Wabak E.coli O104:H4 2011

Suatu wabak bakteria ''Escherichia coli'' O104:H4 telah bermula di Jerman pada bulan Mei 2011.

Wabak telah bermula selepas beberapa orang telah dijangkiti bakteria membawa kepada sindrom hemolitik-uremik di Jerman, jelasnya selepas memakan terung. Pegawai-pegawai Jerman pada mulanya menunjuk kepada terung yang dicemari berasal dari Sepanyol sebagai sumber wabak, tetapi kemudiannya mengenalpasti bahawa terung-terung Sepanyol bukannya sumber later  *E.&nbsp;coli*. Sepanyol sudah menyatakan rasa marahnya kepada pautan Jerman *tidak berasas* kepada kaitan terung Sepanyol dengan wabak *E.&nbsp;coli* yang membunuh.

Tambahan kepada Jerman, di mana wabak paling teruk, terdapat kes-kes seumpama itu juga dilaporkan di beberapa negara termasuklah  Switzerland, Poland, Belanda, Sweden, Denmark, United Kingdom dan AS.

Sindrom hemolitik-uremik (HUS) adalah satu kecemasan perubatan dan memerlukan rawatan segera. Di Jerman, 17 orang telah mati dan sekitar 500 sudah dimasukkan ke hospotal dengan HUS disebabkan oleh wabak yang memburuk.

## Negara-negara wabak
### Jerman
Setakat ini Jerman menjadi negara yang paling teruk dengan wabak, dengan enam belas orang dilaporkan mati daripada penyakit sehingga 1 Jun, dan dengan 450 disahkan dan sehingga 1,200 orang disyaki. Merujuk kepada pegawai perubatan, wabak ini dikesan dari satu stor di Hamburg, dari empat terung, tiga dari Sepanyol dan keempat dari tidak diketahui asal usulnya mengandungi bakteria telah diperiksa. Di dalam gerakbelas, bermula pada 26 Mei , ppihak penguasa Jerman telah mula menyingkirkan terung Sepanyol dari stor-stor.   On 30 Mei, pegawai perubatan Jerman telah bermesyuarat mengenai wabak itu, dilaporkan oleh pegawai perubatan Eropah sebagai yang paling banyak direkodkan di Jerman.

Dua belas kematian dilaporkan adalah wanita. Semua kecuali satu telah direkodkan di Jerman Utara, tetapi ketakutan bahawa wabak merebak meningkat apabila seorang wanita berusia 91 tahun mati di barat negeri North Rhine-Westphalia. Doktor menyasarkan harapan pada dadah Eculizumab, satu dadah yang berkesan terhadap sindrom hemolitik-uremik.

### Sepanyol
Hanya seorang Sepanyol dijangkiti adalah seorang olahragawan yang telah berada di Jerman pada Mei 22 untuk terlibat di dalam  Marathon Hamburg.

### Sweden
Pada 31 Mei, kematian orang Sweden daripada wabak itu telah dilaporkan. Ia adalah seorang wanita 50-an telah mati di hospital di Borås selepas dijangkini semasa melancong ke Jerman. Di dalam semua 41 kes yang di rawat di hospital Sweden sehingga 31 Mei, semuanya berkaitan dengan wabak di Jerman. Lima belas daripada kes-kes dianggap serius.

### Denmark
Pegawai di Denmark telah berkata bahawa  sehingga 30 Mei,empat belas kes telah disahkan, dengan sekurang-kurangnya 26 kes disyaki. Tujuh daripada mereka telah dijangkiti oleh jangkitan sudah menderita kegagalan ginjal, satu tanda yang wujud di dalam peringkat akhir jangkitan.

Denmark's Veterinary and Food Administration (DVFA) telah mula memeriksa terung Denmark bagi sebarang jangkitan, manakal mereka menasihatkan agar menjauhi terung dari Sepanyol dan terung, salad dan tomato mentah dari from Jerman.

### Belanda
Sehingga 30 Mei, telah diumumkan oleh  RIVM beberapa orang yang melawat Jerman telah jatuh sakit. Daripada orang-orang ini, tiga telah dibawa ke hospital dengan kegagalan buah pinggang, dan dua disahkan dijangkiti. Kes-kes yang lain masih lagi di dalam siasatan.

### United Kingdom
Pada 28 Mei, telah diumumkan  bahawa tiga orang, semua warga Jerman yang sebelum in berada di Jermany, telah dijangkiti dengan penyakit itu. Pada 29 Me,   Agensi Piawaian Makanan  UK telah mengeluarkan satu kenyataan bahawa tiada terung yang dijangkiti oleh HUS sudah dijual di negara berkenaan.

### Switzerland
Ia telah sampai di Switzerland pada 31 Mei dan telah membuatkan seorang jatuh sakit, tetapi butiran terperinci tidak diberikan. Kes yang kedua telah dilaporkan pada 1 Jun 2011.

### Finland

Pada Jun 1, National Institute for Health and Welfare (THL) telah memulakan pemeriksaan samada seorang pesakit yang telah sampai di Hospital Maria Helsinki pada minggu sebelumnya telah menderita daripada strain enterohemorhagik *Escherichia coli* (EHEC) -.

