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E. Coli Outbreak Waning, Still More Questions Than Answers

Germany's health minister has reported that the worst of the E. coli outbreak that has killed 26 people in Europe is probably on the decline. Despite two new fatalities and 300 new cases reported June 8, rates of new infection are dropping.

Despite this potentially good news about this outbreak, the epidemic remains surrounded more by questions and unknowns than by quantifiable facts. Scientists have been unable to identify the source of the outbreak or the reason for its unusual severity, and nobody can predict the long-term impacts on the hard-hit European agriculture sector.

Germany's E. Coli Outbreak: A Primer

Here's a summary of the major events of this E. coli outbreak over the past weeks:

The crisis began on May 2. As of June 8, Germany has reported 2,658 cases, nearly 700 of which have involved serious complications requiring hospitalization. Another 100 cases are elsewhere in Europe and in the U.S. Of the 26 fatalities, 25 so far have been in Germany, with the remaining one in Sweden.

As of June 5, only 4 cases had been reported in stateside, and all of those were in people who had recently traveled to Germany.

All signs point to the infections originating with some form of raw salad vegetable, but researchers have been unable to pinpoint its precise origin. German health officials first pointed the finger at Spanish cucumbers, but on May 31, admitted that they had made a mistake.

More recently, attention turned to beansprouts from an organic farm in northern Germany, but so far tests from that farm have come back negative. Officials stress that these initial negative results do not conclusively prove that the infection did not originate with this farm, there may simply no longer be any infected produce on the premises.

As the source of the contamination remains unclear, German officials have advised that all visitors and residents of Germany avoid eating raw vegetables.

Unusually Potent Strain of E. Coli

The strain of E. coli responsible for this outbreak is causing severe illnesses at an unusually high rate, but scientists remain unsure as to why that is.

According to Dr. Dennis Maki, an infectious disease specialist at the University of Wisconsin, in a typical E. coli outbreak, no more than 10 percent of infected individuals would be likely to require hospitalization from severe complications. In this particular strain, approximately a third of cases have resulted in hospitalization.

The most serious strains of E. coli, like the one in Germany, act by releasing toxins, called Shiga-toxins, into the body of their hosts. The most severe result of E. coli infection is called hemolytic (or haemolytic) uremic syndrome, whose early symptoms include bloody diarrhea and abdominal pain.

Severe impacts include acute kidney failure, hemolytic anemia, and low blood platelet count. It usually affects predominantly children, but this particular strain is unusual in that 86 percent of affected people are adults.

Some experts argue that the strain of E. coli circulating in Germany is not any more dangerous than previous strains of the bacteria--it's just that more people have been exposed to it, or that they were exposed to an unusually high level of contamination.

Others think that poor treatment may be the culprit, as antibiotics--perhaps used to treat the most severe cases--may in fact make matters worse, because they kill off "good" intestinal bacteria to leave a clear field for antibiotic-resistant strains of E. coli, or because the E. coli bacteria may actually release more toxins as they die.

Maki himself theorizes that this new strain has acquired the ability to produce far more toxins than earlier strains, and these toxins are responsible for the damage caused by the bacteria.

Investigation Of Sources

While frustrating and scary that the cause of the outbreak has been difficult to find, it is not uncommon. The source of the largest serious outbreak of E. coli, which sickened over 8,000 people in Japan in 1996, was never proven in a lab, though it was widely attributed to contaminated radish sprouts.

The more time passes, the less likely we are to ever have conclusive proof of the source that has contaminated so many people in Europe.

Part of the problem is that tracking the source relies, first and foremost, on the intensive questioning of infected individuals about what they ate around the time of infection. Because it generally takes a week between infection and the onset of the first symptom (usually, diarrhea) and another week before the onset of any more serious symptoms, people's memories can become hazy. It also allows plenty of time for the farms in question to move most of their stock before they know it's infected.

Dr. Robert Tauxe, Deputy Director of the Center for Disease Control, says that "Even if all the samples are negative, maybe you just missed it. You can go to a place reeking of chlorine, and find nothing."

Impacts On Farmers

The effects of the outbreak are being felt by farmers across the EU, as many people have been scared off of eating vegetables altogether. Russia recently halted the import of all European produce.

On June 7, the EU held an emergency meeting to address the outbreak, and the most concrete outcome of that meeting seems to be a compensation plan for farmers. The European Commission proposed a starting figure of 150 million euros (about $220 million) to compensate European farmers. This is being derided as insufficient by many countries, particularly Spain, which has already lost $256 million in exports and could still be losing $292 million a week.

Moving Forward

The World Health Organization is not recommending any travel or trade restrictions against Germany. They are recommending that vegetables be thoroughly washed and cooked before eating, and that individuals in the country be diligent about washing their hands, especially before eating.

The search for the source of contamination continues.

Check back here for updates as they arise.

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