title: Analysis of Escherichia Coli O104:H4 Outbreak in Germany in 2011 Using Differentiation Method for Unusual Epidemiological Events.
abstract: OBJECTIVE
  The aim of the study was to further clarify the origin of Escherichia coli O104:H4 outbreak in Germany in 2011 (German Ec) as the likelihood of a deliberate act has not been excluded in previous analyses.
  
  
  METHODS
  We use an original and the most detailed scoring method so far, with 33 parameters pertaining to the source of infection/reservoir or possible perpetrator, pathogen or biological agent, transmission mechanism/factors or means/media of delivery, and population at risk or target.
  
  
  RESULTS
  Total scores for a deliberate or accidental epidemic indicate that the outbreak was more probably caused unintentionally, presumably due to technical accidents or hygienic shortcomings in the food chain.
  
  
  CONCLUSIONS
  The validity of the present assessment is limited by the lack of data on the reservoir of the pathogen, the source of infection, and the mode of food contamination. Conclusive evidences on these parameters are essential for the final clarification of the outbreak origin.
authors.affiliation: Military Academy, University of Defense, Belgrade, Serbia.|Medical Corps Headquarters, Army of Serbia, Belgrade, Serbia.
authors.forename: Vladan
authors.initials: V
authors.lastname: Radosavljević
authors.affiliation: Specialist in Microbiology, Virology and Infection Epidemiology, Munich, Germany.
authors.forename: Ernst Jürgen
authors.initials: EJ
authors.lastname: Finke
authors.affiliation: Institute of Hygiene and Medical Ecology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Goran
authors.initials: G
authors.lastname: Belojević
mesh_terms: D004196:Disease Outbreaks; D004927:Escherichia coli Infections / Q000453:epidemiology*; D005260:Female; D005517:Foodborne Diseases / Q000453:epidemiology*; D005858:Germany / Q000453:epidemiology; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology*; D006801:Humans; D008297:Male; D012189:Retrospective Studies
keywords: Escherichia coli; Germany; Shiga toxin; epidemics; gastroenteritis; haemolytic-uremic syndrome