A major German E. coli outbreak also includes a woman from the United States who had been to the country.
A total of 255 cases are linked to the outbreak. One person over 90 years old with HUS died but this was a probable case without lab confirmation. The median age of the patients is 4 years old.
There are 137 confirmed infections. Of these, 38 have progressed to hemolytic uremic syndrome (HUS). HUS is a clinical syndrome related to E. coli, which can lead to kidney failure, brain damage and death.
There are also six probable and 112 possible cases. It is as yet unclear if they are part of the outbreak as laboratory results are pending. Six of these people have developed HUS.
Illness onset dates for confirmed cases are between Aug. 11 and Sept. 19, 2025. The median age of these patients is 4, with a range of less than 1 to 94 years old. Among confirmed cases with available information, 51 percent are female.
The Robert Koch Institute (RKI) has also received information on three outbreak cases via EU networks. They involve an infected U.S. woman who had traveled to Mecklenburg-Vorpommern, and one child each from Luxembourg and the Netherlands who had not been to Germany.
The current outbreak is the largest since the 2011 E. coli O104:H4 incident when the final case count was 4,075 including 908 HUS cases and 50 deaths in 16 countries.
Ongoing search for source
The National Reference Center (NRZ) for Salmonella and other bacterial enteritis pathogens at RKI identified the outbreak strain as E. coli O45:H2. This type of E. coli is rare in Germany. From January 2015 to June 2025, the NRZ detected only 13 strains of this serovar. These isolates are not genetically closely related to the outbreak strain.
The Mekcklenburg-Vorpommern State Office for Health and Social Affairs (LAGuS) has been providing regular updates on the number of people sick. There are 126 patients and 19 HUS cases, of which 65 and 15 are confirmed. A dozen adults and 53 children are confirmed cases.
In the first two weeks, affected people had almost exclusively been in Mecklenburg-Vorpommern in the days before onset of illness, either on vacation or as residents. The later outbreak cases are primarily people in Nordrhein-Westfalen. The area of Düsseldorf appears to be the most affected.
The RKI is surveying patients and their parents by telephone, conducting a case-control study and analyzing shopping receipts to try and find the source of infection. No single food product has been identified so far.
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