Programa sectorial

Press release June 10, 2011, Update from 9:00

Joint statement issued by the Federal Institute for Risk Assessment (BfR), Federal Office of Consumer Protection and Food safety (BVL), Robert Koch Institute (RKI)

Conclusions 1. BfR, BVL and RKI jointly conclude that the current general recommendation to abstain from eating cucumbers, tomatoes, lettuce in northern parts of Germany does not needto be upheld. 2. In addition to adherence to good hygiene practices, BfR, BVL and RKI recommend abstaining from eating raw sprouts. Households and gastronomic businesses should dispose of any sprouts currently in stock as well as any food items that might have come in contact with these. 3. BfR, BVL and RKI recommend in addition that all food products originating from a distinct producer in LowerSaxony be taken from the market. 4. BfR, BVL and RKI recommend strict adherence to good hygienic practices when handling food or caring for patients. This notice replaces earlier recommendations issued by BfR and RKI regarding the consumption of cucumbers, tomatoes and lettuce.

State of knowledge regarding human infections Current situation Data from several surveillance systems established atthe Robert Koch Institute confirm a decline in the number of new EHEC infections. The sentinel surveillance system established in hospital emergency departments shows that the daily number of patients presenting with bloody diarrhoea – as the first indication of a possible EHEC infection – as well as the proportion of female cases is declining. Mathematical modelling of statutory notificationdata taking into account the notification delay also confirms that the number of reported cases in the affected areas is continually decreasing, both using the date of symptom onset as well as the date of hospitalization. The observed decline may be due to changes in the dietary consumption of cucumbers, tomatoes and lettuce (which may indirectly have led to a reduced consumption of sprouts) or to agradual disappearance of the source of infection.

Earlier epidemiological studies
Since May, 20, 2011 RKI together with other federal and state authorities for health and food safety has been investigating an outbreak of hemolytic uremic syndrome (HUS) in northern Germany. The cause of the outbreak could be progressively narrowed down through the analysis of several consecutiveepidemiological studies that built upon one another. For methodological reasons, the first two case-control studies were limited to exposures that were hypothesized – based on extensive exploratory interviews – to potentially explain a large proportion of cases. Epidemiological analysis of these studies showed that cases consumed raw tomatoes, cucumbers and lettuce significantly more often than healthy studyparticipants. These findings were complemented by results of another case-control study conducted among affected customers of a canteen that revealed a strong association between the consumption of foods from the salad bar and EHEC infection. As neither the results of these studies results nor available information from investigations of the food safety authorities permitted a more preciseidentification of the source of infections, RKI initiated further studies. „Recipe-based restaurant cohort study” With a high probability, the results of the „recipe-based restaurant cohort study” finally permit narrowing down the source of the infection to the consumption of sprouts. It was possible to apply this methodological approach only after a sufficient number of restaurant customers could beidentified to ensure adequate statistical power of this analysis. To ascertain the consumption of raw fruit and vegetables by patients and controls more objectively and less dependently on memory, RKI used the following approach in the “recipebased restaurant cohort study”: Five groups (travel groups, clubs, etc) that comprised a total of 112 participants and included 19 individuals who acquired EHEC...