E. Coli: The Aftermath

Photo credit: PlaxcoLab (CC BY-SA)

By Gabriella Vas

On June 12, 2011, yet another German died of kidney failure due to an E. Coli infection.

With this, the death toll of one of the world’s largest known E. Coli outbreaks rose to 36, while registered cases amount to 3325 in 13 EU states, according to the latest update published by the European Centre for Disease Prevention and Control (ECDC).

Though the bacterium Escherichia Coli is generally a harmless inhabitant of the human and animal gut, its Shiga-toxin producing (STEC) strains can cause severe enteric and systemic disease in humans and lead to serious complications, such as kidney failure due to haemolytic uremic syndrome (HUS).

The disease spreads through contact with animals unaffected by the deadly strain, and through contaminated food or water. Person-to-person transmission, though also possible, has not been reported in this outbreak.

Even a small dose of the bacteria can set off the infection, with the first symptoms appearing after 3 to 8 days. Treatment consists mostly of rehydration; antibiotics may do more harm than good, triggering a further release of the toxin or a deterioration into HUS.

While similar infections usually affect children, the majority of patients in this outbreak are adults, predominantly women, a risk-assessment report by the ECDC revealed. Almost exclusively, cases are located in or have traveled to Northern Germany.

Farmers’ Clamors Successful

The outbreak was first reported by Germany on May 22 through the Early Warning and Response System (EWRS) of the EU. Initially, cucumbers and other raw vegetables from Spain were suspected of carrying the bacteria. German authorities warned against the consumption of these, and they were promptly removed from the market.

On June 1, tests conducted by Germany’s Federal Institute for Risk Assessment (BfR) lifted the blame from the incriminated batch of produce, but by this time, Spanish agricultural exporters had already claimed a profit loss of 200 million euros weekly, and demanded compensation.

According to press releases by the European Commission, at the meeting of health care ministers on June 6, Commissioner for Health and Consumer Policy John Dalli expressed regrets concerning the farmers’ damages, but pointed out that in such a case of emergency, quick updates to the public are just as important as verifying information.

The following day, at the EC meeting for agricultural ministers, Commissioner for Agriculture Dacian Ciolos proposed a 150 million euro compensation to the affected producers from the common EU budget, amounting to about 30% of their damages. As several member states pushed for 100% compensation, the Commissioner promised to propose an amendment in the regulations that would permit this increase.

Given the relative success of European farmers to claim compensation for their loss of profit, the question arises: what about the people who have suffered a much more serious damage, that of health, due to the same outbreak?

History Repeating?

Precedents include the serial blunders of the leading Norwegian meat producer Gilde, with repeated cases of contamination between December 2005 and May 2006, which led to over a dozen children falling ill, one of whom died. Though, after several recalls and tests exposing outrageous hygienic conditions, the guilt of Gilde was beyond doubt, it in turn accused retailers, and even the Norwegian Food Safety Authority faced charges of mishandling the situation. Eventually, though, Gilde offered a compensation of 20000 to 175000 NOK (2500 to 22300 euros) to 18 victims, Aftenposten.no reported.

In a different case of food contamination, earlier this year in Germany, up to 3000 tons of animal feed additive were found to contain traces of dioxin, a substance known to cause cancer in humans, according to BBC Online. Though authorities declared that the level of dioxin in the affected products did not pose a health risk, consumers were advised to “keep an eye out” for possibly tainted eggs and poultry.

Harles&Jentzsch, the company that had produced the contaminated feed, was to be fined or face up to three years in prison based on German law, though officials pressed for a tightening of the regulations to impose stricter penalties.

However, as a May update by the Meat Trade News Daily revealed, Harles&Jentzsch might eventually get away with a 20000 euro fine. That is a relatively mild punishment, considering that the food scandal H&J brought about cost thousands of animal lives and a dramatic loss of revenue for the entire German meat and eggs sector.

To cite another example, in January 2011, victims of an E. Coli outbreak in Britain were granted eligible for compensation upon successful negotiation by the solicitors Hodge, Jones and Allen. It appears that in the summer of 2009, all of them had visited a farm in Surrey which keeps tame goats, cows and other animals for petting.

Faced with evidence that a deadly strain of E. Coli had been detected in the animals’ pens, and that it remained open for two weeks after the first infections had been reported, the farm declined to dispute its liability. 93 people contracted the disease, including some children who suffered so serious kidney damage that they may need organ replacements in the future.

No One In Charge

“I am sorry we cannot answer your questions”, confessed Dr Stefan Etgeton, Head of Health and Nutrition at the Federation of German Consumer Organizations (VZBV). “This is not an issue we have been working on”, commented Ophélie Spanneut of the European Consumers’ Organization (BEUC) in Brussels.

