An ongoing outbreak of foodborne enterohemorrhagic Escherichia coli (EHEC) O45:H2 infections is sweeping Germany, marking the most significant EHEC outbreak the country has seen since 2011. As of October 22, 2025, German public health authorities have confirmed 183 outbreak cases, resulting in 48 instances of hemolytic uremic syndrome (HUS) and three deaths (two confirmed and one probable). The total case count, including probable and possible cases, stands at 351.

The source of the outbreak is not yet confirmed, but epidemiological interviews suggest foodborne transmission, likely via contaminated meat or sausage products—although plant-based foods have not been ruled out.

The Robert Koch Institute’s Epidemiological Bulletin dated October 23, 2025 details the ongoing outbreak investigation.

Geographic Spread and International Cases

The outbreak initially emerged in Mecklenburg-Western Pomerania in northern Germany, later shifting to central North Rhine-Westphalia. Additional cases have been identified in Lower Franconia (Bavaria) and other German states. At least four confirmed cases have been reported internationally—in the U.S., the Netherlands, Italy, and Luxembourg—with epidemiological links to Germany.

Genomic and Epidemiological Insights

The outbreak isolates form a distinct genomic cluster, exhibiting greater variability than typically observed in EHEC outbreaks. The pathogen strain includes key virulence genes: Shiga toxin-producing gene stx2a, Intimin gene eaeA, and Enterohemolysin gene ehxA, all associated with severe clinical outcomes.

Symptom onset among confirmed cases ranges between August 11 and October 6, 2025. Epidemiological interviews suggest contaminated meat or sausage products as the vehicle of illness, but plant-based foods have not yet been ruled out. Animal and waterborne sources have been ruled out.

Pediatric Impact and Mortality

Children under the age of 10 are disproportionately affected, with a median age of four among confirmed cases. All confirmed HUS cases have occurred in this age group. Of the confirmed cases, 51 percent are female. So far, three deaths have been reported: a child under ten years of age with HUS, a woman aged 70–80, and a probable case involving a woman over 90 years of age with HUS.

Comparative Context and Outlook

The present outbreak is the largest in Germany since the 2011 EHEC O104:H4 event, involving more than 3,800 cases and 53 deaths. Current risk factors include the unknown source, pediatric susceptibility, ongoing case emergence, and wide regional distribution. Without identification of the contamination source, additional cases and international spread remain possible.

Update, November 26, 2025: More than 400 confirmed and possible cases have now been reported, with three associated deaths. The vehicle of illness is likely foodborne, but has not yet been identified.