7 June 2011
New cases of enterohaemorrhagic E. coli (EHEC) causing haemolytic uraemic syndrome (HUS) continue to be reported from Germany. As of 6 June 2011, the Robert Koch Institute (www.rki.de) recorded 630 cases of HUS and an additional 1 601 cases of EHEC. The total number of officially reported deaths has risen to 22. Outside of Germany, travel-associated cases of HUS and EHEC have been detected throughout Europe and as far as the US.
We have not yet detected any suspected or laboratory-confirmed cases in South Africa; however, healthcare workers are requested to be on the look-out. Any person presenting with diarrhoea (which may be bloody) or HUS and a history of recent travel to Germany, or close contact with a visitor/returning traveller from Germany, should immediately seek medical attention. Healthcare workers are requested to report such cases to the NICD and obtain stool specimens for testing (as outlined in the NICD-NHLS May Special Communiqué).
Investigations into the cause of the outbreak are ongoing. Preliminary results from a case-control study suggest that raw tomatoes, cucumbers and/or leafy salad vegetables may have been the cause. Furthermore, trace-back investigations from affected restaurants suggest sprouts grown in the north of Germany may have been the major vehicle responsible for this outbreak. However, these reports are not yet substantiated and laboratory testing conducted on these foods have not yet identified EHEC O104. Our advice, therefore, remains the same. Travellers to Germany should refrain from eating raw/uncooked tomatoes, cucumber, lettuce and sprouts for the present time. Personal hygiene, including frequent hand washing, also plays an important role in the prevention of enteric infections.
The National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service,