The Germany-based E. coli O104:H4 epidemic is now the second-largest and most deadly on record.

Canadian press reported Monday afternoon that the E. coli O104:H4 outbreak has now sickened more than 2,330 people, most of them in Germany, over the past month. The first case has also shown up in Canada in an Ontario man who travelled to Germany this spring. Four cases have surfaced in the United States (one each in Wisconsin, Michigan and Massachusetts and one unnamed state); all recently returned from Germany.

As of Sunday morning the death toll remained at 22. There are 627 cases of hemolytic uremic syndrome, the complication that can cause kidney failure.

The rest of history’s large outbreaks of Shiga toxin-producing E. coli:

• 12,680 sickened in 1996 in Sakai, Japan from radish sprouts. Fukushima H, Hashizume T, Morita Y, Tanaka J, Azuma K, Mizumoto Y, Kaneno M, Matsuura MO, Konma K, and Kitani T. 1999. Clinical experiences in Sakai City Hospital during the massive outbreak of enterohemorrhagic Escherichia coli O157 infections in Sakai City, 1996. Pediatr Int 41:213-217.

• 2,300 sickened in 2000 in Walkerton, Canada from drinking water. Hrudey SE, Payment P, Huck PM, Gillham RW, and Hrudey EJ. 2003. A fatal waterborne disease epidemic in Walkerton, Ontario: comparison with other waterborne outbreaks in the developed world. Water Sci Technol 47:7-14.

• 1,000 sickened in 1999 in New York, USA from well water. Charatan F. 1999. New York outbreak of E. coli poisoning affects 1000 and kills two. Brit Med J 319:873.

• 788 sickened in 2000 in Wisconsin, USA from raw beef, cross contamination of other foods (Sizzler). Archer, John (personal communication). Epidemiologist, Wisconsin Division of Public Health, Bureau of Communicable Diseases and Preparedness, Communicable Disease Epidemiology Section.

• 700 sickened in 1992-93 in Western USA from hamburger at fast food restaurant (Jack in the Box). Bell BP, Goldoft M, Griffin PM, Davis MA, Gordon DC, Tarr PI, Bartleson CA, Lewis JH, Barrett TJ, Wells JG, and et al. 1994. A multistate outbreak of Escherichia coli O157:H7 associated bloody diarrhea and hemolytic uremic syndrome from hamburgers. The Washington experience. J Am Med Assoc 272:1349-1353.

• 633 sickened in 1995 in Fife, Scotland from sewage contamination of drinking water. IG and Roworth M. 1996. An outbreak of Escherichia coli O157 and campylobacteriosis associated with contamination of a drinking water supply. Public Health 110:277-282.

• 512 sickened in 1996-97 in Scotland from meat from one shop. Cowden JM, Ahmed S, Donaghy M, and Riley A. 2001. Epidemiological investigation of the Central Scotland outbreak of Escherichia coli O157 infection, November to December 1996. Epidemiol Infect 126:335-341.


• 503 sickened in 1996 in Scotland from lunch foods. Pennington H. 1998. Factors involved in recent outbreaks of Escherichia coli O157:H7 in Scotland and recommendations for its control. J Food Safety 18:383-391.


• 332 sickened in 1997 in UK from restaurant food. Anonymous. 1997. Escherichia coli O157 outbreak in Lincolnshire. CDR Weekly 7:101.

• 329 sickened in 1999 in Illinois, Kentucky and Missouri, USA from beef. Illinois Dept. of Health. 1999. Petersburg E. coli outbreak traced to beef.

Thanks to Human Illness Caused by E. coli O157:H7 from Food and Non-food Sources.  M. Ellin Doyle, John Archer, Charles W. Kaspar, and Ronald Weiss.