Cases Cases began as early as 1 May 2011 with a man in
Aachen reporting bloody diarrhea. On 26 May, German health officials hastily and prematurely announced that cucumbers from Spain were identified as a source of the
E. coli outbreak in Germany, when in fact the source were Egyptian sprouts. On 27 May 2011, German officials issued an alert distributed to nearby countries, identifying organic cucumbers from Spain and withdrawing them from the market. 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 cross-contamination during
transport in Germany and distribution in
Hamburg are not discounted; in fact, the most probable cause is cross-contamination inside Germany. The
Robert Koch Institute advises against eating raw tomatoes, cucumbers, and lettuces in Germany to prevent further cases. On 31 May, an EU official said the transport chain was so long, the cucumbers from Spain could have been contaminated at any point along the transit route. Spanish officials said before, there was no proof that the outbreak originated in Spain; Spanish Secretary of State for European Affairs
Diego López Garrido said, "you can't attribute the origin of this sickness to Spain." The only previous documented case of EHEC O104:H4 was in
South Korea in 2005, and researchers pointed at contaminated
hamburgers as a possible cause. On 4 June, German and EU officials had allegedly been examining data that indicated an open catering event at a restaurant in
Lübeck, Germany, was a possible starting point of the ongoing deadly
E. coli outbreak in Europe. German hospitals were nearly overwhelmed by the number of
E. coli victims. A spokesman for the agriculture ministry in
Lower Saxony, warned people on 5 June to stop eating local
bean sprouts, as they had become the latest suspected cause of the
E. coli outbreak. A farm in
Bienenbuettel, Lower Saxony, was announced as the probable source, but on 6 June, officials said this could not be substantiated by tests. Of the 40 samples from the farm that were being examined, 23 had tested negative. But on 10 June, the head of the Robert Koch Institute confirmed the sprouts were the source of the outbreak, and people who ate the sprouts were nine times more likely to have bloody diarrhea. The
WHO have confirmed on 10 June this statement on the update 13 of the EHEC outbreak. According to the head of the national
E. coli lab at the German Federal Institute for Risk Assessment, the strain responsible for the outbreak has been circulating in Germany for 10 years, and in humans not cattle. He said it is likely to have gotten into food via human feces. A joint risk-assessment by
EFSA/
ECDC, issued 29 June 2011, made a connection between the German outbreak and a HUS outbreak in the
Bordeaux area of France, first reported on 24 June, in which infection with
E. coli O104:H4 has been confirmed in several patients. The assessment implicated
fenugreek seeds imported from
Egypt in 2009 and 2010, from which sprouts were grown, as a common source of both outbreaks, but cautioned, "there is still much uncertainty about whether this is truly the common cause of the infections", as tests on the seeds had not yet found any
E. coli bacteria of the O104:H4 strain. The potentially contaminated seeds were widely distributed in Europe. Egypt, for its part, steadfastly denied it may have been the source of deadly
E. coli strain, with the Minister of Agriculture calling speculations to that effect "sheer lies". Using epidemiological methods the outbreaks in 2011 were traced to a shipment of seeds from Egypt that arrived in Germany in December 2009. ==International response==