Travel Warnings
For the safety of students and faculty abroad, the SDSU Education Abroad Office does not permit study abroad in countries under a U.S. Department of State issued Travel Warning. Students wishing to travel to a country with a Travel Warning will not receive guidance nor will they be eligible for financial aid.
For a list of current travel warnings, please visit the Department of State’s Travel Warnings web site.
Health Advisory
SDSU Student Health Services
June 6, 2011
The U.S. Centers for Disease Control (CDC) and the World Health Organization are monitoring a large outbreak of Shiga toxin-producing Escherichia coli O104:H4 (STEC) infections centered in Germany. Most infections have been reported in people in northern Germany (mainly Bremen, Hamburg, Lower Saxony, and Schleswig-Holstein) or in people who have recently traveled to these areas. Scattered cases have been reported elsewhere in Europe, mainly in those who have traveled to northern Germany. The source of this outbreak is being investigated.
Over one thousand people have been infected, developing symptoms including severe stomach cramps, diarrhea (which is often bloody) and vomiting. If there is fever, it usually is not very high. Most people get better within 5–7 days, but an unusually high percentage of those affected have developed a complication called hemolytic uremic syndrome (HUS). HUS is a disorder that usually occurs when an infection in the digestive system (such as STEC) produces toxic substances that destroy red blood cells and cause kidney injury. Early symptoms of HUS include decreased frequency or volume of urination, feeling very tired, and losing pink color in the cheeks and inside the lower eyelids. Signs of HUS typically start 5–7 days after the start of diarrhea, and diarrhea or bloody stools may no longer be present when HUS develops.
Advice for US Travelers to Germany
While risk to Americans traveling in Europe appears to be low, CDC has reported three cases of HUS in the United States have been reported in persons who recently traveled to Hamburg, Germany. German health authorities recommend that people in Germany, especially in the northern part of the country, avoid eating raw tomatoes, fresh cucumbers, and leafy salads, until further notice. Travelers should also follow regular food safety measures when handling fruit and vegetables.
If you have traveled to Germany and have bloody diarrhea and stomach cramps or symptoms of HUS (see below), go to a doctor right away and tell him or her about your recent travel. Inform the medical provider about the outbreak of STEC infections in Germany and the importance of being tested for STEC infection.
It is not recommended to give antibiotics to patients with suspected STEC infections until complete diagnostic testing can be performed and STEC infection is ruled out. Some studies have shown that administering antibiotics in patients with STEC infections might increase their risk of developing HUS. However, the decision to start antibiotics should be tailored to each individual. For example, there may be reasons to give antibiotics in patients with severe intestinal inflammation if perforation of their bowel is of concern. However, isolates of STEC from patients in Germany have demonstrated resistance to multiple antibiotics, so picking a “correct” antibiotic may be difficult.