Category Archives: Haemolytic Uremic Syndrome

France – French E. coli outbreak linked to dairy

Food Safety News

At least a dozen children have been sickened in France with officials linking illnesses to a dairy company.

Since early June, 12 cases of haemolytic uremic syndrome (HUS) have been reported in the Provence-Alpes-Côte d’Azur and Occitanie regions. HUS is a severe complication associated with E. coli infection that causes kidney failure and sometimes death.

Seven boys and five girls aged 11 months to 9 years old are sick. They fell ill from June 4 to July 18.

In France, Shiga toxin-producing E. coli (STEC) surveillance is only based on HUS in children younger than 15, so it only catches the most severe cases.

Santé publique France, the Directorate General for Food (DGAL) and Directorate General for Health (DGS) are part of the investigation.

France -Pediatric haemolytic uremic syndrome: preventive measures in the face of summer risks

Sante Publique

Each year, during the summer period, an increase in foodborne infections, including paediatric haemolytic uremic syndrome (HUS), is observed. HUS is a serious infectious disease most often food-borne. In children, this syndrome is most often caused by an infection due to a bacterium belonging to the family of Escherichia coli ( E. coli ) producing toxins, called Shiga-toxins. Public Health France recalls the preventive measures.

In the kitchen

  • Hand washing should be systematic before meal preparation;
  • Meat, and especially minced beef, but also minced meat preparations, must be well cooked through (and not pink or rare);
  • Raw milk, cheeses made from raw milk and dairy products made from raw milk should not be consumed by children under 5 years of age (prefer cooked pressed cheeses (such as Emmental, Comté, Gruyère, Beaufort), processed cheese spreads and pasteurized milk cheeses);
  • Flour-based preparations (pizza/cookie dough/cake/pie/pancake, etc.) should not be eaten raw or undercooked;
  • Vegetables, salads, fruits and aromatic herbs, in particular those which are going to be eaten raw, must be carefully washed before consumption, after peeling if necessary;
  • Raw foods should be kept separate from cooked or ready-to-eat foods;
  • Cooked meals and leftover food must be quickly put in the refrigerator and sufficiently reheated before consumption;
  • Kitchen utensils (especially when they have previously been in contact with raw foods such as meat or cheese), as well as work surfaces, must be thoroughly washed to avoid the risk of cross-contamination.

During activities and leisure

  • Children should not drink untreated water (well water, river, torrent, etc.) and avoid swallowing it when swimming (lake, river, pond, etc.);
  • Avoid contact of very young children (under 5 years old) with cows, calves, sheep, goats, etc., and their environment; in the event of contact with these animals, hand washing (water and soap) must be systematic before the child puts his fingers to his mouth.

France – Prosecutors open criminal inquiry into French STEC E. coli outbreak linked to Nestlé pizza

Food Safety News

French authorities have stepped up their investigations related to an E. coli outbreak in the country linked to pizzas made by Nestlé.

The latest figures from Santé publique France show 56 cases and two deaths from Buitoni brand Fraîch’Up pizzas.

The Paris prosecutor’s office opened a criminal inquiry into the incident this past week. Charges include the involuntary manslaughter of one person, the injuring of 14 others and marketing a product dangerous to health.

An investigation had already been launched on March 22 and searches of the Nestlé factory in Caudry took place, authorized by the public health department of the Paris prosecutor’s office, on April 13.

A judicial inquiry is led by an investigating judge and was opened at the request of the public prosecutor to carry out such a highly complex investigation.

More than 50 children sick
Of the 56 infections, 54 were caused by E. coli O26 and two by E. coli O103, according to Santé publique France, the country’s public health agency.

Research – Joint FAO/WHO Expert Meeting on Microbiological Risk Assessment (JEMRA) on Shiga toxin-producing Escherichia coli (STEC) associated with meat and dairy products

