ public health surveillance systems are designed to be able to identify this, and other rare STEC strains, in ill people,” the CDC said in a media alert. But then the statement adds: “However, the ability to detect STEC infections through surveillance depends on proper diagnostic testing of patients presenting with symptoms …”


As Food Safety News gets ready to leave Germany, we extend a special thanks to residents of Hamburg, who have been generous with their time and patient in their explanations during an uncertain and overwhelming period. I would especially like to thank Andreas Arndt, without whom this series would not have been possible.