You will find below two documents from the European Center for Disease Prevention and Control and the Robert Koch Institute (RKI) that point to their level of understanding back on May 26/27th. The Health Ministry of Germany still seems to say that they don't know the source of the outbreak eight days later. The other news are hat the specialists are still asking people what they have eaten when in fact, the two reports below show you that you just need to be in physical contact (hand to hand) with people that have been exposed to it to get sick. In short, getting the cell phone records of sick people might be a much better way to evaluating second hand exposure than asking people if they have eaten raw tomatoes. If the exposure to a large part of the population is due to uncleaned surfaces touched by first exposed people then asking whether they have eaten tomatoes won't help. We now have 12 countries with citizens who have been exposed to this outbreak and so we are beginning to have enough statistics to find out the culprit.
From a May 27th European Center for Disease Prevention and Control risk assessment:
"...The update provided by Germany on 27 May reports 276 cases of HUS since 25 April. While HUS cases are usually observed in children under 5 years of age, in this outbreak 87% are adults, with a clear predominance of women (68%). Cases in children of school age are also reported. Two people affected by HUS have died. The onset of disease relating to the latest reported case was 25 May. New cases are still being reported.
Laboratory results from samples taken from patients have identified STEC strain of serotype O104:H4 (Stx2-positive, eae-negative). A German study has shown that eae-negative STEC strains generally affect adults more than children. Two strains isolated from patients from Hesse and Bremerhaven were shown to be highly resistant against third generation cephalosporins (ESBL) and resistant to trimethoprim/sulfonamid and tetracyclines. Most cases are from, or have a history of travel to, northern Germany (mainly Hamburg, Northern Lower Saxony, Schleswig-Holstein). Clusters of cases were reported from Hesse and linked to a catering company that supplies cafeterias. These most likely constitute a satellite outbreak.
The source of the outbreak has not yet been confirmed and intensive investigations are ongoing. German health authorities suspect that contaminated food is the vehicle of the outbreak, based on the epidemiological description (e.g. age and geographical distribution) of the cases. Current investigations are focused on raw vegetables. Preliminary results of a case-control study (with 25 cases and 96 controls) conducted by the Robert Koch Institute (RKI) and the health authorities in Hamburg demonstrate a significant association between disease and the consumption of raw tomatoes, fresh cucumbers and lettuce. Considering that the ongoing outbreak included many cases with a severe course of disease, the RKI and the Federal Institute for Risk Assessment (BfR) recommend people in Germany to abstain from consuming raw tomatoes, fresh cucumbers and leafy salads, especially in the northern part of the country, until further notice. Regular food hygiene rules remain in effect. .."
Preliminary results of the STEC/HUS Case Control StudyPreliminary results of the epidemiological case-control study conducted jointly by the Robert Koch Institute and Hamburg Health Authorities show that the patients affected by the current EHEC outbreak consumed raw tomatoes, cucumbers and lettuce significantly more often compared to the healthy controls. However, whether only one or more of these three vegetables are associated with the outbreak remains unclear.Although the consumption of the described food items could explain the majority of the HUS-cases, other food items cannot be definitely excluded as the source of infection. The study was carried out in Hamburg only; therefore results cannot be generalized to other affected areas in Germany.In total 25 cases with HUS and 96 controls from Hamburg were included in the study since Friday, 20th of May 2011. They were matched according to gender, age group and area of residence. Detailed information concerning consumed food, eating habits and other possible sources of infection was compared between the hospitalized patients and healthy individuals (controls).The outbreak has affected the Northern part of Germany most severely, suggesting that the contaminated food items were mainly distributed there. Nevertheless, as HUS-cases were reported from other parts of Germany as well, contaminated food items could be present in other regions as well.As the outbreak is still ongoing and the public health impact is serious, the RKI and the BfR recommend as a precaution until further notice - in addition to the usual hygienic measures concerning handling of fruits and vegetables – not to eat raw tomatoes, cucumbers and lettuce, especially in the Northern Germany.It remains of vital importance for all persons with diarrhea to follow strict hand hygiene, especially if in contact with small children and immunocompromised individuals. Recommendations for good kitchen hygiene practice, as described in the BfR information sheet (www.bfr.bund.de), remain valid.Date: 26.05.2011.."