The Epidemic Detectives The Hunt for the Source of Germany's E. Coli Outbreak
Part 3: Outrage in Spain
Meanwhile, as a result of Lehmacher's discovery, the investigators had now set their sights on Spain. Every year, Germany imports 3 million tons of fruits and vegetables from the Mediterranean country, more than from any other country. Some 80 percent of this produce grows in Andalusia, which was also the source of the three Spanish EHEC-contaminated cucumbers.
But this region, in particular, has long had a bad reputation. Moroccan guest workers work long hours in greenhouses for starvation wages -- and under questionable hygienic conditions. Weren't the Spanish suppliers the obvious culprits in the outbreak?
Not at all, as it turns out, because practices in the region have improved in the meantime. "Spain is now in a good position. The produce is clean," says Manfred Santen, a chemistry expert with the environmental organization Greenpeace. In fact, Spanish farmers have fundamentally changed their working and production conditions.
Not surprisingly, the Spaniards are outraged and feel that they were being made into scapegoats. The two operations where the contaminated cucumbers came from were shut down on Friday evening.
Wherever it happened, the question of how the pathogen got onto the vegetables was still unresolved by the weekend. The suspicion that liquid manure contaminated the cucumbers seems to make sense, but only at first glance.
The E. coli bacterium is formed in the intestines of ruminants -- cows, sheep and goats -- and reaches the fields in their excrement. Vegetable farmers who have no livestock of their own can buy urine and feces from farm animals from suppliers of so-called liquid manure. As a rule, however, the plants are never in direct contact with the liquid manure, which is spread onto the fields before sowing.
Since the 1980s, the United States has also seen wave after wave of deadly E. coli outbreaks. While searching for the sources of the infection, scientists discovered that the bacteria enter the agricultural cycle through irrigation systems. Canadian scientists found large concentrations of the pathogen in samples taken from wells near US factory farming operations.
But this realization hardly applies to the current European case. In Spain, there is very little livestock in places where fruit and vegetables are cultivated.
Slugs Under Suspicion
Now the scientists are taking a closer look at a group of pests that were previously above suspicion: slugs. Biologists from the University of Aberdeen in Scotland identified the mollusks as potential E. coli carriers -- the bacteria can survive for up to 14 days on the slimy surface of their bodies. Arion vulgaris, the Spanish slug, has long been a problem in Germany, but it's an even bigger and more widespread problem in its native Spain.
Be it liquid manure, water or slugs, cucumbers or lettuce, organic or conventional farms -- whatever the source of the bacteria, the only solution for consumers is to wash their hands. Hand washing is also effective against smear infection, or transmission of the bacteria by way of unwashed hands after using the toilet, but this path of infection is very rare.
Fruit and vegetables are only truly germ-free when cooked. And until now, washing produce with water was seen as an effective way to eliminate the risk, because it was generally understood that E. coli is only found on the surface of produce.
That was until scientists in the department of plant pathology at the Scottish Crop Research Institute in Aberdeen made an alarming discovery: The pathogens apparently felt so comfortable on the tomatoes and lettuce they studied that they migrated from the surface to lower layers of tissue to colonize the fruit.
'Hopefully Everything Will Be All Right'
Perhaps it was these particularly tenacious bacteria that were so disastrous for Caroline E. The 24-year-old student, who is four months' pregnant, has always taken pains to eat healthy food. She usually bought organic vegetables, which she always washed. Now she is on Ward 5B at the UKE, which has been reserved for severe cases of HUS since last Wednesday. A mustachioed guard sits at the entrance to the ward and makes sure that visitors disinfect their hands and put on plastic gloves and protective gowns.
"I've seen people in the ICU who are really in bad shape," says Caroline E., a young woman with smooth, light-brown hair and angular glasses. She says her only symptom is mild diarrhea. In fact, she only went to the doctor after finding out that a work colleague had contracted EHEC. "I just wanted to make sure that I didn't have it," she says. She already had HUS by then.
Doctors aren't sure yet how Caroline's condition will develop, but she seems calm. "I feel better now that I'm in treatment," she says, noting that the doctors assured her that the infection wouldn't harm her unborn child. "If they can only improve my blood counts soon, hopefully everything will be all right," she says.
And then she adds, defiantly: "I can even eat chocolate again."
Translated from the German by Christopher Sultan
- Part 1: The Hunt for the Source of Germany's E. Coli Outbreak
- Part 2: Reconstructing Patients' Meals
- Part 3: Outrage in Spain