Food Safety Newsletter - FoodHACCP.com Trainings from FoodHACCP.com Basic and Advanced HACCP, Basic Food Safety Microbiology, and International Conference for Food Safety and Quality. To check more information, click on picture To check more information, click on picture German E. coli O104:H4 - 38 Dead, 824 with HUS, 3351 Ill - Massachusetts, Michigan, and Wisconsin with 5 Source : by Bill Marler on June 15, 2011 And E. coli O104:H4 that has been linked to locally grown organic sprouts, according to the European Food Safety authority, has caused 821 HUS cases, including 24 deaths, and 2,530 non-HUS cases, including 13 deaths. Germany also reports two new HUS cases and 17 new non-HUS STEC cases. Germany reports a new HUS death. In Luxembourg, one STEC case developed HUS. However, according to press reports, a total of 38 people have died, including a 90-year-old reported dead Wednesday by Hamburg authorities.

According to the CDC, four confirmed cases and one suspect case of STEC O104:H4 infections have been identified. Of these five cases, four recently traveled to Hamburg, Germany, where they were likely exposed. The bacterial isolates from the three HUS cases reported in Massachusetts, Michigan, and Wisconsin and one case with Shiga toxin-positive diarrheal illness in Michigan have been confirmed as matching the outbreak strain. The Michigan case with Shiga toxin-positive diarrheal illness did not travel to Germany, but is a close contact of the Michigan case with HUS. Their diarrheal illness developed later and was likely acquired through contact with the HUS case. Germany pledges 'immediate' review after E.coli crisis contained Source : By Rory Harrington, (10,Jun,2011) Germany has indicated it will conduct a review into the effectiveness of its response to the huge outbreak of E.coli as it sought to rebut growing unease that it appeared no nearer confirming the source of the deadly bacteria.

German authorities are facing mounting criticism that the fragmented nature of its regional and federal health bodies hampered the speed and efficacy of its response as the official death toll confirmed by the European Centre for Disease Control (ECDC) rose to 27, with a further 2,900 sickened across 12 countries. No epidemic police Health Minister Daniel Bahr told Reuters yesterday that its health bodies would embark on an "immediate evaluation" of how they cooperated in the aftermath of the crisis that some reports claim has killed 30 and cost Europe's fruit and vegetable producers hundreds of millions of Euros. But he ruled out the notion of a centralised "epidemic police", labelling it a "typical German response". Baerbel Hoehn, an environment minister in North Rhine-Westphalia, raised concerns that the decentralised political system may have led to a lack of focussed leadership. Responsibility for monitoring E.coli cases falls to each of the country's 16 states, while Federal authorities provide advice to regional bodies and the public. The medical director of the University Medical Center Hamburg-Eppendorf, the largest hospital at the epicentre of the outbreak, backed this view.

"Clearly a more centralized structure is probably better suited to handle this," said Joerg F. Debatin. "But that really goes down to the roots of what the German political system is made up of." Too long? Concern has been voiced that while the first victims of the new E.coli 0104:H4 were diagnosed on 2 May, the alarm wasn't raised through the EU-wide rapid alert system for a further three weeks. Critics have suggested this has been a major reason behind the continuing failure of the authorities to pinpoint its source. If, as is believed, some sort of fresh vegetables are behind the outbreak, the time within such perishable foods are consumed may mean the trail is already too cold for scientists to follow and the cause of the problem impossible to trace. German officials have already erroneously labelled Spanish cucumbers as the source, while last weekend Gert Lindemann, agriculture minister for Lower Saxony, blamed beansprouts. While scientist refuse to rule the latter out, no tests have yet found traces of the specific E.coli strain on dozens of samples taken. While the number of new cases being reported daily is now dropping significantly Behr said it was likely more deaths would occur.

Yesterday, the spotlight once again fell on cucumbers after E.coli was found on the vegetable contained in rubbish from a family in Saxony-Anhalt. However, reports suggested that it was not the same strain tied to the current outbreak. The Netherlands also recalled a batch of E.coli-contaminated beansprouts but again the bacteria is not an exact match. Longterm kidney threat in E. coli victims Hemolytic uremic syndrome, seen in German outbreak, can lead to kidney failure Source: By Melissa Eddy (15,Jun,2011) As Europe's E. coli crisis wanes, some experts are now warning of a looming threat: possible long-term kidney complications for many of the victims. Many of the roughly 3,200 E. coli patients are recovering and returning home, and only a handful of new cases are being reported. But along with a record death toll of 38, the outbreak also produced an unprecedented number of patients with a rare ailment known as hemolytic uremic syndrome, or HUS, which can lead to kidney failure. Germany usually sees some 40 to 50 such cases a year; 784 people suffered from HUS in the outbreak.

The complication usually hits about 10 percent of E. coli patients and kills up to 5 percent of those infected. Some experts warn that Germany could now face dozens of patients needing kidney transplants. "We cannot forget these people," said Dr. Karl Lauterbach, a health expert with the opposition Social Democrats who is predicting that 50 to 100 could need long-term dialysis or an organ transplant - a procedure for which they could wait up to a decade. "We need more kidney donations, we need a better treatment system and in the future we cannot underestimate such infections." The E. coli strain that broke out in Germany affected adults who were otherwise healthy and mostly aged between 20 and 50. German health authorities believe they may have been the hardest hit because they are typical consumers of vegetable sprouts, which have been identified as the source of the outbreak. In previous E. coli outbreaks, up to half of patients who developed the kidney complication were still suffering from long-term side effects 10 to 20 years after first falling sick, including high blood pressure caused by dialysis. In addition to possible kidney problems, people who have survived serious E.

coli infections may also suffer from neurological damage, as the bacteria may have eaten away at blood vessels in the brain. That could mean suffering from seizures or epilepsy years after patients recover from their initial illness. Dr. Friedrich Hagenmueller, the medical director of Asklepios Hospital Altona, in Hamburg, the center of the outbreak over the past weeks, said most patients have been recovering well, and cautioned it is too early to speculate about future complications. "There is still a chance that many of these people will get well. We see a lot of young patients who are recovering very well," he said in a telephone interview. "At the moment, nobody knows what percent of patients will suffer long-term effects." According to Germany's Organ Transplant Foundation, some 8,000 patients were waiting for a kidney, while only about 2,900 transplants were conducted in 2010. Lauterbach said that while the nation's health system could cope with the strain, being on long-term dialysis while awaiting a transplant would mean a severe drop in quality of life. And even if a patient appears to have initially recovered from kidney failure, there could still be serious setbacks as time passes, said Dr.

