Epidemiology and Infection

Original Papers

Sorbitol-fermenting enterohaemorrhagic Escherichia coli O157:H causes another outbreak of haemolytic uraemic syndrome in children

K. ALPERSa1 c1, D. WERBERa1, C. FRANKa1, J. KOCHa1, A. W. FRIEDRICHa2, H. KARCHa2, M. AN DER HEIDENa1, R. PRAGERa3, A. FRUTHa3, M. BIELASZEWSKAa2, G. MORLOCKa4, A. HEISSENHUBERa4, A. DIEDLERa5, A. GERBERa6 and A. AMMONa1

a1 Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany

a2 National Consulting Laboratory on Haemolytic Uraemic Syndrome, Institute for Hygiene, University of Münster, Germany

a3 National Reference Centre for Salmonella and other Enteric Pathogens, Robert Koch Institut, Wernigerode, Germany

a4 Bavarian Health and Food Safety Authority, Munich, Germany

a5 Landesgesundheitsamt Baden-Württemberg, Germany

a6 Zentrum für Kinderheilkunde und Jugendmedizin, University of Freiburg, Germany

SUMMARY

An outbreak of haemolytic uraemic syndrome (HUS) among children caused by infection with sorbitol-fermenting enterohaemorrhagic Escherichia coli O157:H (SF EHEC O157:H) occurred in Germany in 2002. This pathogen has caused several outbreaks so far, yet its reservoir and routes of transmission remain unknown. SF EHEC O157:H is easily missed as most laboratory protocols target the more common sorbitol non-fermenting strains. We performed active case-finding, extensive exploratory interviews and a case-control study. Clinical and environmental samples were screened for SF EHEC O157:H and the isolates were subtyped by pulsed-field gel electrophoresis. We identified 38 case-patients in 11 federal states. Four case-patients died during the acute phase (case-fatality ratio 11%). The case-control study could not identify a single vehicle or source. Further studies are necessary to identify the pathogen's reservoir(s). Stool samples of patients with HUS should be tested with an adequate microbiological set-up to quickly identify SF EHEC O157:H.

(Accepted September 15 2008)

(Online publication November 21 2008)

Correspondence:

c1 Author for correspondence: K. Alpers, M.D., M.Sc. (Epi), DTM&H, Department for Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 10, D-13353 Berlin, Germany. (Email: alpersk@rki.de)

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