Timeliness of Surveillance during Outbreak of Shiga Toxin–producing Escherichia coli, Germany, 2011

DOI: http://dx.doi.org/10.3201/eid1710.111027
Suggested citation for this article: Altmann M, Wadl M, Altmann D, Benzler J, Eckmanns T, Krause G, et al. Timeliness of surveillance during outbreak of Shiga toxin–producing Escherichia coli, Germany, 2011. Emerg Infect Dis. 2011 Oct; [Epub ahead of print]

Timeliness of Surveillance during Outbreak of Shiga Toxin–producing Escherichia coli, Germany, 2011
Mathias Altmann, Maria Wadl, Doris Altmann, Justus Benzler, Tim Eckmanns, Gérard Krause, Anke Spode, and Matthias an der Heiden

Author affiliations: Robert Koch Institute, Berlin, Germany (M. Altmann, M. Wadl, D. Altmann, J. Benzler, T. Eckmanns, G. Krause, M. an der Heiden); and Health Department of the Hamburg Northern District, Hamburg, Germany (A. Spode)

In the context of a large outbreak of Shiga toxin–producing Escherichia coli O104:H4 in Germany, we quantified the timeliness of the German surveillance system for hemolytic uremic syndrome and Shiga toxin–producing E. coli notifiable diseases from 2003–2011. Although reporting occurred faster than required by law, potential for improvement exists at all levels of the information chain.
In May and June 2011, Germany experienced the largest outbreak of hemolytic uremic syndrome (HUS) and bloody diarrhea related to Shiga toxin–producing Escherichia coli (STEC) ever reported (1,2). As of June 20, a total of 2,518 STEC cases and 786 HUS cases meeting the case definitions for this outbreak were reported to the national agency for infectious disease epidemiology (Robert Koch Institute [RKI]) through the surveillance system in Germany for notifiable diseases (GSSND) (3). The first outbreak-associated case-patient fell ill on May 1, followed by a sharp increase in the number of HUS case-patients on May 9 (by onset of symptom). Case numbers by disease onset peaked around May 22. Epidemiologic and food trace-back investigations identified fenugreek sprouts, grown from seeds probably contaminated by STEC, at a farm in Lower Saxony to be the vehicle of the outbreak (4). From June 10 on, German authorities recommended that raw sprouts should not be eaten.
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