Charles Tomson, president of Britain's Renal Association. "There may be a time bomb effect of people who recover enough kidney function, start passing urine, their kidneys start working well enough to clear waste products, but then those people may be at increased risk of kidney failure later because they've had a period of major kidney damage and it just takes less to upset them later," Tomson said. Since the new E. coli strain appeared more lethal than related strains in the past, it was possible there would be more patients with complicated side effects in the future, he said. In Germany, if a person has not signed up to be a donor, the next of kin must decide whether to donate in the event of sudden death. That means a German can wait from seven to 10 years for a kidney, while patients seeking transplants in Britain or the United States face average wait times of around three to five years. Studies commissioned by the German Foundation for Organ Transplant show that more than 80 percent of the population would be willing to donate organs, but only a fraction fill out the necessary paperwork. That leaves bereaved relatives forced to make the choice in a moment of duress. Most decide against it.

"There is not enough information about the issue," said Thomas Mehlitz, who is the transplant coordinator for Berlin's Charite Hospital and is faced with a constant lack of healthy organs needed for patients. AP Medical Writer Maria Cheng contributed to this report from London. First child death from E. coli reported in Germany Source : By_en_hl (15,Jun,2011) A two-year-old boy became the first child to be killed by the deadly E. coli in Germany on Tuesday, officials said. To date, the terrifying EHEC infection has claimed 36 lives in Germany and one in Sweden. The child, from the northern town of Celle, died in hospital in Hanover of kidney failure and abnormal breakdown of red blood cells, two extreme symptoms of the infection with enterohaemorrhagic E. coli (EHEC), authorities in the state of Lower Saxony said. The boy became the youngest known fatal victim since the outbreak of E. coli in May. His father and 10-year-old brother were also infected with the deadly bacteria, but are recovering, doctors told a local newspaper.

The Robert Koch Institute, Germany's national disease prevention and control agency, said on Tuesday that a total of 3, 235 cases had been reported in the country. Among them, 782 people are suffering from haemolytic uraemic syndrome (HUS), a life- threatening illness arising from E. coli, which would destroy human kidney and nervous system. The institute added that the number of new infections is declining sharply in recent days, with only seven reported on Tuesday. German authorities announced on Friday that bean sprouts from a farm in northern Germany were one source of the outbreak, and dropped the previous warning against eating raw cucumbers, tomatoes and lettuce. However, the food panic has caused losses worth hundreds of millions of dollars for European farmers. Evidence Suggests Sprout Seeds Were Contaminated Source : by Mary Rothschild | Jun 13, 2011 Health authorities have said contaminated bean sprouts were the source of the outbreak of E. coli O104:H4 in Germany, and that became more evident this weekend. But as the epidemiological and laboratory evidence mounted, so did the toll of victims, even as the rate of infection slowed.

The latest numbers released Monday: 36 dead and 3,330 ill. Meanwhile, the German Federal Institute for Risk Assessment (BfR) reported Monday that epidemiological evidence "confirms suspicions" that sprout seeds could be at the center of the contamination, and advised against eating raw sprouts, even homegrown sprouts. The BfR said a family in Lower Saxony became infected with enterohemmorhagic E. coli (EHEC) after eating home-sprouted seeds. Investigators now believe they have "definitive proof" that sprouts from an organic farm in the Bienenb?ttel, Germany were at least one source of the outbreak, The Local newspaper reported Sunday. On Saturday, an analysis by BfR confirmed that bacteria on sprouts found in the garbage bin of two case patients in Rhein-Sieg-Kreis matched the outbreak strain, according to the Federal Consumer and Agriculture Ministry.

European Union Health Commissioner John Dalli said in a statement, "The source of contamination is now identified and the epidemiological findings are backed by laboratory results." Here are more highlights from the investigation and other reports: The investigation: -- Friday's announcement that bean and seed sprouts were the "most likely vehicle" of the outbreak was the conclusion of authorities from the Robert Koch Institute (RKI), the Federal Institute for Risk Assessment and the Federal Office of Consumer Protection and Food Safety. "It is the sprouts," RKI president Reinhard Burger said at their joint news conference. -- So far there is no evidence that bean and seed sprouts from the implicated farm in Lower Saxony were exported beyond Germany. -- Authorities are recommending that people in Germany not eat raw bean and seed sprouts of any origin. "Households, caterers, and restaurants should dispose of any bean and seed sprouts that they have, and food items that might have come in contact with them ...." -- Meanwhile, the recommendation to avoid cucumbers, tomatoes and lettuce in northern Germany has been cancelled since Friday.

The illnesses: -- As of June 10, 68 percent of the cases of hemolytic uremic syndrome (HUS) in Germany were in females and 88 percent in adults aged 20 years or older. -- As of June 10, 60 percent of the E. coli infections (without HUS) were in females and 87 percent in adults aged 20 years or older. -- On Saturday, RKI said there had been a reduction in the number of E. coli/HUS cases reported to them. The number of patients showing up at emergency rooms with bloody diarrhea has not decreased since June 6. -- Cases of illnesses linked to the outbreak in Germany have now been reported in Austria, Canada, the Czech Republic, Denmark, France, Greece, Luxembourg, Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United Kingdom and the United States. -- At present, RKI says the possibility of human introduction of the E. coli pathogen into the sprouts at the farm can't be ruled out. "However, water, preceding suppliers or seeds are also possible sources.

These possibilities are currently under investigation through investigations of supply chains and laboratory analyses." -- Because the seed used for the production of sprouts may also be the source of the pathogen, other sprout producing businesses could potentially be contributing to the spread of E. coli O104:H4 as well, RKI warned. News reports from Germany: -- Karl Lauterbach, health spokesman for the opposition Social Democrats, told the Bild am Sonntag newspaper that about 100 patients have suffered such terrible kidney damage that they may require transplants or need dialysis for the rest of their lives. -- In Germany local hospitals report E. coli infections to state health officials, who then notifiy RKI, the national health authority, a process that can take at least a week. That slow reporting process may be one reason the epidemic became so widespread. -- RKI reported that fewer new cases of bloody diarrhea are being reported, but it is not yet clear whether this is because people have been avoiding tomatoes, cucumbers and lettuce (items often served with sprouts), or because the contaminated sprouts have been depleted. Publisher's Platform: Warning Labels for Sprouts?

Source : by Bill Marler | Jun 12, 2011 With well over 40 outbreaks linked to sprouts over the last few decades, it should come as no surprise that the 33 dead and more than 3,000 ill (789 with HUS) in Europe and the United States have been linked to German-grown, locally consumed organic sprouts. In fact, the Chemical and Veterinary Investigation Office of Rhine-Ruhr-Wupper has found E. coli O104 in an opened package of sprouts retrieved from the trash of a household in Rhein-Sieg-Kreis. Two of the three family members in the household ate the sprouts and were infected with the outbreak pathogen. The sprouts came from G?rtnerhoff Bienenb?ttel GmbH from Lower Saxony. John Remmel, Consumer Protection Minister for North Rhine-Westphalia, cautions that the new finding is not definitive, as the package of sprouts had already been opened. Additional studies are still in progress.

