In May of 2011, an outbreak of diarrhea and hemolytic-uremic syndrome began in Northern Germany.  According to the New England Journal of Medicine, a total of 3167 cases of non-hemolytic-uremic syndrome Shiga-toxin-producing E. coli and 908 cases of hemolytic-uremic syndrome, a disease which attacks the kidneys, resulted in 50 deaths.  The causative agent was found to be a virulent strain of E. coli, O104:H4, which had never before been associated with large scale outbreaks.

Answers the following 10 questions in APA format, in-text citation, references include. Each question need to answer with a short paragraph. Maximum 3 pages.

1. How quickly was the strain identified?
2. What are the characteristics of the bug?
3. Why did the investigators first think that the outbreak was caused by cucumbers?  What dispelled this evidence?
   Sequences were different.
4. Where did the strain come from?
5. How did they identify the organic farm as the source?
6. What does it mean for a news article to say, “They are still strongly suspicious of the sprouts because the epidemiological link was strong.  It’s just that they haven’t found it at the farm.”  Do you believe that it was from the farm?  What kinds of epidemiological evidence did they bring?
7. Generate a timeline of the response.  Investigate  the response, and determine which steps you think could be improved.
8. Is this a new strain of E. coli?
9. This outbreak did not affect the US, if at all.  What actions did the US government take to protect its citizens from this outbreak?  Did they do enough?
10. Apply any other factors you think may be relevant to this outbreak based on your readings of the Epidemiology chapter. https://www.ncbi.nlm.nih.gov/books/NBK7993/

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