Rapid communication Open Access
Like 0


We report an ongoing, protracted and geographically dispersed outbreak of haemolytic uraemic syndrome (HUS) and gastroenteritis in Germany, involving 30 cases since December 2016. The outbreak was caused by the sorbitol-fermenting immotile variant of Shiga toxin-producing (STEC) O157. Molecular typing revealed close relatedness between isolates from 14 cases. One HUS patient died. Results of a case–control study suggest packaged minced meat as the most likely food vehicle. Food safety investigations are ongoing.


Article metrics loading...

Loading full text...

Full text loading...



  1. Mellmann A, Bletz S, Böking T, Kipp F, Becker K, Schultes A, et al. Real-Time Genome Sequencing of Resistant Bacteria Provides Precision Infection Control in an Institutional Setting. J Clin Microbiol. 2016;54(12):2874-81.  https://doi.org/10.1128/JCM.00790-16  PMID: 27558178 
  2. Karch H, Wiss R, Gloning H, Emmrich P, Aleksić S, Bockemühl J. [Hemolytic-uremic syndrome in infants due to verotoxin-producing Escherichia coli]. Dtsch Med Wochenschr. 1990;115(13):489-95. German.  https://doi.org/10.1055/s-2008-1065036  PMID: 2180670 
  3. Nielsen S, Frank C, Fruth A, Spode A, Prager R, Graff A, et al. Desperately seeking diarrhoea: outbreak of haemolytic uraemic syndrome caused by emerging sorbitol-fermenting shiga toxin-producing Escherichia coli O157:H-, Germany, 2009. Zoonoses Public Health. 2011;58(8):567-72.  https://doi.org/10.1111/j.1863-2378.2011.01405.x  PMID: 21824358 
  4. Alpers K, Werber D, Frank C, Koch J, Friedrich AW, Karch H, et al. Sorbitol-fermenting enterohaemorrhagic Escherichia coli O157:H- causes another outbreak of haemolytic uraemic syndrome in children. Epidemiol Infect. 2009;137(3):389-95.  https://doi.org/10.1017/S0950268808001465  PMID: 19021923 
  5. Ammon A, Petersen LR, Karch H. A large outbreak of hemolytic uremic syndrome caused by an unusual sorbitol-fermenting strain of Escherichia coli O157:H-. J Infect Dis. 1999;179(5):1274-7.  https://doi.org/10.1086/314715  PMID: 10191236 
  6. King LA, Loukiadis E, Mariani-Kurkdjian P, Haeghebaert S, Weill FX, Baliere C, et al. Foodborne transmission of sorbitol-fermenting Escherichia coli O157:[H7] via ground beef: an outbreak in northern France, 2011. Clin Microbiol Infect. 2014;20(12):O1136-44.  https://doi.org/10.1111/1469-0691.12736  PMID: 24962059 
  7. Jaakkonen A, Salmenlinna S, Rimhanen-Finne R, Lundström H, Heinikainen S, Hakkinen M, et al. Severe Outbreak of Sorbitol-Fermenting Escherichia coli O157 via Unpasteurized Milk and Farm Visits, Finland 2012. Zoonoses Public Health. 2017.  https://doi.org/10.1111/zph.12327  PMID: 28045227 
  8. Werber D, Bielaszewska M, Frank C, Stark K, Karch H. Watch out for the even eviler cousin-sorbitol-fermenting E coli O157. Lancet. 2011;377(9762):298-9.  https://doi.org/10.1016/S0140-6736(11)60090-1  PMID: 21256378 
  9. Pollock KG, Locking ME, Beattie TJ, Maxwell H, Ramage I, Hughes D, et al. Sorbitol-fermenting Escherichia coli O157, Scotland. Emerg Infect Dis. 2010;16(5):881-2.  https://doi.org/10.3201/eid1605.091919  PMID: 20409394 
  10. Orth D, Grif K, Dierich MP, Würzner R. Sorbitol-fermenting Shiga toxin-producing Escherichia coli O157: indications for an animal reservoir. Epidemiol Infect. 2006;134(4):719-23.  https://doi.org/10.1017/S0950268805005467  PMID: 16371175 
  11. Zweifel C, Fierz L, Cernela N, Laaksonen S, Fredriksson-Ahomaa M, Stephan R. Characteristics of Shiga Toxin-Producing Escherichia coli O157 in Slaughtered Reindeer from Northern Finland. J Food Prot. 2017;80(3):454-8.  https://doi.org/10.4315/0362-028X.JFP-16-457  PMID: 28207302 
  12. Bielaszewska M, Schmidt H, Liesegang A, Prager R, Rabsch W, Tschäpe H, et al. Cattle can be a reservoir of sorbitol-fermenting shiga toxin-producing Escherichia coli O157:H(-) strains and a source of human diseases. J Clin Microbiol. 2000;38(9):3470-3. PMID: 10970407 

Data & Media loading...

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error