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    Cases in Germany

    The Health Protection Agency says that there have been 470 cases of HUS in Germany, with nine reported deaths. German authorities have also reported 1,064 cases of bloody diarrhea related to the outbreak with four deaths, bringing the total number of official reported deaths in Germany to 13. German media have put the death toll higher, reporting that at least 17 people have died.

    The Food Standards Agency in the U.K. says it has found no evidence that produce from possible sources identified with the outbreak has found its way into U.K. food outlets. It says that the European Commission has not been able to identify the exact source of the contamination.

    The outbreak was caused by a rare organism called verocytotoxin-producing E. coli (VTEC) O104. Reports from Germany refer to the VTEC cases as cases of Shiga-toxin producing E. coli (STEC). VTEC is also sometimes called Enterohaemorrhagic E. coli (EHEC).

    Cucumbers Initially Blamed

    Initial reports in Germany blamed Spanish cucumbers for the outbreak. These have not been confirmed and investigations are continuing.

    The Health Protection Agency says that until the sources are found, anyone visiting Germany should avoid raw tomatoes, cucumbers, and leafy salad including lettuce, especially in the north of the country.

    The Health Protection Agency is working with the authorities in Germany, the European Centre for Disease Control, and the WHO.

    Hemolytic Uremic Syndrome

    Hemolytic uremic syndrome is a serious complication from VTEC infection that affects the blood, kidneys, and in severe cases, the central nervous system. It requires hospitalization and can be fatal.

    Most people normally carry harmless strains of E. coli in their intestines. The harmless strains and the type causing illness are usually contracted by eating or drinking contaminated food or water. It can also spread from other people or animals through contact with feces.

    Dilys Morgan, head of the gastrointestinal, emerging, and zoonotic infections department at the Health Protection Agency, says in a statement, "The HPA continues to actively monitor the situation very carefully and we are working with the authorities in Germany and with our counterparts across Europe as to the cause of the outbreak.

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