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Crisis management overall positive during the EHEC epidemic
The Federal Minister of Health Daniel Bahr (FDP) has drawn a positive balance with regard to crisis management during the recent EHEC epidemic. Even if the information policy may have had a chaotic effect on the public, the fight against EHEC infections and the identification of the new, particularly aggressive bacteria of the serotype O104: H4 (HUSEC041) from the genus Enterohaemorrhagic Escherichia coli (EHEC) went relatively well.
As part of a panel discussion at the annual meeting of the German Society of Nephrology that will continue until tomorrow, the Federal Minister of Health had expressly praised "the cooperation of clinics across national borders" in combating the EHEC epidemic. In addition, "the identification of sprouts on a global scale is a top achievement," said the Federal Minister of Health. When the first EHEC infections appeared immediately after taking office on May 19, his staff had already prepared him for the fact that the EHEC crisis could be far more stressful than swine flu in 2009, reports Daniel Bahr. Last but not least, due to the good crisis management, the EHEC epidemic was, in retrospect, significantly less serious than many experts initially feared.
Most severe EHEC epidemic in Germany to date As the numbers in the final report from the Robert Koch Institute (RKI) show, as many people in the past EHEC epidemic became infected with the dangerous intestinal bacteria as never before in Germany. Since the first infections occurred in May 2011, 3,842 people have been diagnosed with an EHEC infection, 855 of them suffered from the so-called hemolytic uraemic syndrome (HUS) and 53 people died from the consequences of the infection. The unusually high proportion of EHEC infected with HUS is an exceptional situation compared to the previous EHEC epidemics. The new, particularly aggressive HUSEC 041 pathogens caused severe EHEC symptoms of HUS significantly more often, with increasing health impairments including kidney failure and neurological disorders being observed, explained the Federal Minister of Health. The kidney specialists who looked after the care of HUS patients deserve special credit here, explained Daniel Bahr.
Praise for the rapid identification of the source of infection At the annual meeting of the German Society for Nephrology, the experts also reported that the identification of the food causing the EHEC was extremely quick. While the search for the source of the infection may have seemed a bit chaotic in public, the period in which the fenugreek sprouts from Egypt were identified as the pathogen speaks for itself, said Gérard Krause, head of the Department of Infection Epidemiology at the RKI. For comparison, the expert gives the example of a series of Salmonella infections in the USA from 2008. After more and more people fell ill with the Salmonella strain "Saintpaul", the search for the source of the infection took seven weeks. Those affected had eaten contaminated chili peppers, which were cut into small pieces in commercially available tomato sauces. With the recent EHEC epidemic, however, it only took three weeks for the fenugreek sprouts from Egypt to be identified as the source of the EHEC infections, emphasized Gérard Krause.
However, the researchers were also a little lucky in their search for the source of the infection, since most EHEC infected people were not even aware that they had consumed the sprouts. It was only through the accumulation of infections after visiting certain restaurants and the evaluation of photos of the meal dish that much attention was paid to the fact that all patients who had consumed fenugreek sprouts. During the further investigations, the authorities found that the Bockhornklee sprouts from a company in the Uelzen district were offered in all 41 restaurants and canteens, in which several people were infected with EHEC. According to the experts, sprouts are generally considered to be a kind of “stealth food”, since very few sufferers think of eating the sprouts as a possible cause of the illnesses after an infection.
Further investigations to assess health risks required The participants in the panel discussion at the annual meeting of the German Society for Nephrology also underlined the importance of the work of the team around the microbiologist and EHEC expert Prof. Dr. Helge Karch from the Institute of Hygiene at the Center for Clinical Theoretical Medicine at the University of Münster in combating the EHEC epidemic. The Münster-based researchers had already developed a rapid test immediately after the first EHEC infections appeared, with which the new, particularly aggressive pathogen HUSEC 041 can be clearly detected. Prof. Karch himself emphasized, however, that “we still do not know much about how the strain was created and how it will develop.” According to the expert, further investigations are urgently required in order to conclude the health risks posed by the new EHEC pathogen to rate. The microbiologist and his team have been working on a register of the EHEC bacteria that cause HUS for years, although the strain HUSEC 041 was “nowhere known in the world” and therefore “nobody was in sight”, explained Karch.
Criticism of communication and reporting around the EHEC epidemic The SPD health expert Karl Lauterbach, who, as representative of the opposition, also pointed out a little about the shortcomings in crisis management in the EHEC epidemic, was another participant in the panel discussion. Although the balance in the fight against epidemics should be assessed positively, the reporting system has to be criticized clearly, said Lauterbach. The SPD health expert was not alone in making this allegation, because the federal structures and reporting channels have in fact brought about considerable delays. The President of the German Society for Nephrology, Reinhard Brunkhorst, also criticized the usual official route to the RKI via the health offices and state authorities and raised the question: "How can you be satisfied if it takes ten days for a report to reach the RKI ? ”According to Brunkhorst and Lauterbach, direct reporting of the EHEC infections to the RKI would also be clearly advantageous in terms of disease control. In addition, the treating doctors should be more involved in the search for the source of the infection, the experts demanded.
The conference president and medical director of the Berlin Charité, Ulrich Frei, also criticized the poor communication about the EHEC crisis in public. The Federal Minister of Health also saw some weaknesses here and emphasized that he would have liked to have communicated more calmly "with more consultation". The fact that "six different theories on the cause of EHEC" came up in various media talks, ranging from "bio-terrorism to asparagus and strawberries to." to the cut flowers from Mother's Day ”caused additional uncertainty in public. The SPD politician Lauterbach also criticized the actions of some state ministers, whom he would have expected to be more cautious. The premature announcement of suspected sources of infection was sometimes unsafe for the public leave a chaotic impression. (fp)
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EHEC epidemic survived