E coli

The E Coli O104:H4 outbreak in Germany – are there lessons to be learnt?

With every foodborne outbreak, there are always lessons to be learnt. Dr Lucia Anelich of Anelich Consulting, one of SA’s foremost micriobology and food safety authorities, writes that this devastating outbreak – 49 fatalities and 4 178 people sickened – underscores a number of issues, and at the same time, gives us cause to pause and to reflect upon our own systems in South Africa, both at national and local authority level, as well as at the level of the food industry.

Since May, Germany has been the focus of one the largest and most severe outbreaks in the world of haemolytic uremic syndrome (HUS). 

On May 19, 2011, the Robert Koch Institute, Germany’s public health authority at national level, was informed about three cases of HUS in children admitted on the same day to the university hospital in the city of Hamburg.

On May 20, a team from the Robert Koch Institute arrived in Hamburg to assist with the public health investigation. It quickly became clear that the case numbers were continuing to rise, that there were also cases in adults, and that other areas of Germany, especially northern Germany, were also affected.

An investigation of the outbreak involving all levels of public-health and food-safety authorities was initiated to identify the causative agent and the vehicle of infection in order to prevent further cases of the disease. What evolved was akin to a government’s (and producer’s) worst nightmare: 49 deaths, over 4 100 people who fell ill, of which more than 862 developed HUS, many of whom will remain on kidney dialysis for the rest of their lives.

Most cases were from Germany and the remainder had a history of travel to Germany, resulting in cases being reported from nine other countries. Recent reports also show a far smaller outbreak in France, with 15 people becoming ill, with no reported deaths as yet.

Finding the cause of the outbreak proved to be a similar to finding a needle in the haystack, but find it they did and it took a huge number of resources to achieve that. The cause has now been identified as the consumption of organic uncooked sprouted seeds from a single producer in Germany which were contaminated with a Shiga toxin-producing strain of Escherichia coli (STEC). 

Furthermore, analysis of investigations of the German and French outbreaks, points towards an imported lot of fenugreek seeds from Egypt as the most likely common link. This E coli turned out to be STEC E coli O104:H4, a strain with some remarkable features, which make it exceptionally virulent ie:

  • This serotype is very rare and possesses an unusual combination of two virulence factors, it that of STEC, which allows it to produce the so-called Shiga-like toxin that E. coli O157:H7 does, and the “clumping” characteristic attributable to “enteroaggregative” E coli, a pathogen linked to diarrhoea outbreaks in developing countries, especially in children. The organisms clump together, like a stack of bricks, which allows them to adhere to cells that line the intestines.
  • It has never before been reported in animals or food.
  • It is multi-drug resistant – that is one of the reasons why, most often, antibiotic treatment of the infection does not work.
  • It has become one of the most virulent and aggressive non-O157 serotypes with a high attack rate. While HUS, caused by STEC infections, is usually observed in children under five years of age, in this outbreak the great majority of cases were adults, of which two thirds were women. The reason for this is still unknown – it may simply be that women are more likely than men and children to eat raw salad ingredients, from a health-consciousness point of view.
  • The median incubation time for this strain is 8 days, which differs from Shiga-toxin-producing E coli O157:H7, which has an incubation period of 3-4 days.

Like other STEC E coli though, the infective dose is very low, which means that it is difficult to detect in the implicated sprouts, if present in low numbers. Therefore, negative microbiological tests carried out on seeds cannot be interpreted as proof that a lot is not contaminated with the organism.

In the meantime, in order to protect consumers in the EU and travellers to the EU from infection by this strain during this particular outbreak, the European Food Safety Authority (EFSA) and the European Centre for Disease Prevention and Control have issued a strong recommendation advising consumers not to grow sprouts for their own consumption and not to eat sprouts or sprouted seeds unless they have been cooked thoroughly.

With every foodborne outbreak, there are always lessons to be learnt. This outbreak underscores a number of issues; at the same time it gives us cause to pause and to reflect upon our own systems in South Africa, both at national and local authority level, as well as at the level of the food industry. 

The dreadful consequences and loss of life experienced during this outbreak, reminds us that we must always remain vigilant and expect the unexpected; microorganisms are living entities, constantly changing and evolving, picking up characteristics along the way and giving rise to new strains, which at times will result in more virulent strains than any previous ones known to man. This often leads to disastrous consequences for human health and for international trade. Furthermore, this outbreak highlights the fact that microbiological hazards, as opposed to chemical hazards, remain the more important class of hazard in terms of food safety.

The message is clear – food safety management systems such as the Hazard Analysis and Critical Point system (HACCP) should be implemented, applied and controlled correctly, particularly for high-risk foods, such as foods eaten raw and those not destined to be heated before consumption. 

Regardless of the fact that HACCP is not mandatory in South Africa for most food sectors and that food companies (including the food service industry) are obliged to ensure safe food reaches the consumer, the cost of and benefit derived from implementing and maintaining a proper and stringent HACCP system would certainly outweigh the potential disastrous consequences of a class action suit under the Consumer Protection Act, should a similar outbreak occur in South Africa.

About Dr Lucia Anelich

Dr Lucia AnelichDirector of Anelich Consulting and is a well-known food safety expert, both nationally and internationally. She is currently conducting a project for the Food and Agriculture Organization (FAO) on food safety and has recently returned from Dubai where she lectured to students completing their Masters’ degrees in HACCP. She is leaving shortly for the Annual Meeting of the International Association for Food Protection in the USA where she has been invited to give three presentations: Food Safety in Africa; South African Food Law and Future Directions; Private Food Safety Standards and Their Impact on the South African Food Industry.  

She is currently running a course with a colleague, Andrew Murray from Andrew Murray Consulting on the new South African National Standard 10049 on Pre-Requisite Programmes for food safety management, which includes an element on the Consumer Protection Act and how it relates to food safety – the next one is being held in Johannesburg on 23 August 2011. 

Other services offered include in-house training on various food safety matters, including food microbiology, foodborne pathogens, food safety management systems such as HACCP, risk management, microbiological risk assessment and more.  In addition, she can assist industry to implement food safety management systems, conduct pre-audit assessments, establish microbiological criteria and microbiological specifications based on latest scientific evidence and conducts trouble-shooting exercises for industry. 

For further information, contact Dr Lucia Anelich on 012 362 5960 / 082 908 3166 / [email protected]

Read more about Anelich Consulting here