More than 20 E. coli infections are being investigated in a German municipality.

Four day care centers in the Lützow-Lübstorf district are affected by the outbreak of E. coli O26. Lützow-Lübstorf is in Nordwestmecklenburg, in Mecklenburg-Vorpommern, Germany.

Enterohaemorrhagic E. coli (EHEC) are often referred to as Shiga toxin-producing E. coli (STEC).

Authorities initially reported 18 patients but that had risen to 25 by the end of this past week. They warned further testing is ongoing so more cases are expected. Those sick include children and their relatives as well as a couple of day care center employees.

The majority of those affected have mild or no symptoms, but there are also some cases of severe diarrhea. Currently, there have not been any hospitalizations and no patients have developed hemolytic uremic syndrome (HUS).

Testing of products and in the premises of a food processing company that supplies the daycare centers was negative. Officials believe the pathogen did not enter the centers via food prepared by the company, but through other means, which are being investigated.

Symptoms of E. coli infections vary for each person but often include severe stomach cramps and diarrhea, which is often bloody. Some patients may also have a fever. Most patients recover within five to seven days. Others can develop severe or life-threatening symptoms and complications, according to the Centers for Disease Control and Prevention (CDC).

about 5 percent to 10 percent of those diagnosed with E. coli infections develop a potentially life-threatening kidney failure complication, known as a hemolytic uremic syndrome. Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruises or bleeding, and pallor.

updat on Hepatitis A infections
Meanwhile, the number of people infected with hepatitis A in a different German community has risen to 28.

Investigations by authorities are looking at the employees of a bakery branch in the region. Some patients have no link to the bakery so genotyping of Hepatitis A strains is being carried out with results pending.

Investigations into the outbreak in Dummerstorf in the Rostock district of Mecklenburg-Vorpommern are ongoing. The most recent patient became symptomatic on Nov. 18.

There are 25 sick people in the Rostock district and three cases of hepatitis A related to the outbreak in neighboring areas. Those sick include children and adults and at least four people have needed hospital treatment.

More than 200 potential contacts were identified and some vaccinations have been carried out within the incubation period to allow the body to develop antibodies and prevent further spread of infection.

Hepatitis A is spread when someone ingests the virus through close contact with an infected person or by eating contaminated food or drink. The incubation period is usually 14 to 28 days, but it can take up to 50 days for symptoms to develop. Symptoms can last up to two months and include fatigue, nausea, stomach pain, and jaundice, which is a yellowing of the skin or eyes.