In early May 2011, authorities in northern Germany were alerted to an unusually high number of cases of bloody diarrhea and hemolytic uremic syndrome (HUS). Public health microbiologists observed that affected patients were not shedding the typical etiologic agent of this syndrome: Escherichia coli of serotype O157:H7, also known as enterohemorrhagic E. coli (EHEC). A thorough investigation implicated the real culprit: a rare E. coli serotype known as O104:H4. By the end of June, the outbreak peaked, with the European Union reporting 888 HUS cases, including 31 deaths, and 3189 non-HUS cases, including 17 deaths (1).

Noting precedent with EHEC and similar outbreaks, German epidemiologists scrambled to implicate a food source. Although initial investigations indicted cucumbers imported from Spain, the first questionnaires inadvertently omitted sprouts from the queried food items, thereby suggesting vegetables commonly served therewith. Revision of the questionnaires identified sprouts grown on a farm in Lower Saxony as the true villains, revealing the necessity of considering cotravelers in any epidemiologic investigation.

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