More than 120 sick in German E. coli outbreak

German officials are continuing to battle a serious E. coli outbreak that may have sickened more than 120 people.

In total, 121 patients are linked to the outbreak. Of these, 67 are confirmed and 20 people have developed hemolytic uremic syndrome (HUS). HUS is a clinical syndrome related to E. coli, which can lead to kidney failure, brain damage and death. Of the 54 probable cases, eight have developed HUS.

Confirmed infections are illnesses in which E. coli O45:H2 is detected by laboratory analysis. Suspected cases are illnesses for which diagnostics are not yet sufficient or for which no pathogen isolate is available.

Mostly children sick
The Mekcklenburg-Vorpommern State Office for Health and Social Affairs (LAGuS) and the State Office for Agriculture, Food Safety and Fisheries (LALLF) started investigating an unusual cluster of E. coli infections in August. The Robert Koch Institute (RKI) has been supporting the outbreak investigation since the end of August.

As part of the weekly exchange between the state authorities for infection control and the RKI, LAGuS reported five cases of E. coli or HUS in children in the Vorpommern-Rügen district in mid-August. The infections mainly affected vacationers who had stayed in the region. Shortly afterwards, additional patients, particularly children, were reported in Mecklenburg-Vorpommern.

The National Reference Center (NRZ) for Salmonella and other bacterial enteritis pathogens at RKI then identified the outbreak strain as E. coli O45:H2.

The median age of confirmed cases is 5 years old, and among all outbreak cases it is 7 with a range of under 1 to 92 years old. Females are slightly more affected than males. Date of illness onset is between Aug.11 and Sept. 9. These details may change as lab confirmation is still pending for several patients.

Search for source ongoing
RKI staff are interviewing patients or their parents by phone using a questionnaire to generate hypotheses about possible causes and sources of infection. Sick individuals who live in Mecklenburg-Vorpommern are asked about the seven days before they fell sick.

Based on information so far, characteristics of the pathogen, and experience with other outbreaks, officials believe illnesses were caused by contaminated food. However, the probable cause of infection has not yet been narrowed down through the surveys. Even the analysis of receipts and information from shopping apps has not yielded the breakthrough.

A case-control study is being conducted, in which the data from patients on the frequency of consumption of certain foods are compared with responses from a control group.

The outbreak strain is rare in Germany. From January 2015 to June 2025, the NRZ detected only 13 strains of this serovar among 10,633 analyzed samples. 

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