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No U.S. Outbreak; Cases Linked to German Lettuce, Cucumber, Tomatoes

June 3, 2011 -- Six Americans, two of them on a military base in Germany, have been sickened by the deadly new E. coli strain outbreak in northern Germany.

Four of the Americans fell ill after separately visiting Germany. One became ill on the airplane while on the way back to the U.S. Two women and one man remain hospitalized. The two members of the military remain in Germany.

German researchers have linked the outbreak to contaminated lettuce, cucumbers, and/or tomatoes. But it's not yet clear exactly which produce carries the dangerous bacteria or how it became contaminated.

However, it's very unlikely that any of the contaminated food has or will reach the U.S., says David Elder, director of regional operations for the FDA.

"This outbreak has not affected the U.S. Our produce remains safe and there is no reason for Americans to alter where they shop or what they eat," Elder said at a news teleconference. "But the U.S. has established import controls and upped surveillance of tomatoes, cucumbers, and lettuce from Germany and Spain. We will examine all such produce, and any found to be contaminated will be intercepted."

The outbreak is caused by a rare strain of shiga toxin-producing E. coli bacteria, dubbed STEC O104:H4. Similar strains have been seen only twice before, says Chris Braden, MD, director of the CDC's division of foodborne, waterborne, and environmental diseases.

Virulent New E. coli Strain

It's a disturbingly virulent bug. The World Health Organization reports that as of June 2, it had caused 552 cases of hemolytic uremic syndrome (HUS), which usually results in serious kidney damage. Twelve of the cases -- 11 of them in Germany -- have been fatal. And the outbreak has caused 1,271 cases of bloody diarrhea, six of them fatal.

While the new bug is causing far more cases of serious disease than other STEC strains, the symptoms are similar: severe stomachcramps, diarrhea (often bloody), and vomiting. Fever, if any, is not very high. Cases usually resolve in five to seven days, unless a person develops HUS about a week after the diarrhea starts.

Germany's highly respected Robert Koch Institute, which is tracking the outbreak in much the same way as the CDC tracks U.S. outbreaks, says HUS cases are unusually high in the northern German states of Hamburg, Schleswig-Holstein, Bremen, and, to a lesser extent, Mecklenburg-Western Pomerania.

People in Germany are being advised not to eat raw cucumbers, lettuce, or tomatoes -- particularly if they are obtained in northern Germany. At this time, the World Health Organization is not recommending any trade restrictions related to this outbreak.

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