Positive outcome of the EHEC epidemic

Overall, crisis management during the EHEC epidemic was positive

12/09/2011

Federal Health Minister Daniel Bahr (FDP) has taken a positive view of the crisis management during the past EHEC epidemic. Although the public information policy may have sometimes been chaotic, the fight against EHEC infection and the identification of the new, particularly aggressive serotype O104: H4 (HUSEC041) of the genus Enterohemorrhagic Escherichia coli (EHEC) have been relatively successful.

Within the framework of a podium discussion at the annual meeting of the German Society for Nephrology, to be held until tomorrow, the Federal Minister of Health had expressly „the cooperation of hospitals across national borders“ in the fight against the EHEC epidemic. In addition, be „the identification of sprouts on a worldwide scale is a top performance“, explained the Federal Minister of Health. When the first EHEC infections occurred immediately after he took office on 19 May, his employees had already prepared him for the fact that the EHEC crisis could be even more stressful than the swine flu in 2009, reported Daniel Bahr. Not least because of the good crisis management, the EHEC epidemic was retrospectively less serious than many experts initially feared.

So far the most severe EHEC epidemic in Germany
As the figures from the final report from the Robert Koch Institute (RKI) show, so many people have become infected with the dangerous intestinal bacteria as never before in Germany in the context of the past EHEC epidemic. According to the RKI, since the occurrence of the first infections in May 2011, 3,842 people have contracted EHEC infection, 855 of them suffered from the so-called hemolytic uremic syndrome (HUS) and 53 people died as a result of the infection. The unusually high proportion of EHEC-infected people suffering from HUS is an absolute exception compared to the previous EHEC epidemics. The new, particularly aggressive pathogen HUSEC 041 caused significantly more severe EHEC symptoms of HUS, with increased health impairments up to kidney failure and neurological disorders were observed, explained the Federal Minister of Health. A special merit here comes to the kidney specialists who have taken care of the care of HUS patients, said Daniel Bahr.

Praise for the rapid identification of the source of infection
At the annual meeting of the German Society of Nephrology, the experts also reported that the identification of EHEC-causing food was extremely fast. Although the search for the source of infection may have been somewhat chaotic in public, the period in which the fenugreek sprouts from Egypt were identified as pathogens speaks for itself, said Gérard Krause, head of the Infectious Disease Epidemiology Unit at RKI. For comparison, the expert cites the example of a series of 2008 salmonella infections in the US. After more and more people on the salmonella strain „Saint Paul“ The search for the source of infection took seven weeks at that time. Those affected had eaten contaminated chili peppers, which were cut into spicy vegetables in commercial tomato sauces. In the past EHEC epidemic, however, it only took three weeks for the fenugreek sprouts from Egypt to be identified as the source of EHEC infections, said Gérard Krause.

However, the researchers also had a bit of luck in their search for the source of infection, because most EHEC infected people were unaware that they had consumed the sprouts. Only by the accumulation of the infections after the visit of certain restaurants and the evaluation of photos of the food court, much on that all patients, who had consumed fenugreek sprouts. In the further investigations, the authorities found that in all 41 restaurants and canteens in which several people had been infected with EHEC, the Bockhornklee sprouts from a farm in the district of Uelzen were offered. According to the experts, sprouts are generally considered a species „Stealth foods“, since the fewest patients after an infection think of the consumption of the sprouts as a possible cause of the illnesses.

Further research is needed to assess health risks
The participants of the panel discussion at the annual meeting of the German Society for Nephrology also underlined the importance of the work of the team around the microbiologist and EHEC expert Prof. Dr. med. Helge Karch from the Institute of Hygiene at the Center for Clinical Theoretical Medicine of the University of Münster in the fight against the EHEC epidemic. The researchers from Münster had already developed a rapid test immediately after the appearance of the first EHEC infections, with which the new, particularly aggressive pathogen HUSEC 041 can be clearly detected. Prof. Dr. Karch himself emphasized that „we still know little about how the tribe originated and how it will evolve.“ According to the expert, further investigations are urgently needed to finally assess the health risks posed by the new EHEC pathogen. The microbiologist and his team have been working for years to compile a register of HUS triggering EHEC bacteria, but the HUSEC 041 strain has so far „nowhere in the world known“ was and him therefore „nobody in the sights“ Karch explained.

Criticism of communication and reporting around the EHEC epidemic
Other participants in the panel discussion included the SPD health expert Karl Lauterbach, who, as a representative of the opposition, also made a brief note of the shortcomings in the crisis management of the EHEC epidemic. Although the balance in the disease control is quite positive, but the reporting system is clearly criticized, said Lauterbach. The SPD health expert was not alone in this accusation, because in fact the federal structures and reporting channels have brought about considerable delays. The president of the German Society for Nephrology, Reinhard Brunkhorst, also criticized the RKI for its usual official route via the health authorities and state authorities and raised the following question: „How can you be satisfied if it takes ten days for a message to arrive at the RKI??“ According to Brunkhorst and Lauterbach, direct reporting of EHEC infections to the RKI would also be of great advantage in terms of disease control. In addition, the treating physicians should be more involved in the search for the source of infection, the experts demanded.

The conference president and medical director of the Berlin Charité, Ulrich Frei, also criticized the lack of communication about the EHEC crisis in public. The Federal Minister of Health also saw some weaknesses here and emphasized that he had a quieter communication „with more consultation. "That in various talks in the media „six different theories about the cause of EHEC“ came up that „from bioterrorism to asparagus and strawberries to the cut flowers of Mother's Day“ ranged, have caused additional uncertainty in the public. The SPD politician Lauterbach also criticized the actions of some state ministers, of which he would have expected more restraint. The premature announcement of assumptions about the source of infection sometimes left a chaotic impression on the public. (Fp)

Also read:
Symptoms of EHEC infection
EHEC epidemic survived