The public health institute in Germany has reported more than 30 people have been sick with E. coli this year after going to Egypt.

The Robert Koch Institute (RKI) noted increased reports of Enterohemorrhagic E. coli (EHEC) related to or after staying in Egypt. Earlier this month, Public Health England also reported an increase in adults and children ill after coming back from Hurghada in Egypt.

In Germany, there are 31 cases of EHEC and five people with hemolytic uremic syndrome (HUS), a type of kidney failure associated with E. coli infection.

This is significantly more than in the same period of previous years. In 2018, there were 21 EHEC and one HUS case. In 2017, nine EHEC and one HUS case were recorded. The rise cannot be explained by the increase in travel to Egypt alone, according to RKI.

It follows a warning by PHE after 18 people fell ill with Shiga toxin-producing E. coli (STEC) infection and one person developed HUS after returning from Egypt this year. Four people needed hospital treatment.

A PHE spokeswoman previously told Food Safety News that it was not an outbreak as a variety of different STEC strains had been detected in visitors to Egypt with STEC O157 and STEC O26 amongst them.

The agency has told the European Centre for Disease Prevention and Control (ECDC) about the cases.

Reducing infection risk
E. coli is transmitted to humans primarily through consumption of contaminated food, such as raw or undercooked ground meat, raw milk, and raw vegetables and sprouts.

The incubation period for E. coli infections can range from three to eight days. Most patients recover within 10 days. Symptoms include diarrhea, nausea, vomiting, abdominal pain, stomach cramps and sometimes fever.

What caused the German cases is unknown and sick people have stayed at different hotels in separate places, according to RKI, which has informed Egyptian authorities about the increase.

Dr. Nick Phin, deputy director of the National Infection Service at PHE, said there are precautions that travelers can take.

“These include ensuring meat is cooked thoroughly, not drinking tap water or ice made from tap water and trying to avoid swallowing water when swimming. Anyone suffering from diarrhea and vomiting should ensure they keep well hydrated and seek medical advice if their symptoms don’t improve within 48 hours. They should also avoid preparing or serving food while they have symptoms and thoroughly wash their hands after using the toilet to stop the bug being passed to others” he said.