A large outbreak of Shiga toxin-producing Escherichia coli O104:H4 (STEC O104:H4) infections have been reported in Germany. The responsible variety of organism shares disease causing characteristics with enteroaggregative E. coli (EAEC).
As of June 2, 2011, case counts confirmed by Germany’s Robert Koch Institute include 520 patients with hemolytic uremic syndrome (HUS) – a type of kidney failure that is associated with E. coli or STEC infections – and 11 deaths.
In the United States, four cases of infections of STEC O104:H4 have been reported in persons who were travellers from Hamburg, Germany. All four cases are pending laboratory confirmation. Centers fro disease control and prevention (CDC) has alerted state health departments of the ongoing outbreak and requested information about any persons with either HUS or Shiga toxin-positive diarrheal illness, with illness onset during or after travel to Germany since April 1, 2011.
Travelers to Germany should be aware that the German public health authorities have recommended against eating raw lettuce, tomatoes or cucumbers, particularly in the northern states of Germany (Hamburg, Bremen, Lower Saxony, and Schleswig Holstein).
The strain of STEC causing these illnesses, STEC O104:H4 is very rare. Symptoms of STEC infection include severe stomach cramps, diarrhea (which is often bloody), and vomiting. If there is fever, it usually is not very high. Most people get better within 5–7 days, but some patients go on to develop HUS—usually about a week after the diarrhea starts. Symptoms of HUS include decreased frequency of urination, feeling very tired, and losing pink color to skin and membranes due to anemia.