However, earlier Reinhard Burger, president of the Robert Koch Institute, Germany's national disease control center, said the pattern of the outbreak had produced enough evidence to draw that conclusion even though [at the time] no tests of sprouts from an organic farm in Lower Saxony had come back positive for the E. coli strain behind the outbreak. Warnings have been lifted against lettuce, tomatoes and cucumbers. On Friday, Burger said at a press conference with the heads of Germany's Federal Institute for Risk Assessment and Federal Office for Consumer Protection: "It is the sprouts." The CDC almost agrees with me: Sprouts Not Healthy Food for Everyone Children, the elderly, and persons whose immune systems are not functioning well should not eat raw sprouts, because current treatments of seeds and sprouts cannot get rid of all bacteria present. Persons who are at high risk for complications from foodborne illness should probably not eat raw sprouts, according to an article in the current issue of Emerging Infectious Diseases, CDC's peer-reviewed journal, which tracks new and reemerging infectious diseases worldwide. Although sprouts are often considered a "health food," the warm, humid conditions needed for growing sprouts from seeds are also ideal for bacteria to flourish. Salmonella, E.

coli, and other bacteria can grow to high levels without affecting the appearance of the sprouts. Researchers have treated both seeds and sprouts with heat or washed them in solutions of chlorine, alcohol, and other chemicals. Some of these disinfectants reduced the levels of bacteria, but a potential hazard remained, especially for persons with weak immune systems. High temperatures that would kill the bacteria on the seeds would also keep them from sprouting. Until an effective way is found to prevent illness from sprouts, they should be eaten with caution, if at all. Sprouts Are the Cause, Who's to Blame? Source : by Ross Anderson (11,Jun, 2011) So the mystery of Germany's sproutbreak is finally solved. Let the finger-pointing begin. Nearly six weeks into the European epidemic of toxic E. coli O104:H4, German authorities Friday confirmed what had been suspected for days - that it was locally grown sprouts from an organic farm in Lower Saxony that sickened more than 3,000 people. But that announcement only intensified public criticism targeting public health officials at the Robert Koch Institute (RKI) and other German agencies responsible for food safety.

First detected in the first few days of May, the outbreak has raged unabated for nearly six weeks, with the toll mounting daily - 3,086 sick, 789 with hemolytic uremic syndrome, 31 dead. Critics pointed out that hundreds, even thousands of illnesses might have been prevented had the source been identified sooner and pulled from regional markets and restaurants. To make matters worse, public attention was drawn for more than a week to other vegetables, especially cucumbers from Spain, which were wrongly fingered as a possible source. The German establishment newspaper Der Spiegel compiled criticisms from all points in the the political spectrum. The conservative Die Welt: "Why did authorities look at Spanish cucumbers so long and so intensely in their search for the E. coli source when a closer look revealed them to be innocent? Why did the E. coli hunters not focus much sooner on the sprouts from Lower Saxony?" That paper pointed out that another German agency, the Federal Institute for Risk Assessment, had warned consumers about "bacterial contamination of sprouts and kitchen-ready salad mixtures." That warning was updated in early May, even as the outbreak was beginning.

"Why didn't the alarm bells go off at the agency?" the newspaper asked. The leftist Frankfurter Rundschau sees a paralyzing conflict between federal and regional authorities. The RKI "isn't allowed to question patients (because) that's the domain of regional authorities," the paper said. That critique reinforced the observations of U.S. epidemiologists, who have wondered from the outset why German officials were so slow to interview victims about what they had eaten in previous days and weeks. "You don't have to interview everybody, just a statistical sample," said Dr. Kirk Smith, foodborne illness director at the Minnesota Department of Health. But tracing outbreaks to their source depends on quick and thorough interviews, using people trained to conduct such interviews, he said. He and others pointed out that the concentration of illnesses in northern Germany should have made the investigation much easier - and quicker. With hundreds of illnesses in a relatively small area, the source is likely to be local -- which should have cast serious doubt on the Spanish cucumber theory. In another critique compiled by Der Spiegel, the Berlin daily Tagesspiegel commented; "Organic is good, chemicals (are) bad. We get this message drummed into us every day.

It is a macabre irony that evil chemistry ... is now saving people whose lives have been endangered by organic food." Other critics focused on the nature of German political authority, which places substantial responsibility with regional health officials. They suggest that a stronger federal authority might have been able to detect and respond more quickly to the epidemic. That analysis is similar to the continuing debate over public health in the U.S., where some state health departments are consistently more successful than others at dealing with foodborne illness. O104:H4 May Change How We Deal With E. coli Source : by James Andrews (16, Jun, 2011) With recent estimates attributing the ongoing German E. coli outbreak to 3,406 illnesses and 39 deaths, it has become the deadliest -- and second largest -- E. coli outbreak in history. And while already singular in its impact, the outbreak sets itself farther apart in that its infections have resulted not from the infamous E. coli strain O157:H7, but O104:H4, a rare strain never before linked to a large foodborne illness outbreak.

In the weeks following the outbreak's onset in Germany, an unprecedented collaboration of scientists worldwide have taken to studying O104, analyzing its genes to compare it to other strains and better understand its underlying characteristics. Jorge Gir?n, Ph.D., E. coli researcher and associate professor of microbiology at the University of Florida's Emerging Pathogens Institute, believes this outbreak could lead to significant adjustments in how both agriculture producers and healthcare providers deal with E. coli. What most predominantly differentiates O104 from O157 is its adoption of numerous traits not typically found congregated in one strain: Not only does it produce the noxious Shiga toxin of the virulent enterohemorrhagic strains, it also possesses defensive enteroaggregative traits --a combined mouthful of properties much more difficult to tolerate physically than verbally. The term "enteroaggregative" refers to sticky strains of the bacteria that group together --aggregate -- into a "stacked-brick pattern" and cling to intestinal tracts. Once there, they induce heavy mucus production in their host's intestines, which they then use for both protection and sustenance. Enteroaggregative E.

coli are known to cause persistent diarrhea, but are historically unrelated to hemorrhaging and hemolytic-uremic syndrome (HUS), the acute kidney disease caused by Shiga toxin-producing enterohemorrhagic E. coli. O157 is enterohemorrhagic, but not enteroaggregative. The bacteria do not aggregate together, but they possess cell structures that help them adhere to intestines, where they produce the Shiga toxin known for inflicting HUS and making E. coli a household name among pathogens. By comparison, O104 clumps together and spurs mucus production for protection while also releasing Shiga toxin into the bloodstream, an adaptation that has resulted in at least 826 cases of HUS in this outbreak. As Ross Anderson reported for Food Safety News two weeks ago, this outbreak's ratio of HUS cases -- now roughly one in four -- is alarmingly high, at least for the time being. HUS cases among O157 infections generally average closer to one in 10.

