Outbreak reportindependent cross-checkabstract checked★ key study I-VEG-135 standard review
Germany 2011: sprouts the likely source
Epidemic profile of Shiga-toxin-producing Escherichia coli O104:H4 outbreak in Germany.
Overview
Frank C et al.. N Engl J Med 2011 · PMID 21696328 · DOI 10.1056/NEJMoa1106483
The outbreak caused 3,816 cases and 54 deaths; sprouts were identified as the most likely vehicle.
Does the study support the specific claim? No · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Describe the 2011 outbreak.
- How was the study done?
Outbreak report.
- How many people, animals or samples were studied?
3,816 cases.
- What was actually found?
Sprouts most likely vehicle.
- How large was the observed effect?
54 deaths.
- What do the results mean in everyday life?
Cucumbers were not the cause.
- What are the study's limitations?
Descriptive.
- What does it say about Elawady's specific claim?
Contradicts the cucumber part.
- Do the results apply to Germany and Europe?
German.
- What can explicitly not be concluded from this study?
Not applicable.
Scientific in-depth review
1. Full reference
- Authors
- Frank C et al.
- Journal
- N Engl J Med
- Year
- 2011
- Identifier
- PMID 21696328 DOI 10.1056/NEJMoa1106483
- Verification
- verified – PubMed efetch 2026-10-26; Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
not stated in abstract
2. Research question
What was the epidemic profile of the 2011 German STEC O104:H4 outbreak?
3. Study design and population
- Study design
- Outbreak report – Outbreak description from national surveillance and hospital cohort
- Population
Reported cases in Germany
- Country
Germany
- Period
1 May-4 July 2011
- Sample size
3,816 cases (845 HUS; 54 deaths)
- Inclusion and exclusion criteria
not stated in abstract
4. Methods and endpoints
- Exposure / intervention
Outbreak strain
- Comparator
none
- Endpoints
Cases, HUS, deaths; incubation
- Statistical methods
Descriptive
5. Actual results
- Results
3,816 cases incl. 54 deaths; 845 (22%) HUS; median incubation 8 days; consumption of sprouts identified as the most likely vehicle of infection.
- Absolute risks
not reported
- Authors' conclusion
HUS occurred predominantly in adults, mostly women; HUS developed in more than 20% of identified cases.
6. Strengths
- National data
7. Weaknesses
- Descriptive
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- not assessable
- Rationale
Outbreak report.
9. Assessment of the statistical interpretation
not applicable
10. Relevance to the specific claim
Names sprouts (not cucumbers) as the most likely vehicle.
11. Independent contrary findings
none
12. Transferability to Germany and Europe
German.
13. Overall methodological judgement
Contradicts the cucumber part of the claim.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | not assessable |
| Precision of results | not applicable |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
none
15. Linked fact checks
- Germany's 2011 E. coli O104:H4 epidemic was traced to sprouts and cucumbers. – Studies contradicting or limiting the claim