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1、ThenewenglandjournalofmedicineoriginalarticleEpidemicProfileofShiga-Toxin–ProducingEscherichiacoliO104:H4OutbreakinGermany—PreliminaryReportChristinaFrank,Ph.D.,DirkWerber,D.V.M.,JakobP.Cramer,M.D.,MonaAskar,M.D.,MirkoFaber,M.D.,MatthiasanderHeiden,Ph.D.,HelenBernard,M.D.,AngelikaFruth,Ph.D.
2、,RitaPrager,Ph.D.,AnkeSpode,M.D.,MariaWadl,D.V.M.,AlexanderZoufaly,M.D.,SabineJordan,M.D.,KlausStark,M.D.,Ph.D.,andGérardKrause,M.D.,Ph.D.,fortheHUSInvestigationTeam*ABSTRACTBackgroundInthisreport,weprovideapreliminarydescriptionofanongoinglargeoutbreakFromtheDepartmentsofInfectiousDis-ofgas
3、troenteritisandthehemolytic–uremicsyndromecausedbyShiga-toxin–pro-easeEpidemiology(C.F.,D.W.,M.F.,M.H.,H.B.,M.W.,K.S.,G.K.)andInfectiousducingEscherichiacoliinGermanyinMayandJune2011.Diseases(A.F.,R.P.)andthePostgradu-ateTrainingforAppliedEpidemiologyMethodsProgram(M.A.),RobertKochInstitute,
4、WeanalyzeddatafromreportsinGermanyofShiga-toxin–producingE.coligastro-Berlin;andtheDepartmentofInternalenteritisandthehemolytic–uremicsyndromeandclinicalinformationonpatientsMedicine,UniversityMedicalCenterHamburg-Eppendorf(J.P.C.,A.Z.,S.J.),presentingtoHamburgUniversityMedicalCenter.Anoutbr
5、eakcasewasdefinedasandtheHealthDepartmentoftheHam-areportedcaseofthehemolytic–uremicsyndromeorofgastroenteritisinapatientburgNorthernDistrict(A.S.)—bothininfectedbyShiga-toxin–producingE.coli,serogroupO104orserogroupunknown,Hamburg,Germany.Addressreprintre-queststoDr.Werberatwerberd@rki.de.w
6、ithanonsetofdiseaseonorafterMay1,2011,inGermany.Drs.FrankandWerbercontributedequal-Resultslytothisarticle.AsofJune18,2011,atotalof3222outbreakcases(including39deaths)havebeenreportedinGermany,810ofwhich(25%)involvedthehemolytic–uremicsyndrome.*ThemembersoftheHemolytic–UremicSyndrome(HUS)Inve
7、stigationTeamareTheoutbreakiscenteredinnorthernGermanyandpeakedaroundMay21to23.listedintheSupplementaryAppendix.Mostofthepatientsinwhomthehemolytic–uremicsyndromehasdevelopedareadults(89%;medianage,43years),andwomenareoverrepresented(68%).Theesti-T