Though Gir?n cautioned it is too early to tell if O104 is truly more virulent than O157, he said O104's nasty combination of traits likely gives it the edge. "The mucus production explains why these bacteria are so persistent," he said. "It's very hard for the immune system to get rid of them while they're embedded in the host material, and it could be that the bacteria are releasing the toxins without even being attacked." O104 is not the first known strain with this particular r?sum? of traits -- a similar strain known as O111:H2 caused a small outbreak in France in 1992 -- but it has by far caused the greatest impact, and it distinguishes itself even further in the victims it affects. Gir?n voiced special concern in the fact that O104 has predominantly caused HUS in adults, when children and the elderly are historically the main victims of Shiga toxin-producing E. coli. On Tuesday, a 2-year-old boy became the first child to die from the outbreak, which has killed 37 adults -- mainly women.

Thus far, no clear explanation for this discrepancy has surfaced, though it might be partially related to eating habits, with children less likely to eat the sprouts that have been implicated as the source of the outbreak. Numerous other commentators, including "Superbug" author and blogger Maryn McKenna, have brought up O104's extensive list of antibiotic resistances, citing it as an enormous --though tangential -- public health concern. Physicians know not to prescribe antibiotics for O157 infections because the sudden killing of the bacteria can release HUS-inducing and potentially deadly amounts of Shiga toxin. As Gir?n pointed out, that fact could have created one major problem in the early development of the outbreak: It is likely that German hospitals were only screening the first enterohemorrhagic E. coli symptoms for O157 and not O104, which no one would have suspected before news of the outbreak spread. "When people come into a hospital with bloody diarrhea, they would normally assume it's O157 and not give antibiotics to the patients," he said.

"In this case, because it wasn't O157, the physicians might have thought it was okay to give antibiotics, not knowing that O104 would produce the Shiga toxin." This potential misunderstanding over antibiotics might at least partially explain the high rate of HUS among the ill. Gir?n said this outbreak may necessitate new screening procedures at hospitals to account for O104 alongside O157, ensuring patients don't receive antibiotics that could exacerbate their illness or kill them. In regard to its environmental origins, O104 takes after the more-prevalent enteroaggregative E. coli in that only humans are its host, not cattle or other ruminants. It can spread through contact with objects in the environment, water, food, or human fecal matter. As a final caution, Gir?n warned that only sufficient cooking can eliminate E. coli from vegetables. Just weeks ago, he and several colleagues published a study showing that E. coli can infiltrate and survive in the inner tissues of spinach after industrial washing techniques and thorough washing in kitchens. "If vegetables are contaminated with E. coli, the only way to absolutely make sure they're safe is to boil or cook the plant.

That's something we're just now starting to understand," he said. "All of this is going to change how produce is treated at the industrial setting." Scientists Shed Light on Germany's Deadly Pathogen Source : by Mary Rothschild |(15,Jun, 2011) As the devastating outbreak of E. coli began unfolding in Germany, there was an urgent need to learn more about the unusual pathogen that was making hundreds of people sick. So data from the genome sequencing of the rare E. coli serotype O104 were instantly released via the Internet to researchers around the world, and a flurry of information-swapping followed. Discussions about this strange bacterium went viral, "rapidly communicated via blogs, Twitter and private web pages," according to an editorial published Tuesday in Eurosurveillance. This combination of advanced molecular typing technology and electronic communication has led to what the authors describe as intriguing, preliminary analyses "outside the standard peer-reviewed scientific publication route." The accompanying report in Eurosurveillance, written by an international team of investigators, emphasizes the importance of working collaboratively to quickly unlock the secrets of an infectious organism.

"The rapid exchange of information, strains and DNA fingerprints within national and international public health and food safety networks has been vital in the quick and alternative assessment of the public health significance causing the outbreak of HUS in Germany in May and June 2011," the authors state. The contributions have resulted not only in "important new findings on the nature and possible origin of the epidemic strain," but the microbiology has helped to devise new lab screening tools for hospitals diagnosing patients and for public health authorities investigating the outbreak. Among the findings: The outbreak strain is not a typical virulent Shiga toxin-producing (STEC) strain, the authors write, but a much rarer and "hypervirulent" hybrid -- an enteroaggregative E. coli (EAggEC) now armed with the ability to produce Shiga toxin. Adding to its virulence is a receptor for iron-chelating aerobactin, which is associated with extraintestinal E. coli strains, like those that cause diseases such as meningitis, sepsis and urinary tract infections outside the intestinal tract.

The genome of the outbreak strain "clustered closest" to an EAggEC strain isolated in 2002, with the addition of the Shiga toxin factor and antibiotic resistance genes. EAggEC causes diarrhea in travelers and persistent diarrhea in infants and young children in countries with poor sanitation, but is common in all parts of the world, industrialized and developing nations alike, the report explains. Unlike STEC, which have an animal reservoir (primarily ruminants), EAggEC have a human reservoir, so E. coli O104 likely does too. "This observation suggests the startling possibility," the authors note, "that this new O104 strain may have the capacity to persist among human populations, perhaps indefinitely." EAggEC is capable of causing diarrhea in adults and children, even in the absence of Shiga toxin, notes the report, which cites a 1993 outbreak of the bacteria among Japanese children that sickened 2,700.

The authors also state that "the role of EAggEC as an important pathogen in AIDS patients continues to develop, and EAggEC now ranks among the most important enteric pathogens in this population group." While most STEC are eae positive, the outbreak O104 strain in Germany is eae negative -- eae being genetic coding for the protein intimin, which the bacteria use to attach to the intestinal wall. The Eurosurveillance report says, " ... it is indeed conceivable that the enteroaggregative adherence phenotype could have allowed these E. coli O104 strains to colonise the intestinal mucosa of the affected patients as efficiently as typical eae-positive STEC/VTEC strains. "The different mechanism of adhesion might also explain why this strain is more likely to cause severe disease in adults rather than children ..." But the authors say this factor needs more study, and that the different rates of hemolytic uremic syndrome (HUS) between adults and children in Germany might just reflect a difference in exposures to the outbreak source. Hybrid strains of E. coli such as O104 aren't new, the researchers suggest.

