Unsolved German E. coli Outbreak Grows, Sickening Hundreds
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 November 20, 2025, German public health authorities have confirmed 199 outbreak cases, resulting in 53 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 428.
The onset of illness for confirmed cases range between August 11 and October 16, 2025. Of the 16 German federal states, nine have reported four or more cases of illness, with the most cases reported in the Northern states of Mecklenburg-Vorpommern and Nordrhein-Westfalen.
The source of the outbreak is not yet confirmed, but epidemiological interviews suggest foodborne transmission. Investigations are ongoing.
Analysis of clinical isolates reveal a distinct genomic cluster compared to other EHEC O45:H2 with notably greater genomic variability within the cluster compared to previous EHEC/HUS outbreaks. The outbreak strain exhibits Shiga toxin-producing gene stx2a, intimin gene eaeA, and enterohemolysin gene ehxA.
The Robert Koch Institute’s Epidemiological Bulletin dated November 20, 2025 details the ongoing outbreak investigation.
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