EFSA and ECDC highlight importance of cooking sprouts thoroughly to reduce risk of further E. coli O104 outbreaks

The European Food Safety Authority (EFSA) and the European Centre for Disease Prevention and Control (ECDC) have jointly prepared a rapid risk assessment of the cluster of Haemolytic Uremic Syndrome (HUS) in Bordeaux, France. In their joint assessment, the two European agencies provide a chronology of events and outline that currently fenugreek sprouts are the most likely connection between the French cases and the previous outbreak in Germany. The epidemiological investigation is focussed on four key areas: food source identification, collaborative trace-back investigations (coordinated by the EFSA Task Force), awareness-raising amongst clinical practitioners and public health advice. In this regard, EFSA and ECDC strongly recommend to advise consumers not to grow sprouts for their own consumption and not to eat sprouts or sprouted seeds unless they have been cooked thoroughly.

The assessment focuses on the hypothesis that the outbreak originates from sprouts. As it is impossible to test all foods for all types of contaminants, it is crucial that the hypothesis that is generated at the start of the investigation process allows for the most likely sources to be examined. At the same time investigators must ensure that the parameters of the inquiry are not too limiting as to exclude possible paths that may require further analysis.

The joint rapid risk assessment highlights the links between the French and German outbreaks, justifying the rationale for investigators following the sprout hypothesis, with a particular focus on fenugreek. As in the German E. coli incident, human cases in France have been monitored and patients have undergone tests to identify the bacterium responsible. In both outbreaks the rare strain of E. Coli O104:H4 has been confirmed.

The assessment concludes that --because fenugreek seeds are often sold as mixes of seeds and that during re-packaging cross-contamination cannot be excluded-- pending outcome of the epidemiological investigation underway, consumers should be advised to ensure that all types of sprouts are thoroughly cooked before consumption.

The assessment also recommends that clinical practitioners should be encouraged to report new HUS cases in a timely manner.

In its conclusions, the assessment does not exclude that more cases may arise and highlights the collaboration between the two agencies together with the European Commission, the World Health Organization and Member States. The rapid exchange of outbreak information has been made possible through Europe’s Rapid Alert System for Food and Feed (RASFF).

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