For example, one HUS outbreak caused by a "mixed pathotype," but a different serotype, was reported from France in 1998. But the authors found five previously reported cases of diarrhea or HUS caused by O104:H4: Germany in 2001, France in 2004, South Korea in 2005, Georgia in 2009 and Finland in 2010. The 2011 German outbreak strain most closely resembles the Georgian strain genetically, they said, but there is no known epidemiological link between the two so "the meaning of this finding remains elusive." The Eurosurveillance editorial says that since June 10, the number of newly reported cases of infection and HUS in Germany has been gradually decreasing, "which suggests we may finally be reaching the end of the outbreak." The search for the source and vehicle of the outbreak has been "long and arduous," the editorial went on, adding that it was "extensive investigations" that finally implicated the organic sprout farm in Lower Saxony near Hamburg.

"Sprouts produced at this farm had been distributed to many of the incriminated restaurants and catering facilities, and thus identified as the likely vehicle of infection," the authors wrote. As of Tuesday, the outbreak toll was 3,335 ill, 817 with HUS and 37 dead, including a 2-year-old boy, the first child to die. How Did German Sprouts Become Contaminated? Source : by Gretchen Goetz (14,Jun , 2011) The German E. coli outbreak that has now claimed 37 lives and damaged fresh produce markets across Europe finally seems to be abating; but the question of how the suspect sprouts became contaminated remains unanswered. Investigators are looking closely at whether the problem originated with sprout seeds. After 5 workers on an organic farm in Bienenb?ttel, Lower Saxony were confirmed to have been infected with the outbreak strain of E. coli, health authorities have been trying to figure out whether they could have transferred the germ onto the sprouts or whether the sprouts made them ill. While investigators said the possibility of human introduction of the E.

coli pathogen into the sprouts at the farm can't be ruled out, and that water and preceding suppliers are also possible sources, there is growing suspicion that the sprout seeds arrived at the farm already carrying the bacteria. What health officials do know is that the 5 infected workers reported eating broccoli, garlic and fenugreek sprouts. Workers who had eaten alfalfa and spicy mix varieties of sprouts remained healthy, according to Der Spiegel. On Monday, the Federal Institute for Risk Assessment (BfR) said a family in Lower Saxony became infected with enterohemmorhagic E. coli (EHEC) after eating home-sprouted seeds grown from a kit, suggesting that seed supplied to several sprout companies may have been contaminated. What is the deadliest E. coli outbreak in history has now sickened 3,335, with 818 developing hemolytic uremic syndrome, or HUS, a life-threatening kidney complication. Because the outbreak was linked to vegetables, more and more countries have been turning away from German produce. Last week, Russia took the drastic step of banning all fresh produce imports from Germany. Monday, Taiwan said it would bar German sprouts from entering the country.

Mistrust from abroad and within the EU has cost vegetable producers dearly this season. At the height of the local growing season, sales have dipped drastically below their usual levels. Approximately 5,900 tons of cucumbers, over 3,200 acres of lettuce and 3, 500 tons of tomatoes have had to be destroyed, reported Germany's Agriculture Minister Ilse Aigner Tuesday. Given these damages, the European Union has increased the compensation it has agreed to give to European farmers from 150 million to 210 million euros, according to Neue Osnabrueker Zeitung. This brings the amount of reparations for farmers up to about 50 percent of profits lots, a "small change," say Spanish agricultural organizations, according to Economics Newspaper. As for the virulent effects of the disease, while the Commissioner of the European Union, John Dalli, said Monday that the problem is now, "under control," health minister Daniel Bahr told Bild that, "More fatalities cannot be ruled out, painful as it is to say." Monday also brought with it a scare that sprouts might not in fact have been the definitive source of the outbreak, when enterohemorrhagic E.

coli (EHEC) was found in lettuce imported from Bavaria, according to Der Spiegel. However, the E. coli strain on the lettuce was determined to be unrelated to the outbreak strain. Nonetheless, the detection of dangerous, Shiga toxin-producing E. coli on vegetables throughout Europe, including Spanish cucumbers and Bavarian lettuce, has raised concern about the prevalence of pathogens on European produce. Tennessee Tracking Three Strains of E. coli Source : by Dan Flynn | (14, Jun, 2011) Clusters of E. coli infection reported in Eastern Tennessee could be the "new normal" as non-O157 Shiga toxin-producing Escherichia coli (STEC) take their place beside O157, making outbreaks all that more difficult to sort out. "It is very confusing," said Tennessee's State Epidemiologist, Dr. Tim F. Jones on Monday, as he explained that in addition to three O157:H7 cases, two cases of E. coli O103 and one of O169 have been confirmed in the eastern end of the state.

Tennessee is being assisted by the Centers for Disease Control and Prevention (CDC) in investigating a total of 11 cases of E. coli infection. Dr. Jones said further complicating the investigation is the fact that in the DNA "fingerprinting" by pulsed-field gel electrophoresis, no two of the PFGE patterns are the same for any of the E. coli strains. PFGE patterns of bacteria isolated from the people who are ill are often used to link cases to a common source. E. coli O103 is one of the "Big Six" among the non-O157 STEC. (The others being 026, O111, O121, O45 and O145.) E. coli O169 is rare, but was reported in 1999 as responsible for two outbreaks in Japan, one involving 132 cases and the second with 126 cases. Jones said the lab-test results have left Tennessee health officials with a difficult investigation, trying to determine common foods and activities for victims. At this point, he said, sources of contamination could be anything from exposure to petting farm animals or swallowing water from the wrong swimming hole.

After health officials confirmed they were dealing with STEC bacteria, two western Virginia siblings turned up in Tennessee hospitals on June 5 with illnesses caused by E. coli O157:H7. The two-year-old girl died, while her five-year-old brother recovered after being treated at the Vanderbilt Medical Center in Knoxville. But Jones said there appears to be no connection between those two cases from western Virginia and the 11 eastern Tennessee cases, not even the O157 cases in Tennessee. Eastern Tennessee annually sees 7 or 8 cases of E. coli illness, and the spike in infections has health officials troubled. The good news may be that three suspected cases came back negative for any STEC bacteria. Only E. coli O157:H7 has been declared an "adulterant" in meat. That means it is an unacceptable, impure substance that regulators will not tolerate. USDA's Food Safety & Inspection Service (FSIS) currently is considering a petition filed in late 2009 by the Seattle food safety law firm of Marler Clark, sponsor of Food Safety News, to declare the "Big Six" as adulterants.

According to CDC figures, there are 31,229 illnesses from non-O157 Shiga toxin-producing E. coli annually in the U.S. The current deadly outbreak in Germany is caused by a strain of non-O157 Shiga toxin-producing E. coli called O104:H4. Except for a handful of returning tourists, cases involving that strain have not been seen in the U.S. German shortcomings in focus as outbreak wanes German officials seek lessons to be learned now that crisis is stabilizing Source : By GEIR MOULSON, MARIA CHENG (13,Jun,2011) The battle against Europe's deadly E. coli outbreak descended into cacophony and confusion. Now that the crisis is stabilizing, German officials acknowledge lessons to be learned. Among the problems: a tangle of federal and regional authorities, chaotic communication and a system for reporting cases that many say is antiquated. Cases began appearing at the start of May, and the outbreak swelled to crisis level over the next three weeks - with the German city of Hamburg at the epicenter. It appears to be waning after sickening more than 3,000 people and killing 36.

