E. coli stock.jpgThe source of the E. coli O104:H4 outbreak is still unclear.  However, governments across Europe are still urging people to not consume cucumbers, tomatoes or lettuce.  Test results on Spanish cucumbers tested positive for EHEC, but apparently not the same strain that is sickening and killing people – mostly women – across Europe.

Now, Austria, Denmark, Germany, France, the Netherlands, Norway, Spain, Sweden, Switzerland and the United Kingdom have reported cases of haemolytic uraemic syndrome (HUS) and/or bloody diarrhoea. HUS, which can lead to kidney failure, is a complication of an infection by particular Escherichia coli bacteria, enterohemmorhagic E. coli (EHEC), which can cause hemorrhagic colitis with bloody diarrhoea. While most E. coli bacteria are harmless, the EHEC group can produce toxins, known as Shigatoxins or verotoxins, which damage blood cells and the kidneys. EHEC bacteria that produce these toxins belong to the so-called Shigatoxin-producing E. coli (STEC) or verocytotoxin-producing E.coli (VTEC).

As of 31 May 2011, 400 cases of HUS and 843 cases of EHEC infection (1243 in total) were reported to WHO. Most of these were in Germany, where there were 373 cases of HUS and 796 of EHEC.  There are reports of 16 deaths.

To date, all cases but two were reported in people who had travelled to or been in northern Germany during the incubation period for the disease. One laboratory-confirmed case of EHEC infection and HUS with no apparent link to Germany or to other known cases was reported in Denmark, and in Norway there was a case where the patient had a visitor from Germany.  It is unclear the number of secondary cases (person to person infections).

As of 30 May 2011 in Germany, 61% of reported EHEC cases were in women and girls, and 88% in people aged 20 years or older. The corresponding figures for HUS cases were both 88%.

And, yes, there are two reported illnesses in the United States, both recent travelers to Germany.