Deadly E. Coli Outbreak Linked to German Sprouts

Gert Lindemann, the agriculture minister in the northern state of Lower Saxony, said in Hanover that Germans should not eat sprouts until further notice, with definitive test results available Monday. Mr. Lindemann said that the authorities could not yet rule out other possible sources for the outbreak and urged Germans to continue avoiding tomatoes, cucumbers and lettuce.

The suggestion that sprouts may be the cause of the outbreak, one of the most catastrophic food-borne illnesses in years, was met with caution by public health experts.

“We would want either epidemiological evidence or confirmed laboratory evidence,” said Dr. Robert Tauxe, deputy director of food-borne diseases for the Centers for Disease Control and Prevention in Atlanta.

The German authorities had acted prematurely once before in their investigation, blaming cucumbers grown in Spain for the outbreak after preliminary tests showed that they might have contained toxic E. coli bacteria. Further tests showed that the Spanish cucumbers did not contain the strain making people sick, and investigators then backtracked.

That episode infuriated Spanish farmers who lost tens of millions of dollars in sales and were forced to abandon ripe vegetables to rot in the fields, as demand collapsed.

The outbreak in Germany, which the health authorities first reported in late May, is caused by a rare strain of toxic E. coli that can cause bloody diarrhea. In extreme cases it can cause acute kidney failure and death. In previous outbreaks involving other strains of E. coli, kidney failure appeared most often among children. In this outbreak, most victims with kidney failure have been adults and more than two-thirds have been women.

The outbreak showed no signs of abating on Sunday, with Germany’s national disease control center reporting that the death toll had risen to 22 and that 2,153 people were ill, more than 600 of them in intensive care.

Mr. Lindemann said that locally grown bean sprouts were the “most convincing” cause, and that the farm that grew them in the Uelzen area had been shut down. But he said 18 sprout mixtures were under suspicion, including sprouts of beans, broccoli, peas, chickpeas, garlic, lentils, mung beans and radishes. The sprouts are often used in mixed salads.

The suspect farm’s produce — including herbs, fruits, flowers and potatoes — was impounded. At least one of the farm’s employees was also infected with the E. coli bacteria, Mr. Lindemann said.

Some experts in food-borne illnesses expressed surprise at Mr. Lindemann’s announcement, not because sprouts were an unlikely source of the deadly bacteria but for the opposite reason: sprouts have long been associated with food-borne illness and are a food most commonly suspected in this sort of outbreak. As such, the experts said, sprouts should have been among the first foods scrutinized by investigators.

Dr. Tauxe, who has talked to European officials during the investigation, though not on Sunday, said sprouts were included in a questionnaire that German investigators had used to interview victims of the outbreak to determine what they had eaten. He said that the officials in charge of the investigation had been aware of the common link between sprouts and food-borne illness.

“It’s not something they’re likely to have missed,” Dr. Tauxe said.

American experts said that investigators of any such outbreak in the United States would have been sure to have examined the possibility that sprouts might have been the cause.

“This is one of the things that everybody in our local health departments knows, that if you hear about one person eating sprouts you’re supposed to ring the alarm bell,” said William E. Keene, a senior epidemiologist of the Oregon Public Health Division, who has investigated many outbreaks involving sprouts. “A single case in a salmonella or E. coli O157 outbreak is a red flag,” he said, referring to the most common E. coli bacteria.

Since 1996, sprouts have been linked to at least 30 illness outbreaks, according to a United States federal food safety Web site that warns that children, the elderly, pregnant women and people with weak immune systems should not eat uncooked sprouts.

Sprouts were found to be the cause of one of the most severe series of outbreaks of E. coli ever identified, in Japan in 1996. In those outbreaks about 10,000 people, many of them children, fell ill after eating food containing uncooked radish sprouts. That involved the common O157:H7 strain of E. coli. The current outbreak in Germany involves a rare strain known as O104:H4.

Bacteria can flourish in the warm, humid conditions in which sprouts are grown, according to a report by the Centers for Disease Control. Investigators have sometimes found that the seeds used to grow sprouts are contaminated with bad bacteria, like E. coli or salmonella. Once those seeds start growing, the bacteria can easily spread.