"We must succeed in speaking with one voice in order to give citizens the necessary information, the necessary transparency," Health Minister Daniel Bahr conceded after officials on Friday finally declared sprouts from a farm in northern Germany to be the culprit. A case in point: the sprouts were first fingered as a likely cause by regional officials nearly a week earlier, but authorities backtracked when initial tests turned out negative. All the while, a warning against cucumbers, tomatoes and lettuce, based purely on patient interviews, remained in place, causing major losses for farmers - especially in Spain. Hamburg officials for days fingered Spanish cucumbers as the probable source, but tests cleared them. The European Union's health commissioner at one point warned Germany against issuing more premature conclusions about the origin of contaminated food. Critics say the outbreak exposed weaknesses in Germany's cherished but sometimes cumbersome federal system, in which - alongside national institutions - 16 state governments have their own health authorities, a state of affairs that can result in long, potentially time-consuming, reporting chains. An editorial in the medical journal Lancet remarked that "coordination of the German public health response seems to have been utterly absent" and said that underlined a wider lack of coordination in Europe.

It said "there is a strong case for a Europe-wide review of national and continental responses to infectious disease outbreaks." The German press has been scathing. "A jumble of responsibilities reigns," German daily Sueddeutsche Zeitung commented in an editorial. It noted that the battle involved at least four offices at federal level, plus the states' health ministries and local health offices. Some in the governing coalition think critics have a point. "The cases that we are seeing today are brutal and come on very quickly, and in my opinion this diversity of official structures isn't suited to it," said lawmaker Hans-Michael Goldmann, head of parliament's consumer affairs committee. The current system, he said, dates back to the crisis a decade ago over the human form of mad cow disease - an infection that usually takes years to develop. Goldmann told German radio that three federal authorities - the disease control center, the risk assessment and food safety agencies, which report to different ministries - should now be merged into a single agency focusing on health. Another problem: a reporting system under which hospitals' notifications of a serious illness still often wind their way to the national disease control center by conventional post.

Karl Lauterbach, a health policy spokesman for the opposition Social Democrats, called for those notifications in future to be e-mailed directly to the center. "We will examine in the (parliamentary) health committee how many infections could have been prevented by an obligation to report electronically," Lauterbach told the Bild am Sonntag newspaper. Bahr, the health minister, conceded that the issue needs addressing "after a phase of calm." "It's incomprehensible to me, too, that we are still using antiquated means of communication here," he said on ZDF television. Bahr said federal authorities were informed quickly of the infections by officials in Hamburg, but information needs to be exchanged faster in future "to get a nationwide overview quickly." Paul Hunter, a professor of health protection at the University of East Anglia in England, said the outbreak could have been detected sooner if doctors regularly did lab tests on patients with diarrhea - a standard practice in Britain. "The health system in Germany should surely be able to pay for standard lab tests for people with bloody diarrhea," he said.

"If they had been testing people earlier in Germany, this outbreak would certainly have been picked up far sooner." Flemming Scheutz, the head of a World Health Organization collaborating laboratory in Denmark, said many European countries' health ministries "have no understanding" of the need to detect dangerous E. coli in the early stages. "Once it hits like this, with a virulent strain, the entire diagnostic sector is not prepared for it because the techniques are not in place," he said. "The outbreak detection is delayed maybe a week, so that means the interviews with the patients go back maybe two weeks instead of one week and how many people remember what they ate two weeks ago?" German authorities also could have helped themselves by zeroing in on the few dozen cases of people who fell sick abroad after visiting the country, said Norman Noah, a professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine. "Those people would have been far more likely to remember what they ate and where," he said. German officials have defended their warning on Spanish cucumbers, saying the vegetables were contaminated with a different strain of E. coli. But Noah said it should have been clear that was the wrong trail.

"A big clue was that the outbreak was so localized in northern Germany, yet Spanish cucumbers are sold everywhere," he said. "That really did not fit." FDA on nanotechnology: Size matters, but it's not everything ... Source : By Elaine Watson (10,Jun,2011) The Food and Drug Administration (FDA) will take size and functionality into account when it considers whether a product contains nanomaterials or involves nanotechnology, according to a new draft guidance document. But it has not come up with a legal definition of nanomaterials (yet), says the FDA. "The draft guidance does not establish a regulatory definition of the term 'nanotechnology' or any related vocabulary. Over time, we plan to issue more specific guidances tailored to particular products or classes of products." When considering whether an FDA-regulated product contains nanomaterials or involves the application of nanotechnology, FDA will in future ask: o Whether an engineered material or end product has at least one dimension in the nanoscale range (1 - 100 nanometers).

o Whether an engineered material or end product exhibits properties or phenomena, including physical or chemical properties or biological effects attributable to its dimensions, even if these fall outside the nanoscale range, up to one micrometer. These considerations will apply not only to new products, but also where manufacturing changes alter the dimensions, properties or effects of a material or its components, says the FDA. Legal minefield Agreeing on a legal definition of nanomaterials that satisfies food manufacturers, regulators, enforcement bodies and consumers has proved challenging on both sides of the Atlantic, however. If a definition concentrates on size alone, it will encompass a vast swathe of perfectly innocuous and naturally-occurring nanomaterials in products from milk to chocolate, confusing shoppers without serving any useful purpose, point out food manufacturers. But building a definition around 'insoluble', 'manufactured', or 'engineered' nanoparticles is also problematic because of the difficulty of pinning down the precise meaning of these terms, argue lawyers.

Even definitions based on whether nanomaterials behave 'significantly' differently to their normal-sized counterparts raise similar issues (what's the definition of 'significantly'?) Even agreeing on how to measure such tiny materials is a thorny issue owing to the unusual shape and structure of many nanoparticles. And as particle sizes in many materials are rarely consistent, many substances contain some particles on the nanoscale, and some that are not. Meanwhile, the cost and complexity of the equipment needed to examine materials at this scale - atomic force or scanning electron microscopes, for example - makes enforcement expensive and challenging. Unilever: Nano labels must be meaningful and specific In a round table debate on nanotechnology facilitated by the UK's Food Standards Agency last year, Unilever R&D director, regulatory affairs, consumer confidence and sustainability, Charles-Francois Gaudefroy, said several factors needed to be taken into account when coming up with a worakable definition of a nanomaterial.

