Without wishing to cause alarm, a threat to public health has become apparent in Germany, which we thought we should bring to your attention.  Please do consider the information below if you have colleagues who are travelling to Germany, or have recently returned from the country.

An outbreak of Enterohaemorrhagic Escherichia coli (EHEC), more commonly known as E coli, has spread to levels of epidemiological significance, with cases reported in a number of different parts of the country.

Although there are usually around 1,000 cases per year in Germany, the past few days have seen over 400 cases present in regions as far apart as Bremen and Lower Saxony.  Specifically (and in addition to Bremen and Lower Saxony), health officials have identified the northern state of Schleswig-Holstein, Hamburg, Hesse and Mecklenburg-Vorpommern, as major sites of infection.

E coli symptoms include abdominal cramps and diarrhoea that may in some cases progress to bloody diarrhoea (haemorrhagic colitis).  Fever and vomiting may also occur.  The incubation period can range from three to eight days, with a median of three to four days.

It is important to note that most patients recover fully within 10 days, however, in a small proportion of patients (particularly young children and the elderly), the infection may lead to severe complications.

Until the source of the outbreak is identified, public health officials will be limited to awareness and maintaining high standards of public hygiene as the most effective ways to contain the outbreak.

E coli is transmitted to humans primarily through consumption of contaminated foods, such as raw or undercooked ground meat products and raw milk.  Faecal contamination of water and other foods, as well as cross-contamination during food preparation (with beef and other meat products, contaminated surfaces and kitchen utensils), will also lead to infection.

Outbreaks have also been associated with the consumption of fruits and vegetables (sprouts, lettuce, coleslaw, salad), where contamination may be due to cntact with faeces from domestic or wild animals at some stage during cultivation or handling.

Should you have colleagues who have recently travelled to Germany who present with any symptoms associated with E coli, medical assistance should be sough at the earliest opportunity.

If you have colleagues planning to travel to Germany, awareness of the risks associated with food preparation and an affirmation of personal hygiene standards should be considered, as well as being aware of the presenting symptoms associated with E coli.

We will continue to monitor developments, although if you would like any further advice regarding E coli, or wish to discuss any particular cases, please contact our team at any time.