FAO

Shiga toxin-producing Escherichia coli (STEC) are an important cause of food-borne disease. Infections can result in a wide range of disease symptoms from mild intestinal discomfort and hemorrhagic diarrhea to severe conditions including haemolytic uremic syndrome (HUS), end-stage renal disease and death. In its report on the global burden of food-borne disease, WHO estimated that in 2010 food-borne STEC caused more than 1.2 million illnesses, 128 deaths, and nearly 13 000 Disability Adjusted Life Years (DALYs) (WHO, 2015). The Codex Committee on Food Hygiene (CCFH) has highlighted the importance of STEC in foods since its 32nd Session in 1999, when it prioritized their presence in beef and sprouts as significant public health problems in Member countries (FAO and WHO, 2000). Following a request from the 47th Session in November 2015 (FAO and WHO, 2016), the FAO and WHO published the report Shiga toxin-producing Escherichia coli (STEC) and food: attribution, characterization and monitoring in 2018 (FAO and WHO, 2018). As part of the 50th session of CCFH in November 2018, the FAO/WHO further updated the committee with additional information on STEC that was subsequently published in the report Attributing illness caused by Shiga toxin-producing Escherichia coli (STEC) to specific foods (FAO and WHO, 2019a). The Codex Alimentarius Commission (CAC) at the 42nd Session, July 2019, approved new work on the development of guidelines for the control of STEC in beef, raw milk and cheese produced from raw milk, leafy greens and sprouts (FAO and WHO, 2019b). To support this work, the Joint FAO/WHO Expert Meeting on Shiga toxin-producing Escherichia coli(STEC) associated with Meat and Dairy Products was convened virtually from 1 to 26 June 2020 to review relevant measures for pre- and post-harvest control of STEC in animals and foods of animal origins. The scientific literature describing physical, chemical and biological control measures (and their combinations) against STEC during primary production, processing and post-processing of raw meat, raw milk and raw milk cheeses was reviewed. The efficacy and utility of reported control measures were scored as high, medium or low, based on expert opinion informed by systematic reviews and/or meta-analyses, when available.

Research – France – Update on ongoing investigations into serious cases of haemolytic uraemic syndrome (HUS) in children. Reminder of food risk prevention recommendations. STEC E.coli

Sante Publique

Public Health France and the National Reference Center (CNR) Escherichia coli (Institut Pasteur – Paris), with its associated laboratory (Microbiology Laboratory of the Robert Debré Hospital – Paris), are continuing investigations concerning the increase in the number of cases haemolytic uremic syndrome (HUS) and severe Escherichia coli infection, reported since early February 2022.

Update and ongoing investigations

As of March 11, 2022, 26 cases of HUS or serious infection, linked to E. coli bacteria with similar characteristics, have been identified. These cases occurred in 9 regions of metropolitan France: New Aquitaine (6 cases), Hauts-de-France (5 cases), Ile-de-France (4 cases), Pays de la Loire (4 cases), Brittany (3 case), Bourgogne-Franche-Comté (1 case), Grand Est (1 case), Provence-Alpes-Côte-D’azur (1 case) and Auvergne-Rhône-Alpes (1 case). The sick children, aged 1 to 15 years with a median age of 8 years, presented symptoms between 01/18/2022 and 02/23/2022. Two children died. In addition, 22 additional cases are under investigation.

Public Health France, in conjunction with the CNR, the General Directorate for Food, the General Directorate for Competition, Consumption and the Repression of Fraud, and in coordination with the General Directorate for Health, are continuing investigations into all cases of pediatric HUS reported since January 1, 2022 on national territory in order to identify a possible common source of contamination and to put in place appropriate measures (for example withdrawal-recalls of incriminated products). 

At this stage, the epidemiological investigation has not made it possible to incriminate a particular source of contamination. The health authorities are therefore renewing the general recommendations for the prevention of food risks, in particular for children under 16 years of age.

Recommendations to prevent HUS

The E. coli responsible for HUS are present in the intestines of many ruminant animals (cows, calves, goats, sheep, deer, etc.) and are eliminated by the excrement which can then contaminate the environment (water, manure, soil) and foods. These bacteria tolerate cold well (survival in a refrigerator or freezer), but are destroyed by cooking.

The transmission of the bacterium can be avoided by simple gestures, in particular in children under 16 and the elderly:

  • hand washing should be systematic before meal preparation;
  • meats, and especially minced beef, but also minced meat preparations, must be well cooked through (and not pink through the core);
  • raw milk, cheeses made from raw milk and dairy products made from raw milk should not be consumed by children under 5 years of age; prefer cooked pressed cheeses (such as Emmental, Comté, Gruyère, Beaufort), processed cheese spreads and pasteurized milk cheeses;
  • flour-based preparations (pizza/cookie dough/cake/pie, etc.) should not be eaten raw or undercooked;
  • vegetables, salad, fruit and aromatic herbs, in particular those that are going to be eaten raw, must be carefully washed before consumption, after peeling if necessary;
  • raw foods should be kept separate from cooked or ready-to-eat foods;
  • cooked meals and leftover food must be quickly put in the refrigerator and sufficiently reheated and consumed quickly;
  • kitchen utensils (especially when they have previously been in contact with raw food), as well as work surfaces, must be thoroughly washed;
  • children should not drink untreated water (well water, torrent, etc.) and avoid swallowing it when swimming (lake, pond, etc.);
  • finally, it is necessary to avoid the contact of very young children (under 5 years old) with cows, calves, sheep, goats, deer, etc., and their environment; in case of contact with these animals, hand washing must be systematic.

The health authorities, who are monitoring the evolution of the situation on a daily basis, are fully mobilized to identify the source of this contamination and put in place the appropriate health measures as quickly as possible to avoid the occurrence of new cases. 