“If you’re concerned about your risk of food-borne illness, don’t eat sprouts,” Dr. Keene said. “They’re essentially a dangerous kind of food.”

The Spanish government did not comment Sunday on the latest news in the German investigation. But mounting evidence that the problem should never have been linked to produce from Spanish farms is likely to raise pressure on Germany and the European Union to compensate Spanish farmers for estimated weekly losses of $286 million in revenue because of canceled shipments, as well as massive job cuts among seasonal growers in Andalusia.

That area, the Spanish agricultural heartland, was already suffering the worst unemployment problem in the country.

Judy Dempsey reported from Berlin, and William Neuman from New York. Raphael Minder contributed reporting from Madrid.

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Syria Broadens Deadly Crackdown on Protesters

The breadth of the assault — from the Mediterranean coast to the poor steppe of southern Syria — seemed to represent an important turn in an uprising that has posed the gravest challenge to the 11-year-long rule of President Bashar al-Assad. Though officials have continued to hint at reforms, and even gingerly reached out to some dissidents last week, the escalation of the crackdown seemed to signal the government’s intent to end the uprising by force.

Since the beginning of the uprising, Syria has barred most foreign journalists, and many news accounts have relied on human rights groups and networks of activists inside Syria. But in past days, those activists have complained that they have been almost entirely unable to speak with people in Homs and Baniyas, the most besieged places. Even satellite phones that protest organizers had smuggled across Syria were not working. “It seems that they’ve gotten better in tracking satellite mobile phones,” said Wissam Tarif, executive director of Insan, a Syrian human rights group.

The reasons for the newfound ability to sever communications were unclear, but Obama administration officials have said Iran, which faced a similar uprising in 2009, has provided the Syrian government, a longtime ally, with coercive supplies like tear gas, along with communications equipment that might help interrupt activists’ phones.

“The only country they can trust to back them to the end is Iran,” said an analyst based in Syria who spoke on condition of anonymity for fear of retribution.

The Syrian government’s actions against protesters, which have intensified since Friday, come at a time when the opposition remains unable to act collectively. Even as the United States and the European Union have imposed limited sanctions on government figures, though not Mr. Assad himself, many officials view the opposition as too weak to provide an alternative, a point that the Syrian government has relentlessly pressed. Its argument, either us or chaos, has found a certain resonance among minorities of Christians and heterodox Muslim sects there.

“We’re not focused on a transition right now,” an Obama administration official said in Washington. “We don’t know who we’d talk to and who we’d work with.”

At least 30 tanks were said to be in Baniyas, one of Syria’s most restive locales, which the military entered before dawn on Saturday. Activists and human rights groups complained of receiving almost no information from Baniyas, which has a population of 50,000 and is home to an oil refinery and a hydroelectric plant that serves the region, but one activist said at least 6 people had been killed and 250 people arrested since the operation began.

As in other towns, electricity and water were cut, at least temporarily.

Fighting was reported in Homs, Syria’s third largest city, which tanks entered Friday. Mr. Tarif said 14 people had been killed there; he could not confirm the casualties in Baniyas. Videos smuggled out of Homs, their authenticity undetermined, showed gunfire and crowds of people running for cover across a grassy lot. Mr. Tarif said the military also entered Tafas, in southern Syria.

“This is a campaign that’s going to more cities,” he said. “It’s escalating, and it’s very worrying because they’re also getting better at isolating these places.”

He said his group had documented 750 arrests, most of them in the Damascus suburbs, though he had no precise figures for Homs and Baniyas.

The uprising began in mid-March with protests in Dara’a, a town near Tafas and the border with Jordan. The protesters gathered after security forces arrested and mistreated high school students for scrawling antigovernment graffiti. The unrest soon spread, with successive Fridays in which thousands took to the streets in dozens of towns. The military’s presence in Tafas on Sunday suggests that the plight of Dara’a, part of a landscape knit tightly by extended clan loyalties, has roiled the region around it, a fertile but drought-stricken plateau famous for wheat and vineyards.

The military said it was withdrawing from Dara’a last week, and while armed columns were filmed departing, residents say the military remains in force. Townspeople were allowed to leave their homes Sunday from 8 a.m. to noon, activists said, and intermittent electricity and water were restored to some areas.

