Journal Article

Epidemiological and Ecological Characterization of the EHEC O104:H4 Outbreak in Hamburg, Germany, 2011

Fell, Gerhard, Manitz, Juliane, Hegasy, Guido, Tahden, Maike, Baumgardt, Klaus, Kneib, Thomas

2016

Overview

In 2011, a large outbreak of entero-hemorrhagic E. coli (EHEC) and hemolytic uremic syndrome (HUS) occurred in Germany. The City of Hamburg was the first focus of the epidemic and had the highest incidences among all 16 Federal States of Germany. In this article, we present epidemiological characteristics of the Hamburg notification data. Evaluating the epicurves retrospectively, we found that the first epidemiological signal of the outbreak, which was in form of a HUS case cluster, was received by local health authorities when already 99 EHEC and 48 HUS patients had experienced their first symptoms. However, only two EHEC and seven HUS patients had been notified. Middle-aged women had the highest risk for contracting the infection in Hamburg. Furthermore, we studied timeliness of case notification in the course of the outbreak. To analyze the spatial distribution of EHEC/HUS incidences in 100 districts of Hamburg, we mapped cases' residential addresses using geographic information software. We then conducted an ecological study in order to find a statistical model identifying associations between local socio-economic factors and EHEC/HUS incidences in the epidemic. We employed a Bayesian Poisson model with covariates characterizing the Hamburg districts as well as incorporating structured and unstructured spatial effects. The Deviance Information Criterion was used for stepwise variable selection. We applied different modeling approaches by using primary data, transformed data, and preselected subsets of transformed data in order to identify socio-economic factors characterizing districts where EHEC/HUS outbreak cases had their residence.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adolescent / Adult / Age Factors / Aged / Aged, 80 and over / Analysis / Bayesian analysis / Biology and Life Sciences / Child / Child, Preschool / Disease Outbreaks / E coli / Ecological monitoring / Ecological studies / Ecology and Environmental Sciences / Economic factors / Economic models / Economics / Epidemics / Epidemiology / Escherichia coli / Escherichia coli Infections - epidemiology / Escherichia coli O104 / Female / Germany - epidemiology / Gonorrhea / Health aspects / Health risks / Hemolytic uremic syndrome / Hemolytic-Uremic Syndrome - epidemiology / Hemorrhage / Humans / Hygiene / Infant / Infant, Newborn / Infections / Infectious diseases / Internet / Male / Mathematical models / Medicine and Health Sciences / Middle Aged / Models, Biological / Outbreaks / Patients / People and Places / Physical Sciences / Public health / Research and Analysis Methods / Residential areas / Sex Factors / Social Sciences / Socioeconomic Factors / Socioeconomics / Software / Spatial distribution / Statistical models / Studies / Syphilis / Tuberculosis / Variables