A critical appraisal of the 2011 E.coli outbreak of food poisoning in Germany
E. coli is an abbreviation that stands for Escherichia coli which is a rod shaped, facultative, Gram negative bacterium. This bacterium is very common in the lower intestines of warm blooded animals. Although not all types E.coli bacterium are harmful, there are some stains that are known to cause serious food poisoning in human beings. The harmless E.coli strains are components of normal flora and produce vitamin k2. Moreover, they are important to humans because they inhibit the growth of pathogenic bacteria in the intestines (Bill & Clark 2012:74). The gut flora is made up of 0.1% of E.coli and other related bacteria and is mainly transmitted through fecal-oral means. Many of E.coli cells can only survive for a short time outside the body making them good indicator organisms for testing environmental samples of fecal infection. However, recent research has discovered some strains of the E.coli bacteria that can survive for long periods of time outside the body.
The first case of E.coli outbreak in Germany was reported between May and June in 2011 and was largely concentrated in the northern parts of the country. According to German health officials, the foodborne illness was caused by a new strain of the E.coli bacteria known as O104:H4. The disease was mainly characterized by a number of complications like hemolytic-uremic syndrome (HUS) and bloody diarrhea (Lan & Reeves 2002:84). The high number of deaths was mainly caused by hemolytic-uremic syndromes which require quick treatment. Initially, the outbreak was believed to have been caused by a strain of E.coli known as enterohemorrhagic (EHEC) but future research found that the outbreak was in fact caused by enteroaggregative E. coli (EAEC). Moreover, this strain of E.coli was found to have the ability to produce Shiga toxins. Initial epidemiological research had suggested that vegetables were the main source of infection. More specifically, the German agricultural ministers identified one organic farm in Bienenbüttel as the most likely source of the infection. As a means of controlling the outbreak, the German government ordered for its immediate closure. Despite the fact that laboratories in Bienenbüttel did not detect the E.coli bacteria in produce, one laboratory in North Rhine-Westphalia later established that the outbreak strain was in fact present in packaged sprouts from the suspected farm. On June 30th 2011, fenugreek seed imported from Egypt were announced as the most likely source of the outbreak by the German Bundesinstitut für Risikobewertung (BfR) (Federal Institute for Risk Assessment (Todar 2012: 29). The German E.coli outbreak affected 3,950 people in total and caused 51 deaths in the country alone. Other countries that were affected by the outbreak include the United States, the Netherlands, the United Kingdom, Switzerland, Denmark, Poland and Canada (Bill & Clark 2012: 93). At the beginning of the E.coli outbreak, the German authorities claimed that the bacterium was most likely to have originated from Spain. Without carrying out any tests, the German health officials claimed that the O104 E.coli strain was most likely to have originated from cucumbers imported from Spain. However, future tests revealed that Spanish greenhouses were not the source of the E.coli strain responsible for the outbreak. This claim by the German officials provoked protests by the Spanish government because it made the country lose about 200 million USD per week in agricultural exports.
The 2011 E.coli outbreak in Germany was the worst ever recorded case of shiga toxin producing Escherichia Coli outbreak in the world. The outbreak started on May 8th and was declared over by the German health officials on July 4th the same year. The outbreak could have been more serious if the government did not alert the public to avoid consuming foods from areas suspected to be the likely source of the bacteria. In 2011, Germany encountered the biggest episode of Stec cases ever recorded: what added up to 3,842 cases were accounted for, incorporating 2,987 instances of research facility affirmed E. coli gastroenteritis with 18 passings and 855 instances of hemolytic uremic syndrome (Hus) that prompted 35 lethal conclusions (Lan & Reeves 2002:93). The episode began on May 8, topped on May 22, and was proclaimed fulfilled by July 4. One could contend that open health measures halted the pandemic by alarming individuals to maintain a strategic distance from the utilization of debased sustenance, yet it is likewise conceivable that the plague ceased on the grounds that polluted sustenances were no more present in the business sectors. The procedure has been openly scrutinized for being too moderate and for beginning false press advertisements joining cucumbers and not sprouts to the episode. Reflectively, this feedback must be seen with some control. In the beginning of the episode, the average reporting times for Hus cases were 8 days to analysis, in the ballpark of 10 days to illuminate the nearby health section, and around the range of 12 days for showing up for the Robert Koch Institute (Rki) (3). In a U.S. study on E. coli O157 contaminations, a normal reporting time of 7 days was attained. There are two purposes behind the slower reporting process in Germany (Ihssen et al 2010:83) Germany has a less-brought together open health framework, and these cases introduced with an abnormal profile, facing medical practitioners with another clinical substance. An early epidemiological examination comprised of a case-control study including 26 mature people hospitalized with Hus. Univariate dissection connected just the utilization of sprouts with sickness. Notwithstanding, no sprout cautioning was issued at the start of the episode, since stand out quarter of the patients recalled having depleted sprouts. Next was an accomplice investigation of 177 subjects who had consumed at a solitary restaurant, prompting 33 instances of affirmed Stec the runs. As per the restaurant formula, every one of the 31 cases that could be questioned had depleted uncooked sprouts. An arrangement of natural and follow back and follow send examinations by the German assignment gathering recognized an assembly of Swedish guests who had depleted a sprout mixture. This finding indicated a sprout maker in easier Saxony, Germany, where in May one-third of the workers fell sick, with some of them contaminated with the pestilence strain O104:h4 (Lan & Reeves 2002:102). The following pieces in this perplex were the wholesalers served by this grow maker, joining further groups to sprouts. Strikingly, the German sprout maker had a seed supplier that could be joined to 15 instances of O104:h4 contaminations in Bordeaux, France. These cases were clearly additionally connected with sprout utilization. The beat field gel electrophoresis example of the French disconnects was indistinguishable to that from the German flare-up however unique in relation to those of preoutbreak reference O104 strains, prescribing a solitary source clonal episode, predictable with the epidemiological confirmation. On 10 June, sprouts of fenugreek seeds foreign made from Egypt were declared by the German powers as the offender wellspring of sullying in this episode. On the other hand, none of the sprout mixtures (seeds) tried positive for O104:h4.