 

Deadly Attack by Insurgents in Kandahar

KABUL, Afghanistan — Insurgents staged a complicated attack in Kandahar on Saturday that killed four, including an intelligence officer, a police officer and two civilians, and wounded 45 people.

A 7-year-old girl who was shot in the back and her father being evacuated Saturday by helicopter. The assault lasted six hours.

Three of the wounded were in critical condition, according to doctors at Mirwais Hospital in Kandahar.

The insurgents’ force included at least six suicide bombers who took over buildings near the governor’s office and another near the governor’s home, as well as one near the intelligence agency, the National Directorate of Security. Early Sunday, the situation remained tense, with civilian cars blocked from using the roads, shops closed and the police guarding every crossroad as helicopters roared overhead.

Tooryalai Wesa, the governor of Kandahar Province, said on Saturday that it had been a “hard day for Kandahari people.”

The attack, which lasted more than six hours, came just two weeks after a jailbreak in which nearly 500 prisoners escaped, most from the secure section of the prison where Taliban detainees are held.

Late Saturday, explosions and gunfire could still be heard, and at least one insurgent was still fighting near a traffic intersection, residents said. But it appeared possible there were also insurgents elsewhere in the city.

It was the first major attack since the killing of Osama bin Laden by a Navy Seal team in Pakistan on Monday.

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South Assesses the Toll After a Deadly Barrage of Tornadoes

At least 285 people across six states died in the storms, with more than half — 195 people — in Alabama. This good-time college town, the home of the University of Alabama, has in some places has been shorn to the slab, and accounts for at least 36 of those deaths.

Thousands have been injured, and untold more have been left homeless, hauling their belongings in garbage bags or rooting through disgorged piles of wood and siding to find anything salvageable.

While Alabama was hit the hardest, the storm spared few states across the South. Thirty-four people were reported dead in Tennessee, 33 in Mississippi, 15 in Georgia, 7 in Virginia and one in Kentucky. With search and rescue crews still climbing through debris and making their way down tree-strewn country roads, the toll is expected to rise.

“History tells me estimating deaths is a bad business,” said W. Craig Fugate, the Federal Emergency Management Agency administrator, in a conference call with reporters.

Cries could be heard into the night here on Wednesday, but on Thursday hope was dwindling. Mayor Walt Maddox said that the search and rescue operation would go for 24 to 48 more hours, before the response pivoted its focus to recovery.

“They’re looking for five kids in this rubble here,” said Lathesia Jackson-Gibson, 33, a nurse, pointing to the incoherent heap of planks and household appliances sitting next to the muddled guts of her own house. “They’re mostly small kids.”

President Obama announced that he was coming to Alabama on Friday afternoon, saying in a statement that the federal government had pledged its assistance.

Gov. Robert Bentley toured the state by helicopter along with federal officials, tracking a vast scar that stretched from Birmingham to his hometown, Tuscaloosa. He declared Alabama “a major, major disaster.”

“As we flew down from Birmingham, the track is all the way down, and then when you get in Tuscaloosa here it’s devastating,” Mr. Bentley said at an afternoon news conference, with an obliterated commercial strip as a backdrop.

An enormous response operation was under way across the South, with emergency officials working alongside churches, sororities and other volunteer groups. In Alabama, more than 2,000 National Guard troops have been deployed.

Across nine states, more than 1,680 people spent Wednesday in Red Cross shelters, said Attie Poirier, a spokeswoman with the organization. The last time the Red Cross had set up such an elaborate system of shelters was after Hurricane Katrina, a comparison made by even some of those who had known the experience firsthand.

“It reminds me of home so much,” said Eric Hamilton, 40, a former Louisianan, who was sitting on the sidewalk outside the Belk Activity Center, which was being used as a Red Cross shelter in south Tuscaloosa.

Mr. Hamilton lived in a poor area of Tuscaloosa called Alberta City, which residents now describe merely as “gone.” He wiped tears off his cheeks.

“I’ve never seen so many bodies,” Mr. Hamilton said. “Babies, women. So many bodies.”

Officials at the National Weather Service Storm Prediction Center said they had received 137 tornado reports on Wednesday, with 104 of them coming from Alabama and Mississippi. Over all, there have been 297 confirmed tornadoes this month, breaking a 36-year-old record.

