Friday, June 10, 2011

"The Sprouts Controversy: What's The Source Of E. Coli (STEC) EHEC O104:H4 In GERMANY?" By Reverend Barbara Sexton "The Biblical Biochemist-Where Science Meets the Cross"


 

Dear Readers:
     I am not one to beat around the bush, and so I tell you that, unfortunately, it is uncertain who to completely believe at this time.
     We are still in the 'midst' of having a 'debate' over just where the E. coli STEC O104:H4 has come from.
     Readers will recall that first Spanish cucumbers were implicated, then lettuce and tomatoes and then German organic sprouts.
     Then German organic sprouts were vindicated...and as of this morning, they are once again IMPLICATED...as the source of contamination.
     My advice to you, the consumer, is this: DO NOT EXPECT THE eCDC or the German RKI to PROTECT YOU!  THERE IS JUST TOO MUCH DISAGREEMENT AMONGST THE 'PROFESSIONALS'.
     Simply put, it is best to be wary of any 'conclusions' being drawn by 'experts' at this time.
     Suffice it to say that there is still a scary 'SUPERBUG' out there that is to be avoided at all costs.

     THE BEST THING TO DO IS TO CONSULT THE ADVICE OF YOUR PERSONAL HEALTH CARE PROVIDER AND FOLLOW HIS OR HER ADVICE!
     AND USE YOUR COMMON SENSE!
     Most of all, do not lower your 'index of suspicion' with fresh vegetables of all types (and other food sources?) in Germany and the EU, no matter what you read in the press.
     But, also, if you can be fairly certain that a particular 'brand' or 'source' is OKAY, then go with it.
     Below is a 'Google Translation' of TODAY'S E. coli EHEC (STEC) O104:H4 page of the Robert Koch Institute in Germany (where many recent epidemiological studies are conducted) and the link for those who are interested.
     RKI is claiming that the number of 'samples' (cases) they are getting has been decreasing over the last few days.
     If so, this is a bit of 'good news'.
     And they state that 'The absolute and relative number of patients with bloody diarrhea in emergency rooms of hospitals voluntarily reporting dropped to a lower level.'
LINK: http://www.rki.de/cln_160/nn_217400/DE/Home/Info-HUS.html
     If this trend continues, this is also good.  But do understand that 'self-reporting' is...by it's very nature...sometimes not trustworthy.
     Cases get 'missed', and even deaths get missed, meaning that they are attributed to the wrong thing.
     For those of you who are interested in the numerical details, those that are easy to discern can be found below.
     For the others, I provide a sort of 'explanation' for you.

     But if you just want to know what 'todays totals are', just skip below to the section highlighted in orange.
      German to English translation
To EHEC / HUS outbreak Done
Stand 06.10.2011, 13:00 clock, data as of 06/09/2011, 15.00
For a few days illness of HUS / EHEC at a much lower level are sent to the RKI. The absolute and relative number of patients with bloody diarrhea in emergency rooms of hospitals voluntarily reporting dropped to a lower level. The Robert Koch Institute submitted a total of 759 HUS cases, including 21Todesfälle. So far, the Robert Koch Institute have been made also with 2229 cases of infection with EHEC. Sent nine EHEC cases have died. Altogether, 2988 persons are suffering from HUS or EHEC, 30 people died of HUS or EHEC.
From the reported HUS cases, 75% from Schleswig-Holstein (n = 178), Hamburg (n = 163), Lower Saxony ¬ (n = 122) and England (n = 105). These are all states of the HUS outbreak affected. The vast majority of HUS cases is in the co ¬ men ¬ connection with exposure in northern Germany, 76% of EHEC cases are from the four federal states of Schleswig-Holstein (n = 665), Lower Saxony (n = 464), Hamburg ( n = 318) and England (n = 251). All States are affected by the EHEC outbreak. Link to tables of disease rates by province breakdown can be found at the end of this text.In HUS, the earliest onset of diarrhea was 1 May, the latest onset was with the diarrhea cases reported so far on 6 June. From 1 to 8 May was the case number from 0 to 1 case per day. On 9 May rose to the number of cases in 7 cases and increased continuously up to a maximum of 59 recent cases on 20 and 21 May In EHEC, the earliest onset of diarrhea was 1 May, the latest on 6 June. From 1 to 12 May was the number of cases of EHEC infections 0-18 cases a day. Then the number of cases rose steadily until, at a maximum of 143 in 22nd May
In the current events is one of the world's largest so far described outbreaks of EHEC or HUS and the largest outbreak in Germany, whereby in particular the age and gender distribution unusual. As before, especially adults, mostly women, are affected. At other times, mainly children develop this severe clinical picture: In 2010, for example, were the Robert Koch Institute, 65 HUS cases submitted, 6 were affected more than 18 years.In connection with current events are the RKI recommends:

    
The current dietary recommendations should be followed (see joint press release of BVL, BfR and RKI from 06/10/2011). How far is that all persons with diarrhea should make sure that strict hand-hygiene is maintained, especially against persons and immunocompromised infants. The recommendations for good food hygiene, as described by the Federal Institute for Risk Assessment in its fact sheet for the prevention of EHEC infection (www.bfr.bund.de), remain valid.
    
People with bloody diarrhea should immediately consult a doctor.
    
Physicians should strive for these patients EHEC detection (in the chair). EHEC infections can run without clinical symptoms or cause a watery diarrhea. A smaller proportion of EHEC infections developing as a severe form with cramping abdominal pain, bloody diarrhea. These patients should monitor their physicians with regard to the possible development of HUS closely and pay at the first signs of HUS to appropriate treatment centers. Symptoms of EHEC-associated HUS disease begin within a week after the onset of diarrhea. The period between infection and the first diarrheal symptoms is on average three to four days.
    
Laboratories should be diagnosed by detection of pathogens appropriate to send samples to the National Reference Center for Salmonella enteritis and others at the Robert Koch Institute (Wernigerode). Laboratories and physicians are required by the Infection Protection Act, both microbiologically documented EHEC infections, as well as the clinical picture of HUS (also already suspected disease) immediately to the local health department reported.
Studies in the National Reference Center for Salmonella and other bacterial enteritis at the Robert Koch Institute, as well as the one with the Robert Koch Institute cooperating Konsiliarlaboratorium for hemolytic uremic syndrome (HUS) at the Institute of Hygiene, University of Münster (Prof. H. Karch) have shown that the currently circulating strain with characteristics of two different types of pathogenic Escherichia coli. In addition, there are special resistance properties. Such a new combination of pathogenic properties and the inclusion of resistance genes is known in Escherichia coli.
The National Reference Laboratory in Wernigerode has identified at 439 samples the outbreak strain. The strain shows an increased resistance to cephalosporins of the 3rd Generation (ESBL), and a wide including multiple resistance to trimethoprim / sulphonamide, and tetracycline. However, this is not clinically significant as EHEC infections are not usually treated with antibiotics. An anti-bacterial therapy may prolong the excretion of bacteria and stimulate the production of toxins lead.
The RKI has published information and assistance for the diagnosis of the outbreak strain on its website (link at the end of this text). The Federal Institute for Risk Assessment has expressed itself in a Stellunnahme the pathogen (link at the end of this text). The Konsiliarlabor for HUS at the University of Münster On 06/10/2011, a press release to the outbreak strain.
The HUS is a severe and sometimes fatal complication that can occur with bacterial infections of the intestines called enterohemorrhagic Escherichia coli (EHEC). Each year, the Robert Koch Institute will be sent about 1,000 cases of EHEC. The full picture of HUS is characterized by acute renal failure, anemia by the disintegration of red blood cells and a lack of blood platelets. In 2010, the Robert Koch Institute were sent to two deaths.
The next update of this outbreak information is for 14 June 2011 provided.Further information

