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From: Food Quality & Safety magazine, April/May 2012

Germany Struggles to Strengthen Food Safety after Deadly E. coli Crisis

by Daniel Zimmermann

Chicory ice cream, Bavarian steam beer, and wine of the latest vintage of organic Riesling or pinot noir. During the annual International Green Week in Berlin, Germany’s largest trade exhibition for food and agricultural goods, producers and retailers gather to showcase their latest culinary creations for German and European customers.

Over the past few years, the meeting has been overshadowed by food safety issues that have included eggs tainted by dioxin-contaminated animal feed. Although industry figures indicate that the latest crisis, which involved a rare and deadly strain of E. coli, has resulted in sales losses comparable to the Chernobyl nuclear accident in 1986, only a handful of exhibitors and farmers are willing to talk about the disaster openly. Nearly a year after the devastating outbreak, which killed more than 40 and sickened more than 4,000 people in Germany and other parts of Europe, it is business as usual.

A few hundred miles northeast at the University Medical Center Hamburg-Eppendorf, the deadly strain is still a grim reality. At one of the epicenters of the crisis that kept doctors and German health authorities on their toes last summer, almost 120 patients who suffered from symptoms of the hemolytic-uremic syndrome caused by the infection are still receiving assisted outpatient treatment.

At the height of the outbreak in June, the center treated almost one out of 10 HUS patients in Germany. Data gathered by doctors is expected to reveal clues about the long-term effects of the disease and help develop new therapies to handle crises more effectively. The study has received 1.23 million euros ($1.62 million) in funding from the German Ministry of Health for the next two years and is supported by the Robert Koch Institute, whose EHEC consulting lab experts deciphered the O104:H4 strain. The research will also include data from clinics in other parts of northern Germany, such as the University Medical Center Schleswig-Holstein in nearby Lübeck, where 117 HUS patients are still under medical observation.

Andreas Hensel
Professor Andreas Hensel, president of the Federal Institute of Risk Assessment, says it is only a mattter of time until an outbreak with similar consequences occurs.

“We are closely cooperating with these and other working groups in Germany and the U.S. in order to find markers that could help us to find more information about the severity of the disease and when is the right time to begin treatment,” said Professor Rolf Stahl, MD, chair of the department of nephrology and clinical director of the University Medical Center Hamburg-Eppendorf. “The care that these patients require, however, will probably have to continue for years. Five to 10 percent still suffer from HUS-related health problems like limited renal functions, arterial pressure, and neurological disorders.”

The new E. coli strain did not find the country completely unprepared. Only a few days before the first pediatric cases of HUS were reported by health authorities on May 19, the Federal Institute for Risk Assessment, a governmental body responsible for consumer health protection, released a warning on sprouts and prepared salads that they had found to be partially contaminated with different kinds of bacteria. Though epidemiological studies of infected patients indicated that the source of the contamination was most likely raw tomatoes, cucumbers, or leafy salad greens, investigators were finally able to trace it back to fenugreek seeds that had been imported from Egypt by a horticultural farm in northern Germany for the purpose of growing sprouts. By this point, the disaster had already claimed dozens of lives and a significant number of financial resources as well as hours dedicated by scientists, local administrators, and clinical personnel.

“The O104:H4 type presented a special challenge to us owing to the atypical nature of the strain and the patient spectrum that included predominantly younger people,” said Professor Andreas Hensel, PhD, president of the Federal Institute for Risk Assessment. “Since in these cases usually only three out of four pathogens can be identified at all, we were lucky to be able to have dealt with the threat as fast as we did.”

The European Union, meanwhile, has banned imports of seeds and seedlings from Egypt until the end of this year. According to Dr. Hensel, it is only a matter of time until an outbreak with similar consequences occurs. In view of increasing globalization and changing production conditions in the agriculture and food industry, standards for product identification and traceability will have to play a more prominent role, not only at a national but also at a European level, he said.

Hans-Michael Goldmann
Hans-Michael Goldmann, head of the Germany parliamentary Committee on Food, Agriculture, and Consumer Protection, has called for stronger food safety legislation.

“There is a German saying: ‘Why bother when a sack of rice had fallen over in China?’” Dr. Hensel said. “Now we have come to a point where we literally need to ask ourselves where these sacks are coming from and what is inside.”

Dr. Hensel added that the exchange of information among all members involved in the food production chain and safety control will also have to effect improvements through electronic notification systems and the introduction of centralized databases, a claim widely supported by health professionals, epidemiologists, and supranational institutions like the European Centre for Disease Prevention and Control.

“The chain from local GPs to the European level can be very long,’’ said ECDC Director Marc Sprenger, MD, PhD. “Notification systems across the EU need to be speeded up. The technology is available and not particularly expensive.”

Food and animal feed control regulations in Germany are overseen by more than 400 agencies at state and district level. Cross-state standards regarding quality management and education of personnel involved hardly exist. In emergency cases like a nationwide foodborne outbreak, this system can hinder not only the reporting of lifesaving information but also the identification of the contamination source itself.

“What we need is a central authority similar to a national investigative police agency that is capable to observe and act across state borders,“ said Hans-Michael Goldmann, head of the German parliamentary Committee on Food, Agriculture, and Consumer Protection. Goldmann had called for stronger food safety legislation during the E. coli crisis.

The new E. coli strain did not find the country completely unprepared. Only a few days before the first cases of HUS in children were reported by health authorities on May 19, the Federal Institute for Risk Assessment, a governmental body responsible for consumer health protection, released a warning on sprouts and prepared salads that they had found to be partially contaminated with different kinds of bacteria.

Reacting to the debate, the German Federal Ministry of Food, Agriculture and Consumer Protection recently commissioned a report from the Federal Audit Office to look into the existing regulations. Its recommendations, made public in November, include the introduction of a federal task force and the formation of special units consisting of experts with the mandate to operate nationwide, supporting the states in the implementation of effective food safety controls.

Although ministry officials said that the office’s recommendations will be discussed with ministers of all 16 German states at the next customer protection ministers’ meeting in Hamburg by the end of this year, prospects for regulatory change look poor. Some states have declared they will not agree to the plans unconditionally. In a recent statement, Gert Lindemann, minister of customer protection for Lower Saxony, the state where the farm with the contaminated fenugreek seeds is located, announced his willingness to cooperate with the government yet refused to relinquish authority over food and animal feed controls.

Progress could also be halted through the country’s next federal elections in 2013, in which food safety issues will presumably play only a minor role.

Moreover, foodborne outbreaks do not seem to be considered a significant health threat by German consumers. According to a national poll on risk perceptions conducted by the Federal Institute for Risk Assessment in August last year, those interviewed ranked infection with E. coli lower than the risks associated with eating unhealthy food or too much fat.

Daniel Zimmermann is a journalist in Leipzig, Germany. His areas of interest include health issues, science, and politics. He can be reached at contact@danielzimmermann.info.

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