[The EHEC O104:H4 outbreak in Germany 2011 - lessons learned?!]

[Intensive care back up for infectious disease disasters]

BACKGROUND

Outbreaks of infectious diseases pose particular challenges for hospitals and intensive care units.

OBJECTIVES

Typical infectiological scenarios and their significance for modern intensive care medicine are presented.

MATERIALS AND METHODS

Selected pathogens/infectious diseases that have significantly strained the resources of intensive care units are described.

RESULTS

Intensive medical care is necessary in severe cases of many infectious diseases. In the context of epidemics/pandemics, many critically ill patients have to be admitted within a short time. Examples are the 2009 H1N1 influenza pandemic, the 2011 enterohemorrhagic Escherichia coli (EHEC) outbreak in northern Germany, the 2014/2015 Ebola fever outbreak and the 2020 coronavirus disease 19 (COVID-19) pandemic. Multidisciplinary teams, protocol development, adequate staffing, and training are required to achieve optimal treatment outcomes, including prevention of healthcare worker infections.

CONCLUSIONS

Pandemics and epidemics are unique challenges for intensive care unit preparedness planning.

Public Health Research Resulting from One of the World's Largest Outbreaks Caused by Entero-Hemorrhagic Escherichia coli in Germany 2011: A Review

In 2011, Germany experienced one of the largest outbreaks of entero-hemorrhagic Escherichia coli (EHEC) ever reported. Four years thereafter, we systematically searched for scientific publications in PubMed and MEDPILOT relating to this outbreak in order to assess the pattern of respective research activities and to assess the main findings and recommendations in the field of public health. Following PRISMA guidelines, we selected 133 publications, half of which were published within 17 months after outbreak onset. Clinical medicine was covered by 71, microbiology by 60, epidemiology by 46, outbreak reporting by 11, and food safety by 9 papers. Those on the last three topics drew conclusions on methods in surveillance, diagnosis, and outbreak investigation, on resources in public health, as well as on inter-agency collaboration, and public communication. Although the outbreak primarily affected Germany, most publications were conducted by multinational cooperations. Our findings document how soon and in which fields research was conducted with respect to this outbreak.

Food Safety Crisis Management-A Comparison between Germany and the Netherlands

In order to prevent food safety incidents from becoming a crisis, a good crisis management structure is essential. The aim of the current study was to compare and evaluate the national food incident response plans of 2 neighboring EU Member States: Germany and the Netherlands. This revealed that the structure of these plans is comparable, starting with initial alerting, assessment of the problem, upscaling, an execution phase and finally an evaluation of the crisis management. However, the German communication structure is more complex than the Dutch one and cross-border communication between both countries is currently limited. In general, the presence of national response plans does not guarantee a good and swift response to a food safety incident as this is often hampered by difficulties in tracing the source of the problem as well as difficulties in communication between organizations involved in crisis management. A timely detection can be improved through the development of fast screening and detecting systems and through combining various data sources using computer software systems. Mutual cooperation and communication can be improved through joint exercises or projects. This will help to streamline communication toward consumers and trade partners. Such communication should be transparent relaying not only the facts but also the uncertainties in a crisis in order to gain consumer trust and safeguard international trade.

Analysis of Escherichia Coli O104:H4 Outbreak in Germany in 2011 Using Differentiation Method for Unusual Epidemiological Events

AIM

The aim of the study was to further clarify the origin of Escherichia coli O104:H4 outbreak in Germany in 2011 (German Ec) as the likelihood of a deliberate act has not been excluded in previous analyses.

METHODS

We use an original and the most detailed scoring method so far, with 33 parameters pertaining to the source of infection/reservoir or possible perpetrator, pathogen or biological agent, transmission mechanism/factors or means/media of delivery, and population at risk or target.

RESULTS

Total scores for a deliberate or accidental epidemic indicate that the outbreak was more probably caused unintentionally, presumably due to technical accidents or hygienic shortcomings in the food chain.

CONCLUSIONS

The validity of the present assessment is limited by the lack of data on the reservoir of the pathogen, the source of infection, and the mode of food contamination. Conclusive evidences on these parameters are essential for the final clarification of the outbreak origin.

Practising Uncertainty in the Face of Large-Scale Disease Outbreaks

In contrast to calculable risks, uncertainty—understood here as the unexpected and non-calculable—is under-researched despite its societal and organizational relevance and omnipresence. Against this backdrop, the present study investigates how organizations practise uncertainty in the face of the numerous large-scale outbreaks of disease in Germany between 2000 and 2012. I position this study in the body of knowledge on disasters and crises, normal accident theory, and high-reliability organizations, and propose a practising uncertainty perspective that focuses on how to deal with unexpected external events and/or their latent dangers. I identify two overarching forms of practice, namely, reducing (i.e., coping with unforeseen incidents) and inducing (i.e., championing an overarching cause) uncertainty. I show that actors use both these forms of practice, which constitute the basis of the framework introduced herein, intentionally or unintentionally depending on the differing and sometimes conflicting objectives of the organizations involved.