Epidemic Profile of Shiga-Toxin–ProducingEscherichia coliO104:H4 Outbreak in Germany

作者：Christina Frank, Dirk Werber, Jakob P. Cramer, Mona Askar, Mirko S. Faber, Matthias an der Heiden, Helen Bernard, Angelika Fruth, Rita Prager, Anke Spode, Maria Wadl, Alexander Zoufaly, Sabine Jordan, Markus Josef Kemper, Per Follin, Luise Müller, Lisa A. King, Bettina M. Rosner, Udo Buchholz, Klaus Dieter Stark, Gérard Krause · 发表于：New England Journal of Medicine · 年份：2011 · DOI：10.1056/nejmoa1106483 · 被引用次数：1144 · 研究领域：Escherichia coli research studies、Salmonella and Campylobacter epidemiology、Viral gastroenteritis research and epidemiology

BACKGROUND: We describe an outbreak of gastroenteritis and the hemolytic-uremic syndrome caused by Shiga-toxin-producing Escherichia coli in Germany in May, June, and July, 2011. The consumption of sprouts was identified as the most likely vehicle of infection. METHODS: We analyzed data from reports in Germany of Shiga-toxin-producing E. coli gastroenteritis and the hemolytic-uremic syndrome and clinical information on patients presenting to Hamburg University Medical Center (HUMC). An outbreak case was defined as a reported case of the hemolytic-uremic syndrome or of gastroenteritis in a patient infected by Shiga-toxin-producing E. coli, serogroup O104 or serogroup unknown, with an onset of disease during the period from May 1 through July 4, 2011, in Germany. RESULTS: A total of 3816 cases (including 54 deaths) were reported in Germany, 845 of which (22%) involved the hemolytic-uremic syndrome. The outbreak was centered in northern Germany and peaked around May 21 to 22. Most of the patients in whom the hemolytic-uremic syndrome developed were adults (88%; median age, 42 years), and women were overrepresented (68%). The estimated median incubation period was 8 days, with a median of 5 days from the onset of diarrhea to the development of the hemolytic-uremic syndrome. Among 59 patients prospectively followed at HUMC, the hemolytic-uremic syndrome developed in 12 (20%), with no significant differences according to sex or reported initial symptoms and signs. The outbreak stra...