LINK: http://www.rki.de/cln_160/nn_217400/DE/Home/Info-HUS.html
--------------------------------------------------------------------------------------------
     Below is a more comprehensive report from the eCDC where cases from all over the EU are reported.
     The 'statistics' from RKI and eCDC are comparable, at least, despite the 'politics'.
RKI & eCDC Statistics For GERMANY June 10, 2011
     One can see that for Germany, there have been 759 HUS STEC (EHEC) E. coli O104:H4 cases (with 21 deaths)....And 2229 non-HUS STEC (EHEC) E. coli O104:H4 cases (with 9 deaths
eCDC Statistics For The EU June 10, 2011
      As of today, June 10, 2011, there have been  795 HUS STEC (EHEC) E. coli O104:H4 cases (with 22 deaths)....And 2287 non-HUS STEC (EHEC) E. coli O104:H4 cases (with 9 deaths)
eCDC Statistics TOTALS For The EU  June 10, 2011
     As of today, June 10, 2011, there have been a total of 3,082 cases of STEC (EHEC) E. coli O104:H4 (either with or without HUS)
     And to date, there have been a total of 31 DEATHS attributed to E. coli STEC (EHEC) O104:H4.
 God Bless & Keep You
Reverend Barbara Sexton
"The Biblical Biochemist-Where Science Meets the Cross"
 ----------------------------------------------------------------------------------------------------------------
Outbreak of Shiga toxin-producing E. coli in Germany (10 June 2011, 11:00)
10 Jun 2011
Outbreak of Shiga toxin-producing E. coli in Germany (10 June 2011, 11:00)Epidemiological update, 10 June 2011, 11:00
Since 8 June, Member States have started reporting cases according to a new EU case-definition. This resulted with marginal adjustments of figures compared to previous reports in five Member States, Finland (that is not reporting cases anymore), France, the Netherlands, Sweden and the United Kingdom.
On 22 May, Germany reported a significant increase in the number of patients with haemolytic uremic syndrome (HUS) and bloody diarrhoea caused by Shiga toxin-producing E. coli (STEC). Since 2 May 2011, 795 cases of HUS and 2287 non-HUS STEC cases have been reported from European Union Member States, including 759 HUS cases and 2229 non-HUS STEC cases in Germany. 22 of the HUS cases and 9 non-HUS STEC cases in EU Member states have died. See table below.
While HUS, caused by STEC infections, is usually observed in children under 5 years of age, in this outbreak the great majority of cases are adults, with around two thirds being women.
Laboratory results indicate that STEC serogroup O104:H4 (Stx2-positve, eae-negative, hly-negative, ESBL, aat, aggR, aap) is the causative agent. PFGE results shows indistinguishable pattern of 7 human O104:H4 outbreak strains in Germany and 2 strains of O104:H4 in Denmark.
Although the source of the outbreak is still under investigation, food items originating from a specific farm in northern Germany have been indicated by the German Authorities as the most likely vehicle of infection.
Most cases are from, or have a history of travel to the North of Germany (mainly Schleswig-Holstein, Lower Saxony, North-Rhine-Westphalia and Hamburg). In the EU/EEA, Austria, Denmark, Germany, the Netherlands, Poland, Spain, Sweden and the United Kingdom have reported cases of HUS, while 5 other Member States have reported only non-HUS STEC cases.
Number of HUS and non-HUS STEC cases and associated deaths per EU/EEA Member States as of 10 June 11:00
EU Member States
reporting cases
Number of HUS cases (deaths)
Number of non-HUS STEC cases (deaths)
Austria
1 (0)
3 (0)
Czech Republic
0 (0)
1 (0)
Denmark
8 (0)
12 (0)
France
0 (0)
2 (0)
Germany
759 (21)
2229 (9)
Greece
0 (0)
1 (0)
Luxembourg
0 (0)
1 (0)
The Netherlands
4 (0)
4 (0)
Norway
0 (0)
1 (0)
Poland
2 (0)
0 (0)
Spain
1 (0)
1 (0)
Sweden
17 (1)
30 (0)
The United Kingdom
3 (0)
2 (0)
Total
795 (22)
2 287 (9)
Cases are associated with an exposure in Germany, mainly northern parts. The German Authorities have indicated food originating from a specific farm in Northern Germany as the most likely vehicle of infection. Further investigations are ongoing to identify the original source of the infection. The German Authorities are declaring a decrease of the number of new cases.
STEC is a group of pathogenic Escherichia coli (E. coli) strains capable of producing Shiga toxins, with the potential to cause severe enteric and systemic disease in humans.
Read more
Escherichia coli (E. coli) health topic siteCase definition
  LINK:  http://www.ecdc.europa.eu/en/activities/sciadvice/Lists/ECDC%20Reviews/ECDC_DispForm.aspx?List=512ff74f-77d4-4ad8-b6d6-bf0f23083f30&ID=1105&RootFolder=%2Fen%2Factivities%2Fsciadvice%2FLists%2FECDC%20Reviews

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