### Poland
Pada 30 Mei, seorang wanita telah dimasukkan ke  hospitali di dalam keadaan *E. coli* selepas kembalinya dari Hamburg, yang mana sekurang-kurangnya  467 kes-kes jangkitan usus telah direkodkan  hingga ke tarikh berkenaan.

### Perancis
On May 28, French authorities announced the opening of an investigation on three suspicious cases of food poisoning linked to the German epidemic.

### Amerika Syarikat
European Union officials said three cases had also been reported in the United States, adding that most infections reported outside Germany involved German nationals or people who had recently travelled to the country.

## Asal usul
On May 26, 2011, German officials stated the contaminated vegetables were organic cucumbers that originated in Spain, but European Union spokesperson on 30 May said that two Spanish greenhouses, that were suspected to be sources, had been closed and were being investigated.  The investigation included analyzing soil and water samples from the greenhouses in question, located in the Andalusia region, with results expected by 1 June. Cucumber samples from the Andalusian greenhouses did not show E. coli contamination, but a cross-contamination during transport in Germany or distribution in Hamburg are not discarded.

On May 31, an EU official said that the transport chain was so long that the cucumbers from Spain could have been contaminated at any point that occurred along the transit route.Spanish officials, said before that there was no proof that the outbreak originated in Spain; Spanish Secretary of State for European Affairs Diego Garrido said that "you can't attribute the origin of this sickness to Spain.".

On Tuesday 31 May, lab tests showed that two of the four cucumbers examined did contain toxin-producing *E.&nbsp;coli* strains, but not the O104 strain that was found in patients; this means that Spanish cucumbers are not the source of the outbreak and German authorities have to start all over again in their search for the source. The bacteria in the other two cucumbers have not yet been identified. No other possibilities have been officially proposed.  Paul Hunter, professor of health protection at the University of East Anglia located in Norwich, United Kingdom, pointed out that salads are a regular cause of outbreaks of food borne diseases including STEC, like this one, and *[[Salmonella]]*.  As of the first of June, the source is still unknown.

Genomic sequencing by BGI Shenzhen revealed that the bacteria belong to a "new super-toxic strain", a hybrid that has acquired some virulence abilities of enteroaggregative E. coli (EAEC) strains by horizontal gene transfer.

## Response inside the EU
The German government warned against the consumption of all raw cucumbers, tomatoes and lettuce. 

In response to the outbreak, several countries implemented restrictions or bans on the import of produce. Belgium banned imports of Spanish cucumbers on May 31, Austria banned imports of Spanish cucumbers, tomatoes and aubergines, and the Czech Republic recalled all Spanish cucumbers on sale on May 30. 

### Belgium
Belgium banned imports of Spanish cucumbers on May 31. 

### Sepanyol
On 30 May, the Spanish government said that it was considering requesting compensation from Germany, claiming that "tremendous damage" had been done to the country's agricultural sector as a result of reduced exports stemming from the incompetent way Germany handled the outbreak. Since the beginning of the crisis, farms in the Andalusian region were estimated to have lost up to eight million euros per day. Spanish Health Minister Leire Pajin firmly stated there were no native cases in Spain by May 31.

### Jerman
By May 31, Andreas Hensel, president of Germany's Federal Institute for Risk Assessment, told ZDF television in an interview that "we have found the so-called EHEC pathogens on cucumbers, but that does not mean that they are responsible for the whole outbreak." 
By May 31, Denmark’s Veterinary and Food Administration said it was concerned by the suspicion that Danish cucumbers were  involved and began testing samples to reassure consumers.  

### Belanda
By May 31, The Dutch Food and Wares Authority  spokeswoman  Marian Bestelink,  said that investigations made of the business run by the local Dutch cucumber grower and Dutch warehouse did not uncover any traces of the bacteria at that time.  The Netherlands had also stopped exporting cucumbers to Germany on May 31.

### Denmark
By May 31, Denmark’s Veterinary and Food Administration said it was concerned by the suspicion that Danish cucumbers were  involved and began testing samples to reassure consumers. 

### Itali
By May 31, Italy's Europhobic agriculture lobby, Coldiretti, had also used the outbreak to urge Italians to support their local growers and avoid imports by May 31. 

### Austria
On May 31st, Austrian authorities inspected 33 organic supermarkets to make sure Spanish vegetables had been removed. The move came after an apparently overzealous recall and ban on sales of both cucumbers, tomatoes s and aubergines (eggplants) that had originated in Spain and were delivered to Austrian food stores by various German companies. 

### Republik Czech
The Czech Government officials said that their labs had tested a total 120 potentially tainted Spanish cucumbers the 29th as an interim safety measure, but refused to cast blame for the outbreak, which had yet to reach the Czech Republic by that date. 

## Response by other individual countries

### Russia
According to BBC News, on June 2nd, "Russia has banned the import of all fresh vegetables from the European Union because of the E. coli outbreak centred on Germany."http://www.bbc.co.uk/news/world-europe-13625271

## Response by the United Nations
On May 31, a World Health Organization food safety expert, Hilde Kruse, said "Almost all cases being reported in other countries have a link to travel or residence in Germany" and indicated that Germany was still the most infected country so far. 

## Lihat juga
* List of foodborne illness outbreaks

## Rujukan