Southerners, who have had to learn the drill all too well this month, watched with dread on Wednesday night as the shape-shifting storm system crept eastward across the weather map. Upon hearing the rumble of a tornado, or even the hysterical barking of a family dog, people crammed into closets, bathtubs and restaurant coolers, clutching their children and family photos.

Many of the lucky survivors found a completely different world when they opened their closet doors.

“We heard crashing,” said Steve Sikes, 48, who lives in a middle-class Tuscaloosa neighborhood called the Downs. “Then dirt and pine needles came under the door. We smelled pine.

“When you smell pine,” he said, gesturing, by way of a conclusion, toward a wooden wreck behind him, so mangled that it was hard to tell where tree ended and house began.

Some opened the closet to the open sky, where their roof had been, some yelled until other family members pulled the shelves and walls off them. Others never got out.

Campbell Robertson reported from Tuscaloosa, and Kim Severson from Atlanta. Kevin Sack contributed reporting from Tuscaloosa, and Robbie Brown from Birmingham, Ala.

 

In Thailand, Love of Food Carries Deadly Risks

It can be a fatal attraction, medical researchers say. The raw fish that is so avidly consumed in the stilt houses that sit among rice paddies and wetlands of the country’s northern provinces contain parasites that can accumulate in the liver and lead to a deadly cancer. Known as bile duct cancer, it is relatively uncommon in most parts of the world but represents the majority of the 70 liver cancer deaths a day in Thailand, according to Dr. Banchob Sripa, the head of the tropical disease research laboratory at nearby Khon Kaen University.

“It’s the most deadly and persistent cancer in the region,” Dr. Banchob said.

For the past three decades, he has led an unsuccessful campaign against the parasite, known as a liver fluke and which is also endemic in Cambodia, Laos, Vietnam, parts of China, the Korean Peninsula and Siberia.

Dr. Peter Hotez, the president of the Sabin Vaccine Institute, a nonprofit organization in the United States that researches neglected tropical diseases, describes liver flukes as one of “the most important infectious causes of cancer that no one has ever heard of.”

Cooking the fish would eliminate the risk of infection. But the battle against liver flukes is being undermined in Thailand by a deeply ingrained love of the sour and smoky-tasting fermented dishes that generations of villagers have relished.

Some villagers just cannot break the habit, said Nutcharin Yanarangsri, a volunteer at a government health clinic in the village here who spends her days walking from house to house with a singular message: “Say no to raw fish!”

“We tell them, ‘If you really want to eat it, you’d better boil it or cook it,”’ Ms. Nutcharin said during one of her rounds through the village. “But they tell me, ‘Eating it raw is so delicious. I can’t stop. I love it!”’

Whether it is a green papaya salad with just the right mix of sweet and sour or a duck curry swimming in spices, the cuisine of Thailand is a national passion. The country’s 65 million people seem to spend their waking hours either talking about food or consuming it.

But the Thai love of food has a masochistic side. It is not uncommon for office workers to lunch on searingly hot chili-laced dishes only to rush to the bathroom a few hours later with a bad case of Bangkok belly.

The love of fermented foods, especially in northeastern Thailand, is the extreme version of this gourmand obsession — and that love is often heedless of the consequences.

One popular dish in northeast Thailand is called pla som, or sour fish, which is made by mixing raw fish, garlic, salt, steamed rice and a pinch of seasoning powder. The mixture is shaped into egg-size portions, put into plastic bags and left to sit in the tropical heat for three days. That is not nearly long enough to kill the parasites, which die only after at least six months of fermentation.

Liver flukes are present only in fresh water, but they are not found everywhere. The rate of infection in Bangkok, a five-hour drive away, is close to zero.

Transmitted through feces, the parasites thrive in rural areas without proper sanitation, and they rely on snails, fish, cats and humans as hosts. Yet villagers do not see fermented fish as a dangerous thrill.

This is not analogous to the tradition in Japan of eating fugu, the puffer fish that is potentially toxic when prepared the wrong way.

The deadly effects of eating parasite-infected raw fish accumulate over decades, in the same way that drinking large amounts of alcohol over a lifetime can damage one’s liver. (Heavy drinking increases the chance of bile duct cancer for those infected with the parasite, Dr. Banchob said.)