“These questions are too specialized for me to answer”, reflected Márton Hajdú, spokesperson for the Hungarian Presidency of the European Commission. His colleague, Eszter Lantos added: “The issue of liability in case of such an outbreak is beyond the scope of the EC, which fulfills merely an overseeing role, and more likely to be discussed on member state level.”

Who, then, is in charge of liability and compensation issues in case of an international, food-borne disease outbreak in Europe? Like the gravy bowl at Thanksgiving, the question was passed around among food safety, health and consumer protection organizations, on a European level as well as in the most affected Germany and Denmark.

Eventually, a pattern began to emerge. The core principles of food safety and risk management are the same throughout Europe: observing the entire food chain, with regulations and inspections “from farm to fork”; traceability of all foodstuffs; and, most importantly, separating risk assessment from risk management.

To make sure that scientific research of such importance is not affected by political interests, risk assessment is the duty of independent institutions, which then advise policymakers in charge of risk management. Ideally, transparent risk communication takes place at various levels: within the research community, between government and industry, and, ultimately, towards the public. In order to minimise risk, precautionary measures may be taken even before it is fully assessed.

In the EU, the European Food Safety Authority (EFSA) plays the role of independent scientific advisor to the European Commission, the EP and the European Council, working closely with the European Centre for Disease Prevention and Control (ECDC), and the European office of the World Health Organization (WHO).

The German correspondent of the EFSA is the Federal Institute for Risk Assessment (BfR), providing information to the Federal Ministry of Food, Agriculture and Consumer Protection (BMELV), which is in charge of food safety legislation and risk management measures. If there was any knowledge that would point towards a solution, it was at the BfR, where tests were being conducted to identify the source of the current outbreak.

No One To Blame

In the meantime, on June 10, the official warning against cucumbers, tomatoes and lettuce was cancelled, and suspicion turned to sprouts produced by a farm in Uelzen, south of Hamburg. Up to that day, no claims for compensation by E. Coli patients or families of victims had reached the governments of Germany or Denmark – quite understandably, given the obscurity surrounding the origin of the outbreak.

“In order to confirm our hypothesis, the same strain of bacteria needs to be found on more samples”, explained Jürgen Thier-Kundke, press official at the BfR. “Currently we have some 4-500 sprout samples waiting to be tested. But with the suspicious batch of sprouts soon to expire, it will be increasingly difficult to find further samples. Maybe some leftovers tucked away in somebody’s fridge…”

He added: “In three quarters of food-poisoning outbreaks, the source is never identified. Furthermore, in the present case, so far, no sign of human failure or negligence has been found anywhere in the food chain. It’s quite possible that no one is to blame. The BfR pointed out as early as a year ago that raw produce, by default, carries the risk of bacterial infection. Not just of E. Coli, but salmonella, listeria, what have you.”

The following day, tests conducted with the remaining samples at the BfR went on to prove that it was in fact the sprouts grown at the Uelzen farm that had triggered the outbreak. The BfR press release did not conclude that the producer was in any way responsible.

Battle Over Liability Could Drag On

“E. Coli compensation claims are possible when it can be established that the condition was caused by a failure to adequately prevent E.Coli from being passed on”, it reads on the website of Hodge, Jones and Allen, solicitors dealing with personal injury claims such as E. Coli.

Partner Melanie Williams, and specialist on the issue, elaborated: “If claims are made in connection with holiday travel to Germany, patients can sue the travel agency; if they are linked to the consumption of imported food, the retailer is to be held liable, both under the Consumer Protection Act. In the latter case, the claimant must provide a sample of the defective product as evidence. As for the consumers’ eventual responsibility to stay informed of latest updates or to refrain from eating the indicated vegetables raw, the Consumer Protection Act is not concerned with that – it cannot be expected of people to take such risks into account.”

She added: “The Consumer Protection Act applies only within the UK legislation, but since it reflects EU law, all member states are bound to have similar legislation. That is, although the international nature of this outbreak certainly complicates matters, patients are most likely expected to file compensation claims within their respective countries. Procedures may take up to several years, depending on various factors, such as the opponent’s willingness to cooperate, the course of the disease and the length of medical treatment, as well as the number of people claiming damages. Usually, larger groups take longer to sort out.”

Outlooks Hazy

Fair enough, the story of this devastating disease is far from over, in fact, it evolves from day to day. True, an outbreak of such magnitude, crossing several borders, is bound to entail some confusion. Still, it is difficult to understand why such a crucial issue as health liability has remained practically unheard of so far.

The overall reluctance of officials and experts to deal with the problem is puzzling. All the more so, given the prompt reaction of the European Commission to the claims of the agricultural producers, promising them compensation while also defending, and standing in for, the counter-accused German authorities.

To wrap it up: not only is bloody diarrhea one of the nastiest diseases to die of or to lose a loved one to. Chances are, it’ll prove to be just as nasty when (if ever) it comes to eking out a compensation.

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