Epidemiology and Infection

Original Papers


Transmission of shiga toxin-producing Escherichia coli O104:H4 at a family party possibly due to contamination by a food handler, Germany 2011


a1 Governmental Institute of Public Health of Lower Saxony (NLGA), Hannover, Germany

a2 Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute (RKI), Berlin, Germany in association with the European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden

a3 Local Public Health Department, Göttingen, Germany

a4 Local Public Health Department, Kassel, Germany

a5 Local Veterinary Authority, Kassel, Germany

a6 Hessian State Laboratory, Giessen, Germany

a7 Hesse State Health Office, Department for Health Protection (HLPUG), Dillenburg, Germany


We investigated a cluster of shiga toxin-producing Escherichia coli (STEC) O104:H4 infections after a family party during a large STEC O104:H4 outbreak in Germany. To identify the vehicle we conducted a retrospective cohort study. Stool samples of party guests, and food and environmental samples from the catering company were tested for STEC. We defined cases as party guests with gastrointestinal symptoms and laboratory-confirmed STEC infection. We found 23 cases among 71 guests. By multivariable analysis consumption of salmon [odds ratio (OR) 15, 95% confidence interval (CI) 2·3–97], herb cream (OR 6·5, 95% CI 1·3–33) and bean salad (OR 6·1, 95% CI 1·4–26) were associated with STEC infection. STEC O104:H4 was detected in samples of bell pepper and salmon. The food handler developed STEC infection. Our results point towards transmission via several food items contaminated by a food handler. We recommend regular education of food handlers emphasizing their role in transmitting infectious diseases.

(Received July 17 2012)

(Revised February 01 2013)

(Accepted March 06 2013)

(Online publication April 08 2013)

Key words

  • Foodborne infections;
  • shiga-like toxin-producing E. coli ;
  • outbreaks


c1 Author for correspondence: M. Diercke, Governmental Institute of Public Health of Lower Saxony, Roesebeckstraße 4–6, 30449 Hannover, Germany. (Email: dierckem@rki.de)