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.


  • Outbreaks like this are preventable and traceable, but smug Europeans assumed risk of catastrophic food poisoning applied only to emerging technology, only to things they feared because they knew they didn’t understand them. They embrace an altogether false sense of complacency about grubby old-fashioned methods and hypothetical food production concepts they mis-believe they understand perfectly. ‘This’ we fear, but ‘that’ couldn’t possibly happen here.
    And they were wrong, dead wrong. Disbelief may have played a roll in delayed reporting, smug disbelief. Doh!!
    “Europe’s vaunted ‘farm to fork’ labeling and traceability system, which increases consumer confidence by allowing end user freedom of choice, and tracking to quickly identify and remove from the system any problematic foods, is only applied to GM foods, for which there have never been any documented cases of harm.”
    Europeans have been swilling the organic KoolAide for so long they got believing their own BS, and it came around to bite them on the butt. No surprise, it always happens eventually. It will continue to happen here in the US, as well.
    The glaring void in FSMA gouged out by the Tester amendment will keep our risk high and speed the inevitable arrival of our own ‘unbelievable’ food poisoning catastrophe. Have we, like the Europeans, become too smug to prevent an embarrassing public safety gaff?

  • Gabrielle Meunier

    The US needs a unified database for food instake surveys. European Nations needs this as well. Could be so easy to do and speed up the pathogen determination greatly. We have PulseNet for PFGE analysis but the food surveys are done on a local level and dependent upon a reactive and competent State Health Depts. Not all states have this. This could be an easy fix. Call me!

  • patricia

    Does anyone remember… ‘the its tomatoes..oh no it peppers!’ These are not easy investigations for any country

  • JustTheFacts

    Sluggish reporting in Europe? Maybe…
    But even that is better than no reporting at all…
    Witness the latest machinations of the US produce industry…
    From today’s Marler blog:
    Is cutting government always a good idea?
    I get a lot of emails and comments, most saying things that I tend not to print. However, this email I got this morning is one of the more disturbing one I have received lately:
    There is a program run by USDA called the microbiological data program (MDP) (www.ams.usda.gov/mdp).
    This program collects fresh produce samples from distribution centers and terminal markets from key states across the US and test them for pathogens (salmonella and shiga toxin carrying e coli). The produce industry hates this program as it has found pathogens in domestic and imported samples and FDA has responded to the information and recalled products. The produce industry via the USDA Fruit and vegetable advisory committee recommended to USDA and congress that the program be terminated (http://www.ams.usda.gov/AMSv1.0/getfile?dDocName=STELPRDC5090885). Congress, yielding to industry pressure is going along with this

  • Lisa Bondeson

    I worked as a field epidemiologist for a Division of Infectious Disease at the state level. I can say without a doubt that providers do not report within the time limits specified by state law if at all. While I would hope that it would not take 16 days to be notified of an outbreak, it is certainly possible that an outbreak would be well under way by the time notification took place.