"[It must take into account] particle size; deliberate engineering; digestibility for nanomaterials used in foods and solubility in conditions of use for materials used in home/personal care products; the characteristic properties of the nanomaterial compared to its non-nano forms." As for nano labels, it was important to establish their purpose before ploughing ahead, he stressed: "We support labelling provisions where they provide meaningful specific information to consumers." Nanotechnology in food Nanotechnology promises an exciting range of benefits to consumers from the targeted release of nutrients to antimicrobial biofilms and lighter-weight packaging able to block out oxygen, carbon dioxide and moisture. Other interesting applications include nano-sensors that could detect pathogens, nano-encapsulation of natural food colours and other bioactives, and nanocellulose for moister bread, crispier crackers and juicier meat products. Click here for a round-up of nanotechnology applications in food from our sister title FoodManufacture.co.uk.

Tainted soft drink reports prompt bans on Taiwanese imports Source : By Guy Montague-Jones, (14, Jun, 2011) Food safety authorities in Asia and Australasia have banned a number of soft drinks from Taiwan after it emerged that a clouding agent had been contaminating with the plastics additive DEHP. Sports drinks, juices and fruit jellies are among the products that have been pulled from shelves in Taiwan and banned by trading partners in the wake of the contamination scare. What is DEHP? Used in food and drink packaging to make plastic less brittle, di (2-ethylhexyl) phthalate (DEHP) is not approved as a food additive by any national authority. But it has emerged that a clouding agent used in drinks in Taiwan had been adulterated with the potentially cancer-causing additive. There have so far been no confirmed reports of illness but to protect public health the Taiwanese government has overseen the destruction of 2.3 tons of tainted beverage products, according to Associated Press. International reaction Trading partners have been alerted and food safety authorities in a number of countries have announced product bans. On Friday, Chinese authorities announced the suspension of imports of 950 products from 280 Taiwanese companies.

And an alert published by the USDA Foreign Agricultural Service last week said Hong Kong has so far banned two sports drinks and one fruit jelly product from Taiwan. The contamination incident has also prompted the Hong Kong government to set a maximum threshold for DEHP - bearing in mind that low levels of the additive may be present in food due to migration from plastic packaging. Concern about the DEHP contamination incident spread as far as New Zealand where food safety authorities banned imports of a guava fruit drink and a lemon drink from Taiwan. Meanwhile, the European Food Safety Authority (EFSA) told this publication that it had not been asked to work on the case for the moment. Kellogg warned over listeria in cookie plant 'Significant violations' found during FDA inspection of Georgia facility Source : By_msnbc.com news services (14, Jun, 2011) The Food and Drug Administration says it found traces of listeria at a Kellogg Co. plant in while inspecting a company cookie plant in Augusta, Ga. earlier this year.

In a letter released Tuesday, dated June 7, FDA regulators said "during our inspection we found that you have significant violations of the Current Good Manufacturing Practice (CGMP) regulations for food manufacturers." The pathogen was found in several spots along the production line that come in direct contact with food. Kellogg makes a variety of Keebler and Famous Amos cookies at the factory and says it has "undertaken a number of aggressive actions to address (the FDA's) concerns, including comprehensive cleaning and extensive testing." "While the FDA did not identify specific concerns with the food, we take this situation very seriously ... We have confidence in the safety of our food," Kellogg spokeswoman Kris Charles said. Based on the findings of the inspection, FDA said it had "determined that the foods manufactured at your facility are adulterated ... in that they have been prepared, packed, or held under insanitary conditions whereby they may have become contaminated with filth, or whereby they may have been rendered injurious to health." FDA said Kellogg had 15 working days following receipt of the letter to outline what it planned to do to correct the violations.

Eating food contaminated with the bacterium listeria monocytogenes can cause a dangerous infection called listeriosis. Symptoms may include diarrhea and other gastrointestinal symptoms, fever, muscle aches, stiff neck, confusion and convulsions, according to the Centers for Disease Control and Prevention. In the United States, an estimated 1,600 people become seriously ill with listeriosis each year. Of those infected, about 260 die. Infections during pregnancy can lead to miscarriage, stillbirth, premature delivery or life-threatening infection to the child, CDC said. The company is already struggling to recover from massive recalls of food products last year. Sneaky Salmonella: It's Common, Costly, and Preventable Source : By Capt. Christopher R. Braden (09,Jun,2011) Each year, roughly 1 in 6 people in the United States gets sick from eating contaminated food. Each of those illnesses represents something that went wrong somewhere along the pathway from a farm to our table. Behind these illnesses are familiar culprits (like Salmonella) and causes (like poor food safety practices in farms, factories, restaurants, or homes).

Salmonella are bacteria that cause over one million illnesses each year. This "bug" causes more hospitalizations and deaths than any other type of germ found in food and $365 million in direct medical costs each year. At CDC, we're concerned that Salmonella infections have not declined in 15 years. So, how does Salmonella sneak into foods, what foods do they get into, and what can be done? How does Salmonella get into foods? Simply put-it gets into food through the poop of animals, such as cows, birds, and mice. Because the natural home for Salmonella bacteria is in the gut of these animals, their poop becomes a carrier of the germ if it gets into food or water. For example, if water used to irrigate a field has animal poop in it, the water can contaminate the food growing in the field. Contamination can also occur where food is being made. For instance, a tainted ingredient can get on equipment, floors, storage bins, or someone's hands and then spread to other food. In fact, a cutting board or knife that has germs on it can contaminate other foods and lead to food poisoning. What foods does Salmonella get into?

One reason why it's tough to reduce Salmonella infections is because the germ makes its way into so many different types of foods. Salmonella can contaminate meats, poultry, eggs, fruits, vegetables, and even processed foods such as peanut butter. What can be done? You can't smell or see Salmonella in or on food. That's why it's important to do everything that you can to be food safe at home: o Follow the tried-and-true behaviors of CLEAN, SEPARATE, COOK, and CHILL. When it comes to Salmonella, this means: o Wash your hands, utensils, cutting boards, and other surfaces before and after handling meat and poultry. o Thoroughly wash fresh fruits and vegetables. o Assume that raw chicken and other meat have Salmonella and don't allow them to contaminate surfaces and other foods, such as produce. o Don't wash meat, poultry, and eggs! This can actually spreadSalmonella to other foods. o Cook meat, poultry, and eggs thoroughly to safe temperatures. o Avoid unpasteurized dairy products (including soft cheeses) and juices. o Make sure shellfish are cooked or treated for safe eating.

o Report suspected food poisoning to your local health department. o Never prepare food for others if you have diarrhea or vomiting. o Pay attention to food recall notices. Never serve or eat food that has been recalled. You can also support policies that encourage good food safety practices among farmers, grocery stores, and places that make, sell, or serve food. 39 Ill from Salmonella Tainted Chicks, Ducklings Source : by Mary Rothschild (10,Jun, 2011) A multistate outbreak of Salmonella linked to backyard chicks and ducklings has expanded to affect 39 people in 15 states, the Centers for Disease Control and Prevention reported Thursday. A national mail-order hatchery, Feed Store Chain A, is implicated in the outbreak, which was first reported by the CDC in May. Lab tests detected the Salmonella Altona outbreak bacteria on a chick and in the the yard of an ill person's household in Ohio, as well as from three samples in chick and duckling displays at two of the company's locations in North Carolina. In its latest update report on the outbreak, the CDC said many of the illnesses began between Feb. 25 and May 23.

