Germany’s E. coli Nightmare

The SARS epidemic in 2003 and the outbreak of Creutzfeldt–Jakob or “mad cow” disease in the 1990s have shown that there is a need for the European Union (EU) to strengthen its defenses against epidemics. We have learned significant lessons over time from those emergencies and have therefore seen a clear improvement in alert-and-response systems, surveillance activities, and the collaboration needed to handle a public health crisis. The latest E. coli outbreak tested these systems and has shown that there is still room for improvement.

The ECDC’s main task during this outbreak was to develop and provide independent scientific evidence. We played an important role by making available the best technical and scientific expertise within our field, which allowed authorities at all levels to make the appropriate decisions to protect EU citizens. That is our mandate, and I am certain we made a difference in specific areas and created added value with our work during the E. coli outbreak.

Our initial task was to produce a rapid risk assessment to provide a clear EU perspective. We produced the first risk assessment on May 25 and two updated versions, one on May 27 and another one on July 12. At the end of June, when the cluster of hemolytic uremic syndrome (HUS) in Bordeaux, France, was identified, we also published a joint risk assessment with the European Food Safety Authority (EFSA). Likewise, since the outbreak was first reported by the German authorities, we have been closely monitoring the situation and publishing daily epidemiological updates on our website.

Once the EU’s Early Warning and Response System (EWRS) on health threats was activated, the European Commission (EC) took the lead in coordinating the EU-wide investigations and control measures together with the member states involved. The ECDC and EFSA contributed to and supported these EU-level activities. For example, the EWRS network and the EC rapidly agreed on a common EU case definition proposed by the ECDC. All member states have agreed to use this to ensure the accurate reporting of cases.

The ECDC also produced tools, such as a standard questionnaire, designed to facilitate coordination of EU-wide investigations. The ECDC’s Food and Water-Borne Diseases and Zoonoses Programme was in contact with national experts from the affected countries on a daily basis, increasing the preparedness of institutes and professionals outside Germany.

Cooperation Is the Key

Dr. Sprenger presides over a daily ECDC round table. He meets with experts from different areas at 11:30 a.m. at a session during which all current threats are analyzed.

I believe that good cooperation is, above everything else, the key to success in outbreak investigations. In the beginning of June, an ECDC expert was sent to the Robert Koch Institute to act as a liaison and to support the steps taken by the German authorities. Following a request from the EC, the ECDC joined forces with the EFSA and sent its top experts to help the German authorities. Their task was to get an overview of the situation and support existing German activities.

Once it became clear that this outbreak had been caused by a new strain of E. coli, laboratory experts from different networks worked intensively together to analyze the bacterium. ECDC’s microbiology team, EU reference laboratories, and the World Health Organization’s collaborating laboratories played a vital role in this cooperation. For example, the ECDC disseminated guidance on laboratory tests to confirm infection. This enabled us to get an accurate EU-wide picture of the developing outbreak. The latest results seem to support the hypothesis that sprout seeds contained E. coli O104:H4 contamination.