Somewhere between 1 percent and 5 percent of people infected with the parasites contract liver cancer.

Laos, Vietnam and Cambodia also have high rates of liver cancer, according to statistics from the United Nations. Dr. Banchob estimates that about 10 percent of the population in Laos is infected with liver flukes.

Dr. Hotez of the Sabin Institute said that the parasite is similar to other worms and ailments that get less attention because they rarely afflict wealthy urban populations. “Even though Thailand is a middle-class country, there are still pockets of intense poverty — and with that poverty come high rates of neglected tropical diseases,” Dr. Hotez said. “We’ve got the technology to make vaccines. But we don’t have the funding.”

Dr. Cherdchai Tontisirin, a surgeon in Khon Kaen who has operated on liver cancer patients, blames the Thai government for the persistence of the disease. More could be done to make sure villagers stop eating raw fish, he said.

“The government has never taken this seriously,” Dr. Cherdchai said. “This is a disease that affects only the north and the northeast, and these are regions that have been

Election Fuels Deadly Clashes in Nigeria

Ethnic and religious tensions between Muslims in the north and Christians in the south, discrimination by southerners against immigrants from the north, and frustration over corruption in a country where most subsist on less than $2 a day while top officials have access to billions in oil revenues have set off the latest round of clashes, much as they have in the past.

While more than 300 were killed in Nigeria’s presidential election four years ago, the death toll appeared to be higher this year, as the violence that flared in the wake of the re-election of Nigeria’s president, Goodluck Jonathan, a Christian from the south, instigated a cycle of action and reaction.

Mobs of Muslim youths in the north began rioting after the defeated opposition candidate, Muhammadu Buhari, a Muslim from the north, failed to rein in his supporters. That set off a wave of retaliation against Muslims in Kaduna State in the north, according to Shehu Sani, the head of a leading Nigerian civil rights group.

Mr. Sani, who lives in Kaduna, said Sunday that more than 500 people, mostly Muslims, had been killed in three villages in Kaduna alone since the April 16 presidential election. There was no independent verification of the figure; the authorities have been chary of releasing death tolls for fear of inflaming further violence.

Human Rights Watch said that about 140 were killed in political violence between November and April 17, the day after the election, while acknowledging that many more had died since. Mr. Sani said the total number of victims in the recent violence could top 1,000.

“For presidential elections, on this scale, it’s new,” said Chidi Odinkalu of the Open Society Justice Initiative, adding that the only comparable episodes of violence occurred in the mid-1960s and early 1980s, both times leading to the overthrow of incumbent governments.

A researcher for Human Rights Watch said Sunday that one village in Kaduna “looks like a war zone,” with “not one building standing” and a mosque that had been “gutted.” The researcher, Eric Guttschuss, said he had seen a mosque in another village, Marada Rio, that had been burned down, with anti-Islam graffiti scratched into the ruins, next to inscription reading, “Jesus is Lord.” In other villages, entire streets had been burned down, Mr. Guttschuss said.

Sunday was a day of relative calm in the worst-hit areas like Kaduna, as residents observed a curfew, cleared debris, buried their dead and attended Easter services amid a heavy military and police presence. But there were fears that next week’s elections for governors might bring a renewal of the mayhem.

Mr. Odinkalu said that it was “difficult to come up with a single organizing theory” for the violence. But the persistent cleavage between the country’s relatively wealthier, oil-producing south and its impoverished north, fueled by the intermingling of populations and religions, appeared to lie at the base of this episode, as in previous ones.

Riots in the Muslim north followed Mr. Jonathan’s decisive defeat last week of Mr. Buhari, 57 to 31 percent, in a vote that foreign-observer groups said was perhaps Nigeria’s fairest ever. Mr. Buhari, a former military dictator, swept the north, and after his defeat knife- and machete-wielding youths in northern towns like Kano rampaged through the streets, chanting the general’s name and attacking supporters of Mr. Jonathan’s majority party.

Unlike Mr. Jonathan, Mr. Buhari had refused to condemn, in advance, a possible violent reaction to the election result — a silence analysts said nearly amounted to an invitation to his supporters to take to the streets.