The force of the study of disease transmission contrasted and a microbiological methodology was highlighted by the failure to develop the scourge strain from any of the examined sprouts or from the sprout seeds which were taken from the handling chain. Growth of the strain was just conceivable in a couple of situations where back defilement was quite likely, for example, an opened bundle of sprouts from a family unit with illness. Because of the practically all around utilized society based identification routines for plagues, this disappointment speaks to an observation issue for health and sustenance security dominant voices as a rule. The issue could be brought on by the low irresistible measurements of the pathogen, its rot in nourishment at the minute of examination, or a particular physiological state of microbes characterized as suitable however nonculturable (VBNC). Numerous diverse bacterial species, incorporating E. coli, enter this Vbnc state as a reaction to distressing ecological conditions (Ihssen et al 2010:125). Microbes in the Vbnc state don’t develop on microbiological media however recapture cultivability when revived after stretch alleviation. In fact, O104:h4 entered this Vbnc state when presented to supplement poor conditions, poisonous amassings of copper particles, or faucet water. Soothing the anxiety by copper particle chelating encouraged the revival of O104:h4. Be that as it may, these trials ought to be translated with forethought, since there is so far no immediate confirm that E.coli O104:h4 is found in the VBNC state in nature.
The epidemiological investigation of first fundamentally sustenance borne tainting gets to be much more troublesome when the starting pathogen transmission by means of the evolved way of life is traded by human-to-human transmission. Human-to-human transmission is known to happen in the ballpark of 20% of families with an O157:h7 essential patient. Optional family transmission from mature person patients was likewise prescribed for O104:h4 contaminations in France and The Netherlands, fundamentally dependent upon the perception of deferred onset contrasted with the brooding time of 7 to 9 days for O104:h4 contaminations. Optional transmissions were additionally reported in Hessen, Germany, which is arranged outside of the primary plague center in northern Germany (Todar 2012:38). The study recorded transmission in families, the healing facility, and the microbiological research center.
Health officials in Germany faced a lot of difficulties in isolating the causative organism mainly due to its versatile nature. Based on the investigations carried out during the German epidemic, there are two major distinct pathotypes of the E.coli bacteria namely enteroaggregative E.coli (EAEC and enterohemorrhagic (EHEC) E.coli. It becomes even more difficult to control the E.coli bacteria if the virulence genes are located in the mobile elements of the DNA. Based on this, E. coli outbreaks in Germany, Oregon and Michigan are not the last. This calls for the microbiological community to carryout more research and ensure that the E.coli strains are sequenced on time and in an open way (Peter et al 2011:84). In Germany, the annotation of the E.coli strain responsible for the outbreak was carried out in a community-wide approach through the use of the internet. It brought together bioinformaticians from all corners of the world working day and night to sequence the genomes. Some of the international health organizations that were involved in handling the outbreak were the European Center for Disease Prevention and Control (ECDC) and the world health organization (WHO). The main role of a UK Local Authority based Environmental Health Practitioner would have been control the spread of the bacteria by isolating all infected animals and farm produce.
Lessons from the 2011 E.coli outbreak in Germany
There are a number of lessons that can be learnt from the 2011 E. coli outbreak in Germany. To begin with, there is need to come up with more safe ways of growing foods especially fruits and vegetables. The investigations into the cause of the 2011 E. coli outbreak established the presence of certain strains of the bacteria in a number of vegetables and not on sprouts alone. This raised the question of E. coli prevalence in the European fresh produce (Russo 2003:4). The second lesson that can be learnt from the 2011 E. coli outbreak in Germany is the need for better communication incase any harmful bacteria are found in foods. After the E. coli outbreak, the German government came under a lot of criticism for taking too long to announce the outbreak. The government took too long before it took the report to the Roberth Koch Institute (RKI) (Todar 2012:83). Many of the infections and deaths that resulted from the outbreak could have been avoided had the government warned the people on time. Based on this, it is important for governments all over the world to have an efficient E.coli surveillance and warning system. The final lesson that can be learnt from the E.coli epidemic in Germany is the need to ensure food safety both nationally and internationally. Despite the fact that the 2011 epidemic was concentrated in one area, it had global impacts. According to investigations, the sprout seeds found in the implicated farm were found to have originated from Asia, southern Europe and Germany. It is important for countries to raise food safety standards mostly in free markets like the European Union.
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