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Infections by E. Coli O104:H4 : l'Anses reassesses the risks related to the consumption of sprouts

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News of 01/09/2011

1 september 2011

In May and June 2011, cases of infections by an enterohaemorrhagic Escherichia coli bacterium of serotype O104:H4 were reported respectively in Germany and France, resulting in cases of bloody diarrhoea, haemolytic-uraemic syndrome (HUS) and nearly 50 deaths.
The epidemiological investigation conducted on patients and the traceability survey identified the consumption of sprouts imported from Egypt (fenugreek in particular) as the most probable cause of these infections.
Consequently, on 5 July 2011, the European Commission requested that all Member States withdraw from the market, and then analyse and destroy, all of the batches of fenugreek seeds that had been imported from Egypt. Further to this, the European authorities, as well as some Member States including France, advised against the consumption of raw sprouts.

Reassessing the risks in light of developments in the health situation

In light of developments in the health context of these two epidemics and notably the decision to withdraw from the market and destroy all the seeds concerned, as well as the announcement that the epidemic in France was over, ANSES received a request on 2 August to reassess the risks related to the consumption of sprouts and to review, if necessary, the current recommendations.
To do so, ANSES took stock of the epidemiological situation in France (by reviewing all the cases that occurred). It also examined the results of surveys conducted Europe-wide in an effort to explain the origin of the contamination of seeds imported from Egypt, and, lastly, it reviewed the management measures implemented in France (recommendations to consumers, implementation of systematic control and analysis of seed production facilities and withdrawal and destruction of seeds and beans imported from Egypt).

Raw sprouts may be consumed, undercertain conditions

On the basis of these data and to limit the risk of new cases, ANSES wishes to emphasise that it is critical to eliminate the fenugreek batches responsible for the outbreaks in Germany and France, and that all measures must be taken to destroy any batches that may remain in consumers’ homes.
Regarding producers and distributors of sprouts and seeds for sprouting in France, the Agency deems it necessary to ensure the withdrawal of these fenugreek batches from the food chain. These measures also apply to seed mixes containing fenugreek from the implicated batches.
The Agency also emphasises the importance of ensuring traceability along the entire food chain, which is essential for controlling and mitigating risks, particularly during investigations of outbreaks.
Once these conditions have been fully met, ANSES considers that

  • the absence of prior declared French epidemics related to the consumption of industrially produced sprouts;
  • the establishment of a strong epidemiological link with the consumption of seed batches imported from Egypt;
  • and the guarantee by French sprout producers of the introduction of strengthened control measures, since the outbreak of the epidemic in Germany and conditional upon the compliance with and effectiveness of these measures, which can be verified by the health authorities

are all valid arguments in favour of lifting restrictions on the consumption of raw sprouts produced by professionals in the French sector, with the exception of the fenugreek seeds and beans mentioned in the European Commission’s decision.
Moreover, ANSES wishes to emphasise that the research recommendations made in its Opinion of 7 July 2011 remain relevant, namely:

  • to generate data on the strain involved (prevalence in different countries, virulence, capacity for survival and adherence to surfaces, resistance to antibiotics, impact of cleaning processes, etc.),
  • to develop and standardise detection methods on the European level, particularly by including specificities related to seeds,
  • to investigate the seed production environment, harvesting and packaging conditions, maceration methods, etc., and improve assessment of the impact of industrial sprouting practices,
  • to acquire and process data explaining the specific characteristics of the affected population group (adults, predominantly women) during recent outbreaks.

Hygiene: key to preventing infection

ANSES especially wishes to draw the population’s attention to the importance of adopting good hygiene measures when sprouting seeds at home (thorough cleaning/disinfection of seed germinators in particular, in addition to hand washing before and after handling seeds and sprouts).

It is also important to remind the population of the need to adopt good hygiene measures when preparing meals, as personal and collective hygiene is essential to the prevention of primary EHEC infection as well as its transmission through secondary infection.

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