Analysts said the rioting reflected, in part, northern frustration that the dominant party did not allocate its slot on the presidential ballot to a northerner, as would have been expected under an unwritten practice of alternating northern and southern rule of the country.

 

Deadly Drone Strike by U.S. May Fuel Anger in Pakistan

ISLAMABAD, Pakistan — An American drone attack killed 23 people in North Waziristan on Friday, Pakistani military officials said, in a strike against militants that appeared to signify unyielding pressure by the United States on Pakistan’s military amid increasing opposition to such strikes.

The strike came a day after the chairman of the Joint Chiefs of Staff, Adm. Mike Mullen, met with the Pakistani military chief, Gen. Ashfaq Parvez Kayani, and asked that Pakistan do more to fight militants who use North Waziristan as a base from which to attack United States and NATO forces in Afghanistan.

The assault was the second show of the United States’ determination to continue drone attacks since the head of Pakistan’s spy agency, Lt. Gen. Ahmed Shuja Pasha, met this month in Washington with Director Leon E. Panetta of the Central Intelligence Agency to request a halt to the strikes.

Friday’s attack could further fuel anti-drone sentiment among the Pakistani public. A government official in North Waziristan told Pakistani reporters that five children and four women were among the 23 who were killed.

The attack singled out forces of a militant commander, Hafiz Gul Bahadur, whose loyalists cross the border into Afghanistan to fight American and NATO soldiers, the government official said.

Mr. Bahadur operates under a peace accord with the Pakistani Army that ensures that militants under his control do not attack Pakistani soldiers but concentrate only on allied soldiers.

Those killed Friday were gathered in Spinwam, an area close to Mir Ali in North Waziristan that had become a hub for militants in the past several months, the official said.

In the increasing public war of nerves between the American and Pakistani armies, Pakistan’s government is allowing a planned anti-NATO protest to go ahead in Peshawar this weekend. A political leader, Imran Khan, has called on protesters to stage a sit-in on Saturday to block trucks carrying NATO supplies for the war in Afghanistan. The trucks travel through Peshawar from the seaport of Karachi to Torkham, the gateway to Afghanistan.

The drone strike on Friday came after Admiral Mullen delivered an unusually harsh message during his visit here, saying publicly that Pakistan’s spy agency, Inter-Services Intelligence, directly supported and abetted the Haqqani network of militants in North Waziristan. The network’s militants are responsible for many of the American casualties in Afghanistan, American commanders say.

The United States has long held that the Haqqani network was supported by the Pakistani spy agency, but it rarely says so publicly.

In a separate episode, between the Pakistani military and the Taliban, 16 soldiers from the Pakistani Frontier Corps were killed Thursday when their checkpoint was overrun by 150 militants near the Afghanistan border, a Pakistani security official said.

The battle continued for close to 12 hours at Kharkai in the northern district of Dir in Khyber-Pakhtunkhwa Province, formerly North-West Frontier Province. Two officers sent to reinforce the troops were killed in an ambush, the official said.

The attack by the militants on Pakistani soldiers came as the army embarked on a renewed assault in Mohmand, part of the tribal areas that have proved difficult for the Pakistani Army to hold.

In a report to Congress this month, the Obama administration complained that the Pakistani Army had “no clear path” toward defeating the insurgency inside Pakistan, and cited the failed efforts to eradicate the militants from Mohmand as an illustration. The army “was failing for the third time in two years” to clear militants from Mohmand, the report said.

The 150 militants who carried out the attack on Thursday appeared to have fled the army assault to Afghanistan and then re-entered Pakistan to strike at the soldiers.

General Kayani, the chief of the Pakistani military, visited Mohmand on Thursday for the second stage of a new assault focused on the Suran, a narrow valley on the border with Afghanistan.

In the last few months, American and NATO forces on the other side of the border of Mohmand have helped Pakistan to attack militants as they escaped into Afghanistan, the Pakistani security official said. But the Pakistani militants who attacked in Dir on Thursday appeared to have escaped before the assault on the Suran began and were allowed to re-enter Pakistan by elements in the Afghan Army who were assisting them, the official said.

Jane Perlez reported from Islamabad, and Ismail Khan from Peshawar, Pakistan.