A deadly and rapidly expanding E. coli outbreak has gripped Germany since late August 2025, infecting over 350 people—predominantly young children—and claiming at least three lives, according to the Robert Koch Institute (RKI). Despite months of intensive investigation involving telephone surveys, shopping receipt analysis, and case-control studies, German health authorities remain unable to identify the contaminated food source fueling the nation’s worst E. coli crisis since 2011.
Three Deaths Confirmed
The RKI confirmed on October 23, 2025, that two people have died in direct connection with the outbreak, with a third “probable” death under investigation:
- A child aged 5 to 10 years who developed hemolytic uremic syndrome (HUS)
- A woman aged 70 to 80 who was infected with E. coli
- A woman over 90 years old with HUS (classified as a probable case)
All deceased patients suffered from HUS, a life-threatening complication that causes acute kidney failure, brain damage, and can be fatal. The RKI has withheld additional details about the victims due to privacy protections.
Image Credits: Z thomas, CC BY-SA 4.0, via Wikimedia Commons
351 Cases Across Germany
As of October 23, 2025, the outbreak has been linked to 351 cases nationwide: 183 laboratory-confirmed infections, eight probable cases, and 160 possible cases awaiting test results. This represents a dramatic surge from just 255 total cases reported on October 5.
Most alarmingly, 48 people have developed HUS, all of them children. The median age of confirmed cases is just 4 years old, with ages ranging from less than 1 year to 94 years.
Geographic Spread: From Coastal Resorts to Nationwide Crisis
The outbreak began in late August 2025 in Mecklenburg-Vorpommern, a popular coastal vacation destination in northern Germany. Early cases primarily involved tourists who had visited the region, particularly the districts of Vorpommern-Rügen and Vorpommern-Greifswald.
By late August, nine children had fallen seriously ill in these two districts alone, with five developing HUS. Six children required hospitalization across multiple German states, several in intensive care. Most were vacationers enjoying summer holidays on the Baltic Sea coast.
However, the RKI reports that the outbreak’s geographic center has now shifted dramatically from Mecklenburg-Vorpommern to Nordrhein-Westfalen (North Rhine-Westphalia) in western Germany, particularly the Düsseldorf area. The outbreak has spread to 13 of Germany’s 16 federal states, with only Bremen, Thüringen (Thuringia), and Saarland remaining unaffected.
Bavaria has confirmed nine cases, with eight concentrated in Unterfranken (Lower Franconia). Specific clusters have been identified in the districts of Main-Spessart (four cases), Würzburg (three cases), and Schweinfurt (one case), with an additional case in Rosenheim.
International Cases Linked to German Travel
Four travel-associated cases have been reported through European Union health surveillance networks:
- A woman from the United States who had traveled to Mecklenburg-Vorpommern before falling ill
- A child from the Netherlands who had been shopping for food in Germany
- A child living in Germany who became ill while visiting Italy
- A child from Luxembourg who became ill with no confirmed exposure in Germany
These international cases underscore the outbreak’s reach and the challenges of containing foodborne illnesses in Europe’s border-free Schengen Area with high tourist mobility.
Largest Outbreak Since Deadly 2011 Fenugreek Sprout Crisis
This outbreak represents Germany’s most significant E. coli emergency since 2011, when contaminated fenugreek sprouts caused 4,075 infections, 908 HUS cases, and 50 deaths across 16 countries. The current crisis has already surpassed typical annual infection rates: by mid-2025, Germany had registered approximately 5,300 EHEC cases—more than all of 2024.
Rare E. Coli Strain Identified
Germany’s National Reference Center for Salmonella and Other Bacterial Enteritis Pathogens identified the outbreak strain as E. coli O45:H2, an extremely rare serovar in Germany. From January 2015 to June 2025, the reference center detected only 13 strains of this type, and none were genetically similar to the outbreak strain.
This rarity suggests the contamination may have originated from an unusual or imported source, further complicating identification efforts.
Baffling Investigation: No Food Source Identified
Despite an unprecedented multi-agency investigation, German authorities remain unable to pinpoint the contaminated food product. The RKI and state health offices have employed multiple investigative strategies:
- Detailed telephone interviews with patients and parents about food consumption patterns
- A formal case-control study comparing affected individuals with healthy controls
- Analysis of shopping receipts to identify common food purchases across cases
- Laboratory testing of suspected food samples
The prolonged duration of the outbreak—now spanning over two months—suggests a “protracted source” rather than a single contamination event (point source). RKI epidemiologists note that the absence of a clear data signal pointing to any specific food item suggests multiple contaminated products may be involved.
“This could be the result of contamination at the beginning of food production chains,” RKI researchers wrote in Epidemiological Bulletin 40/2025. The outbreak pattern suggests contaminated foods are being distributed through retail outlets rather than restaurants, as no clusters associated with specific dining establishments have been identified.
Authorities suspect contaminated meat or sausage products may be responsible, though plant-based foods have not been ruled out. Direct transmission through contact with animals or contaminated water sources appears unlikely based on current evidence.
Children Most Vulnerable
The outbreak has disproportionately affected Germany’s youngest residents. Children under 10 years of age represent the overwhelming majority of confirmed cases, with their developing immune systems leaving them particularly vulnerable to severe complications.
In late August, when the outbreak first emerged, at least six children required intensive care treatment in hospitals across multiple German states. Several were vacationing families whose summer holidays ended in medical emergencies.
By the end of August, Mecklenburg-Vorpommern had already reported 134 EHEC cases—more than the entire year of 2024 (132 cases) and nearly double the 80 cases recorded in 2023. This alarming trend signaled the unprecedented nature of the outbreak.
Public Health Warnings Issued
German health authorities have issued nationwide warnings urging citizens to take precautionary measures:
- Avoid consuming undercooked or raw meat and sausage products
- Practice rigorous kitchen hygiene, especially when handling raw foods
- Wash hands thoroughly after bathroom use and before food preparation
- Cook meat products to internal temperatures above 70°C (158°F)
- Wash fruits and vegetables thoroughly before consumption
The warnings emphasize heightened vigilance for families with young children, who face the highest risk of developing life-threatening HUS complications.
What is EHEC and HUS?
EHEC stands for “enterohemorrhagic Escherichia coli”—specific disease-causing strains of the normally harmless intestinal bacterium E. coli. These pathogenic strains produce Shiga toxins that damage blood vessels in the intestines, kidneys, and brain.
HUS (hemolytic uremic syndrome) develops in approximately 5-10% of EHEC infections, primarily affecting young children. The syndrome destroys red blood cells and causes acute kidney failure, requiring immediate intensive medical treatment and sometimes dialysis. Without prompt intervention, HUS can cause permanent kidney damage, neurological impairment, or death.
Ongoing Uncertainty
As the outbreak enters its third month with cases continuing to emerge across Germany, public health officials face mounting pressure to identify the contamination source and prevent additional infections. The geographic shift from northern vacation regions to densely populated western states raises concerns about continued community spread through retail food chains.
German health authorities continue daily monitoring and urge anyone experiencing severe diarrhea (especially bloody diarrhea), abdominal cramps, or symptoms in young children to seek immediate medical attention.