Nine people have been hospitalized due to severe symptoms. Forty-four percent of those sickened are 5 years of age or younger. Eight people have been infected with the outbreak strain of Salmonella in Ohio; six in North Carolina; four in Kentucky and Pennsylvania; three in Maryland and Virginia; two in New York and Tennessee; and one in Georgia, Indiana, Michigan, Minnesota, New York, Vermont, Wisconsin and West Virginia, the CDC said. Illneses that occurred after May 6 may not have been reported due to the time it takes between when a person becomes ill and when the illness is reported. The CDC's advice to people who are raising poultry at home: -- Wash your hands thoroughly with soap and water right after touching live poultry or anything in the area where they live and roam. Adults should supervise hand washing for young children. -- If soap and water are not readily available, use hand sanitizer until you are able to wash your hands thoroughly with soap and water. -- Clean any equipment or materials associated with raising or caring for live poultry outside the house, such as cages or feed or water containers.

-- Do not let children younger than 5 years of age, elderly persons, or people with weak immune systems handle or touch chicks, ducklings, or other live poultry. -- Do not let live poultry inside the house, in bathrooms, or especially in areas where food or drink is prepared, served, or stored, such as kitchens, or outdoor patios. -- Do not snuggle or kiss the birds, touch your mouth, or eat or drink around live poultry. -------------------------- Outbreak map from the Centers for Disease Control and Prevention Two Clues in Germany E. coli Puzzle Source : by Gretchen Goetz (09,Jun, 2011) German officials Wednesday expressed some optimism that Europe's E. coli outbreak is finally ebbing. But they also acknowledged two more food poisoning deaths, and warned that more deaths are likely. As of Thursday, the grim toll from the five-week-old crisis included 27 dead and more than 2,800 ill, 720 of them with hemolytic uremic syndrome (HUS), the serious complication of E. coli infection responsible for 18 of the outbreak fatalities.

After several days during which the investigation focused on bean sprouts as a possible source of the outbreak, German investigators shifted their focus back toward cucumbers. In particular, officials cited a family in eastern Germany that was sickened with the outbreak strain of E. coli O104:H4. A cucumber contaminated with the same strain was found in the family's compost pile. However, investigators cautioned that there is no way to tell whether the family was infected by the cucumber, or vice versa. The cucumber had been in the compost for about 10 days, from May 19 to May 30, so there was a strong possibility that cross contamination could explain why the bacteria was detected on the cucumber. At the same time, new circumstantial evidence lent more credence to the theory that sprouts from a farm in Lower Saxony might have been the spark that lit the outbreak fire. One hundred EHEC patients are now known to have eaten in 4 cafeterias and 3 restaurants where the farm's sprouts were served. In addition, one more farm employee (in addition to 2 others previously identified) may have suffered bloody diarrhea, according to Der Spiegel.

Results of tests from sprouts with a longer growing time (more likely to be connected to earlier batches) are expected Friday. Is the trail too cold? David Acheson, a food safety consultant formerly with the U.S. Food and Drug Administration, told NPR News that many signs indicate that German health authorities are "struggling" in their efforts to find the source. "There's nothing worse than coming up with one source, and then a second source, and coming back and saying: Whoops! We mad a mistake!'" Acheson said. "It really seems like they're all over the map." Acheson and other experts suggest that German health authorities have relied too heavily on high-tech laboratory analysis of victims and potential sources, looking for genetic matches. They appear to have pursued that strategy rather than traditional epidemiology, which relies on extensive interviews with outbreak victims, searching for common denominators -one or more foods that have been consumed by all of the cases. By the time German authorities began investigating, the epidemic had been going on for nearly three weeks, and the contaminated food had either been consumed or discarded, Acheson said. "They want confirmed evidence," Acheson said.

"But this far out, that can be almost impossible to get." An evolved, but not new, strain Meanwhile, the Wall Street Journal reported that the deadly E. coli strain responsible for the outbreak was first identified 10 years ago, in Munster, Germany. Alexander Mellmann of the University Hospital of Munster, told the Journal that the genetic analysis may help trace the epidemic to its source. "Everything we know so far indicates it is an evolved strain," Mellmann told the Journal. "If it was completely unknown, we'd struggle a lot more in our effort to fight it." The cost of medical treatment While lives can not be quantified in terms of money, medical costs can give a good picture of how severe the human damage has been thus far. The U.S. Centers for Disease Control and Prevention (CDC) estimates that a single fatal case of E. coli O157 (another Shiga-toxin producing strain of E. coli with similar effects to the one in this outbreak) costs approximately $7 million dollars in medical expenses.

Multiplying that by the number of deaths in this outbreak so far yields an amount of $168,000,000, and that doesn't include the costly treatment, including kidney dialysis, for the other 671 HUS cases who so far are surviving or medical care for the other 2,000 who are infected. In legal cases, HUS patients are usually rewarded an average of $3 million in damages, which in this outbreak would amount to $2.36 billion, according to attorney Bill Marler of the food safety law firm Marler Clark, publisher of this site. International cases Most of those who have been sickened are in Germany, thought to be the site of exposure, but the epidemic also has affected visitors from 12 other European countries, including Austria, Czech Republic, Denmark, France, Luxembourg, Netherlands, Norway, Poland, Spain, Sweden, Switzerland and the United Kingdom according to World Health Organization (WHO). Sweden and Denmark have been hit hardest. The former has 31 patients, 15 of them with HUS, a staggeringly high figure compared with the usual 10 percent of E. coli patients who develop this complication.

On Wednesday, the Canadian press reported an Ontario resident was ill with the same, virulent strain, but said he is expected to recover. In the U.S., CDC is reporting 3 HUS cases, 1 of them confirmed as part of the outbreak, and 1 suspected E. coli case. All of these case patients recently returned from Germany. CDC has issued an advisory to travelers to Germany echoing the Germans' warning not to eat sprouts, tomatoes, cucumbers or leafy salads in that country -- all are still suspect as possible sources of the epidemic. 6th International Conference for

Question: What salad vegetable was initially at the centre of international debate, notably between Spain and Germany, after a fatal E.coli outbreak in May 2011 in the latter nation?
Answer: Cucumber