Health Advisory

Shiga Toxin-producing E. coli O104 (STEC O104:H4) Infections in U.S. Travelers Returning from Germany

To:      Vermont Healthcare Providers and Clinical Laboratories
From:  Patsy Kelso, PhD, State Epidemiologist for Infectious Disease
Date:   June 06, 2011

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CDC is monitoring a large outbreak of Shiga toxin-producing Escherichia coli O104:H4 (STEC O104:H4) infections ongoing in Germany. As of May 31, 2011, the Robert Koch Institute reported 470 patients with hemolytic uremic syndrome (HUS), and nine deaths. The strain of STEC causing this illness, STEC O104:H4 is very rare. The illness it causes is similar to that caused by E. coli O157:H7.

CDC is not aware of any cases of STEC O104:H4 infection ever being previously reported in the United States. However, to date four cases of HUS in the U.S. have been reported in people who recently traveled to Germany. CDC is working with state health departments to learn more about these suspected cases and obtain bacterial isolates for further characterization. There have been no reported cases to date in Vermont.

Symptoms of STEC infection include severe stomach cramps, diarrhea (which is often bloody) and vomiting. If there is fever, it usually is not very high. Most people improve within 5 to 7 days, but some patients go on to develop HUS, usually about a week after the onset of diarrhea. The classic triad of findings in HUS is acute renal damage, microangiopathic hemolytic anemia (evidence of schistocytes and helmet cells on peripheral blood smear), and thrombocytopenia.

Actions Requested

To ensure STEC infections are detected and characterized as completely as possible, and to improve patient outcomes, we ask Vermont healthcare providers and clinical laboratories to do the following:

It is often difficult to isolate STEC in stool by the time a patient presents with HUS. Immunomagnetic separation (IMS) has been shown to increase recovery of STEC from HUS patients. If necessary, the Health Department Laboratory will forward stool for any patient with HUS without a culture-confirmed STEC infection to the CDC for IMS. In addition, serum can be sent to CDC through the Health Department Laboratory for serologic testing of common STEC serogroups.

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