Research – The Importance of Shiga Toxin-Producing Escherichia coli O145:NM[H28]/H28 Infections in Argentina, 1998–2020

MDPI

Shiga toxin-producing Escherichia coli (STEC) is known as a pathogen associated with food-borne diseases. The STEC O145 serogroup has been related with acute watery diarrhea, bloody diarrhea, hemorrhagic colitis, and hemolytic uremic syndrome (HUS). Argentina has the highest rate of HUS worldwide with 70% of the cases associated with STEC infections. We aimed to describe the epidemiology and genetic diversity of STEC O145 strains isolated across Argentina between 1998–2020. The strains isolated from 543 cases of human disease and four cattle, were pheno-genotipically characterized. Sequencing of five strains was performed. The strains were serotyped as O145:NM[H28]/H28, O145:H25, and O145:HNT, and mainly characterized as O145:NM[H28]/stx2a/eae/ehxA (98.1%). The results obtained by sequencing were consistent with those obtained by traditional methods and additional genes involved in different mechanisms of the pathogen were observed. In this study, we confirmed that STEC O145 strains are the second serogroup after O157 and represent 20.3% of HUS cases in Argentina. The frequency of STEC O145 and other significant serogroups is of utmost importance for public health in the country. This study encourages the improvement of the surveillance system to prevent severe cases of human disease. View Full-Text

France – Child in France dies of E.coli infection as outbreak monitored

Connexion France

Health authorities have not released more information about the child that has died, but 13 other cases in children have prompted a nationwide investigation into the possible source.

Health authorities in France are monitoring an outbreak of E.coli following the death of a child and the detection of 13 cases across the country.

Santé publique France (SPF) issued the alert after the contaminations were first noticed at the beginning of February. The authority has confirmed that one child has died, but has not released information of the date of the death, location, or the age of the child.

Among children aged 1-15, there have been:

  • 5 cases reported in Nouvelle-Aquitaine
  • 3 cases in Hauts-de-France
  • 3 cases in Ile-de-France
  • 1 case in Brittany
  • 1 case in Pays de la Loire.

All of the children were affected by haemolytic uraemic syndrome (HUS), a potentially serious disease in young children, most often caused by food.

It is usually characterised by severe diarrhoea, which can lead to acute renal failure, and usually caused by bacteria belonging to the Escherichia coli (E.coli) family.

The SPF inquiry is looking into every report of similar cases as they are reported to paediatric units, and is aiming to “identify a common source of contamination and put appropriate measures in place”.

It has “not excluded any possibility at this stage”, it said.

Research – HUS reports down in Italy but stable in France; some linked to raw milk

Food Safety News

Italy and France have reported updated statistics on a potentially fatal complication of E. coli infection.

The complication, hemolytic uremic syndrome (HUS) is a type of kidney failure that can result in lifelong, serious health problems and death.

Italian data is from the start of September 2020 to the end of August 2021 when 49 cases were recorded. There were 84 cases from September 2019 to August 2020. French figures cover 2020 when 167 cases were reported.

USA – IDHP final report on Jackson County Shiga-toxin E. Coli / HUS cases

Food Safety News

The Iowa Department of Public Health (IDPH) has completed a final report on last May’s Shiga-toxin E. coli outbreak in a Jackson County childcare facility.  Pursuant to Iowa Open Records law, IDPH has shared its findings with Food Safety News

The onset of the E. coli illnesses occurred from May 6 to May 22.  IDPH and Jackson County Public Health learned, through the reportable disease system, of a Jackson County child suffering from Shiga-toxin E. coli.

“Local public health spoke to the healthcare provider and the case’s family to get information for IDPH’s Shiga-toxin investigation form,” according to the final report. “JCPH learned the child attended local childcare and placed the child under an exclusion order to exclude the child from childcare until resolution of diarrhea and two consecutive tested negative for Shiga-toxin E. coli.”

USA – Pure Eire Dairy closes in wake of E. coli outbreak

Food Safety News

Pure Eire Dairy in Washington state has closed down for good. State officials linked the dairy to an outbreak of E. Coli infections beginning in May.

As of June 24 there were 17 confirmed patients in the outbreak. Ten of the patients are younger than 10 years old. Ten of the 17 patients have had such severe symptoms they had to be admitted to hospitals. The Washington health department has not released the ages of those who have hospitalized.

Of the 17 outbreak patients, four have developed hemolytic uremic syndrome (HUS), a type of kidney failure that can be fatal. Three of the patients live in Arizona and are thought to have become infected through person-to-person contact by visitors from Washington.

Most of the sick people reported eating organic yogurt made by the Pure Eire Dairy in Othello, WA. Both PCC brand and Pure Eire brand yogurt have been recalled.