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  1. Analysis
August 5, 2011

German E. coli outbreak: After the outbreak the learning begins

The German E. coli contamination that has killed more than 50 people is now officially over, according to health officials. But the scale of this event ensures a lengthy aftermath. Ben Cooper looks at the impact of the outbreak and where lessons might be learnt.

The German E. coli contamination that has killed more than 50 people is now officially over, according to health officials. But the scale of this event ensures a lengthy aftermath. Ben Cooper looks at the impact of the outbreak and where lessons might be learnt.


It is telling that a week after officials stated that the E. coli outbreak in Germany was over, just-food is reporting an outbreak of salmonella in the US which has killed one person and made another 70 ill.


What does this suggest to us? That such food scares are more prevalent? Some would say yes and may point to industrialised food production and intensified agriculture as the cause. Others would counter by saying that we need mass-produced food and the science that has made it possible has concurrently contributed to making large-scale food production ever safer.


On that debate, you can pay your money and take your choice.


However, the quick succession of these two events definitely reminds us that such contaminations – while technically avoidable and therefore not ‘inevitable’ – do happen. It is an apparent and regrettable truth that the one we are currently dealing with – or reporting on – will not be the last.


In this sense, there is an analogy with air accidents – in 99.9% of cases avoidable and yet, we know, somehow inevitable.


And that analogy goes further. When an aeroplane goes down, amid all the other reactions, there is an immediate and highly methodical search for the cause in order to try to prevent the same thing from happening again.


With regard to food contaminations, a considerable amount of that work already begins during the event. In that sense, the analogy with air accidents breaks down. The analysis and any resulting intervention performed immediately after an outbreak comes to light actually saves lives during the incident, but by the same token delays or mistakes at that stage may cost lives.


In all, 52 people died from this outbreak, which is a chilling statistic when compared with other large-scale contaminations. The outbreak of E. coli in spinach in the US in 2007, which was considered a major contamination at the time, only resulted in three deaths. The salmonella in peanuts contamination two years later, also in the US, resulted in nine deaths. Some 4,300 people became ill as a result of the German outbreak, compared with around 200 in the 2007 outbreak and 700 in 2009.


But, as with an air crash, the personal tragedy these figures represent can also spawn technological and procedural improvements which can reduce the risk of something similar happening.


Given that the outbreak first began in May and it was some weeks before it was accurately traced to fenugreek seeds imported from Egypt into Germany, with Spanish cucumbers initially blamed in error, questions have been asked as to whether mistakes were made at that vital early stage.


It is interesting to note that the European Food Safety Authority (EFSA) did not convene its taskforce to coordinate investigations in member states until 26 June, after an “urgent” request from the European Commission, though EFSA pointed out that it had begun “close monitoring” of the outbreak on 27 May, and issued public health advice jointly with the European Centre for Disease Prevention and Control (ECDC) on 3 June.


The EFSA taskforce published its report on 5 July http://www.efsa.europa.eu/en/press/news/110705.htm, EFSA having issued a joint assessment with ECDC on 29 June.


In addition to the human toll, the EU is also counting the financial cost. The compensation package being paid to farmers was increased to EUR227m (US$323.9m) at the end of July, having originally been EUR210m. The European farmers’ federation, Copa-Cogeca, estimated that growers were at one stage losing EUR400m per week during the outbreak.


The Commission also launched a promotional campaign on 22 July “to help address the difficulties faced by the fresh fruit and vegetables sector following the E. coli crisis” and “win back consumer trust”.  The campaign consists of an advertorial and an audiovisual package for distribution in all EU countries.


Clearly, the lack of earlier identification of the source has cost money as the package will finance compensation for producers of cucumbers, tomatoes, lettuces, courgettes and sweet peppers that were withdrawn from the market between 26 May and the end of June, as it turned out unnecessarily.


Dr Craig Hedberg of the University of Minnesota School of Public Health is among the health experts who believe the way the outbreak was handled has raised questions. In particular, Hedberg said that omitting sprouts from the original case-control study was an error on the part of German health officials that had led to the erroneous association with cucumbers, lettuce and tomatoes.


Although the reason for this was that the first case-control study had suggested that fewer than half of the sick patients reported eating sprouts, Hedberg said that was “not acceptable” because sprouts were “a known previous vehicle” and therefore should automatically have been part of any case-control study.


During a debate in the European Parliament as early as 7 June, MEPs criticised the German authorities for a lack of communication and coordination, while others said the EU was not prepared for this kind of crisis.


On the other hand, this outbreak has underlined how genetic research can assist in the analysis of food contaminations. Indeed, scientists are heralding the work done in this regard during the outbreak, including the way international cooperation between academics was aided by digital media, as ground-breaking.


Speaking at the opening of a rather timely food safety conference in Brussels last month, John Dalli, EU Commissioner for Health and Consumer Policy, spoke about the outbreak and official EU efforts to address it.


“Lessons must be learned from the recent E. coli crisis as such crises can have devastating public health and economic consequences,” Dalli said. While he said the outbreak had confirmed the importance of “full and efficient implementation” of EU safety mechanisms, he alluded to the negative impact of early mistaken attribution. He said the outbreak had shown that “information on alleged sources of infection must be supported by robust evidence to avoid spreading unjustified panic and creating problems for food producers”.


Dalli catalogued the Commission’s actions, which he said included activating the Rapid Alert System for Food and Feed and the Early Warning and Response System as soon as the outbreak was detected.


He said the Commission had held meetings with EU scientific bodies and public health and food safety authorities “almost on a daily basis”. However, while he mentioned that the assistance of EFSA experts in co-ordinating investigations carried out by the member state authorities had been “crucial” in identifying sprouted seeds as the source of the outbreak, he did not explain why it had taken so long to convene the EFSA taskforce.


“Notwithstanding the good work done, we must identify the right tools for better assessment of outbreak situations and improve communication of health concerns,” he said. “This will help us to avoid incurring considerable economic losses which can result from such outbreaks.”


Dalli concluded by saying that the Commission will “continue to apply the principle that prevention is better than the cure, on which the entire EU food safety legislative framework rests”, and that the forthcoming revision of animal and plant health law would further reinforce this approach.


The scientists carrying out the post-outbreak investigative work are less concerned with the emotive rhetoric and the “lessons have to be learned” platitudes of politicians and bureaucrats. Like air crash investigators, they have to put the human tragedy to one side and focus on preventing the same thing from happening again, or at least reducing the negative impact if it does. And as with air investigators, their success is measured by how long they have to wait before the telephone rings again.

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