My flight got cancelled today to Boston where I was to spend time with one of the six United States E. coli O104:H4 cases. As I passed through airport security before I headed back to the office, I thought about how difficult national and international travel has become post 9-11. Not so for bacteria.

As of today the European Union reported 885 HUS cases, including 31 deaths, and 3,138 non-HUS cases, including 17 deaths, have so far been reported (total 48 deaths and 4,023 ill – likely far more) from the German E. coli O104:H4 outbreak. The latest known date of onset of diarrhea for cases is June 22 (likely secondary transmission from primary cases). The United States reported 5 illnesses (3 with HUS) and 1 possible death.

Last Friday, France reported a cluster of at least 12 patients with bloody diarrhea, who had participated in an event in the commune of Bègles around Bordeaux on June 8. As of June 27, nine people have been hospitalized. Eight of these have developed HUS. The ninth hospitalized case has bloody diarrhea but not HUS, and epidemiological investigations have shown no link with the event in Bègles.  In three cases, infection with E. coli O104:H4 (the German strain) has been confirmed.

French authorities are investigating this new cluster of STEC. Six of the cases reported having eaten sprouts at the event on June 8, and leftovers are currently being analyzed. These suspected sprouts were locally produced, and were not imported from the farm implicated in the outbreak in Germany, but from a British company, Thompson & Morgan who allegedly sourced seed from Italy (not known if Thompson & Morgan are in anyway connect to supplying seed to the German organic sprouter).

In addition, Swedish health authorities say they have identified the first domestic case of E. coli O104:H4 infection. The Swedish Institute for Communicable Disease Control says it’s the first case in Sweden without any direct link to Germany. It remains unclear how the patient was infected. The agency has now started an investigation to trace the source of the infection.

Also today, Danish health authorities said 23 people in Denmark have been infected, including a 24-year-old who had no direct link to Germany. The case was reported last month and it remained unclear how the patient was infected.

Still confusing as to the source of the E. coli O104:H4?  Ill workers, contaminated water, contaminated seed, secondary cases?  All vectors are still, unlike me, up in the air.