Category Archives: HUS


Flour is a natural product and a valuable foodstuff.

However, Shiga toxin-producing Escherichia coli (STEC) were detected in multiple flour samples (wheat, spelt and rye) during routine food monitoring in Germany in 2018. Escherichia (E.) coli are bacteria that occur naturally in the intestines of animals and humans and the detection of E. coli in food is a strong indicator of a faecal contamination.

Bacteria from the faeces or stool can be shed into the environment and subsequently contaminate various animal- and plant-based foods. Direct transmission between animals and humans and from humans to humans are also possible. Certain toxin producing variants of E. coli can cause serious diseases in animals and humans.

E. coli variants that can form Shiga toxins are of particular importance for humans. These are abbreviated as STEC. STEC, which cause diseases in humans, are referred to as entero-hemorrhagic E. coli (EHEC). The symptoms of an infection with STEC are initially gastrointestinal.

The possible severity of the disease ranges from watery to bloody diarrhea. In adults, the course of the disease can also proceed without symptoms. A particularly severe complication is the hemolytic-uremic syndrome (HUS). HUS is a disease that manifests in acute kidney failure, blood coagulation disorders and destruction of the red blood cells and can lead to death in individual cases. This form of the disease affects particularly sensitive groups of people, such as young chil-dren.

Research – The European Scientific Conference on Applied Infectious Disease Epidemiology (ESCAIDE)



Page 71 – An Easter Surprise: Salmonella Typhimurium outbreak linked to chocolate products in the United Kingdom, 2022; a case control study

Page 72  – International outbreak of Salmonella Typhimurium linked to a chocolate factory in 2022: Belgian findings

Page 73 – Whole Genome Sequencing identified a prolonged Salmonella Poona nursery outbreak (2016-2021) in North West England, UK

Page 74 – Climate Warming and increasing Vibrio vulnificus infections in North America

Page 106 – Timely and reliable outbreak investigation using a non-probabilistic online panel as a source of controls – two parallel case-control studies investigating a Salmonella Braenderup outbreak in Germany

Page 107 – An outbreak of Escherichia coli-associated haemolytic uremic syndrome linked to consumption of an unexpected food vehicle, France 2022

Page 108 – Outbreak investigation of cholera in a peri-urban village of Panchkula district, Haryana, India, 2021

Page 109 – Cholera Outbreak Investigation, Ballo Adda Mohalla, Lucknow District, Uttar Pradesh 2021

Page 110 – Norovirus GII.3[P12] outbreak associated with the drinking-water supply in a rural area in Galicia, Spain, 2021

Page 111 – Impact of COVID-19 restrictions on the epidemiology of Cryptosporidium spp. in England and Wales

Page 149 – Monophasic Salmonella Typhimurium outbreak linked to chocolate products, Ireland, 2022

Page 151 – Successful containment of a Listeria monocytogenes outbreak caused by shredded vegetables, Hesse/Germany, 2021-2022

Page 152 – Outbreak of monophasic Salmonella Typhimurium linked to fresh small tomatoes, Sweden, 2021

Page 194 – Cholera Outbreak Investigation, Kamarhati-Municipality, North-24-Parganas District, West Bengal, India 2021

Page 195 – Botulism outbreak and response in Dangara District Tajikistan, October 2020

Page 196 – Outbreak of suspected Clostridium perfringens associated with consumption of roast beef in a restaurant, January 2022 South West England

Page 198 – Doughnuts for weight loss? A norovirus outbreak in the Australian Capital Territory, November 2021

Page 212 – Outbreak of Legionnaires’ disease linked to unregistered cooling towers, West Midlands, England, July-September 2020



Research – France – Haemolytic-uremic syndrome surveillance data in 2021

Sante Publique

In 2021, the overall annual incidence of pediatric HUS was lower than that observed for the past four years.

Even if this decrease in annual incidence is observed in children under three years of age, the incidence in this age group remains high and much higher than that observed in older children. As every year, regional heterogeneity is observed. In 2021, the Bourgogne-France-Compté and Auvergne-Rhône-Alpes regions were particularly affected.

In 2021, serogroup O26 remains the majority, followed by serogroup O80. After several years of decrease in the share of cases due to O157, a slight increase in the number of O157 strains is observed in 2021.

Research – Europe sees large drop in E. coli infections in 2020

Food Safety News

There was a big fall in the number of Shiga toxin-producing E. coli (STEC) infections in Europe in 2020, according to recently published data.

In 2020, 4,824 confirmed STEC infections were reported. This is down from 8,339 in 2019. STEC infection is mainly acquired through consumption of contaminated food or water and contact with animals or their feces.

Data on STEC infections were reported by 29 countries. Notification is voluntary in Belgium, France, Luxembourg, and Spain or based on another type of system in Italy.

Germany with 1,409 and Ireland with 734 had the most infections, accounting for 44 percent of all cases. The highest country-specific notification rates were in Ireland, Malta, Denmark, and Norway.

Research – Sporadic Occurrence of Enteroaggregative Shiga Toxin–Producing Escherichia coli O104:H4 Similar to 2011 Outbreak Strain


We describe the recent detection of 3 Shiga toxin–producing enteroaggregative Escherichia coli O104:H4 isolates from patients and 1 from pork in the Netherlands that were genetically highly similar to isolates from the 2011 large-scale outbreak in Europe. Our findings stress the importance of safeguarding food supply production chains to prevent future outbreaks.

Shiga toxin–producing Escherichia coli (STEC) is a zoonotic pathogen that causes illness ranging from mild diarrhea to haemolytic uremic syndrome and death. During 2011, an exceptionally large outbreak caused by serotype O104:H4 STEC occurred in Europe, mainly in Germany and France, that was associated with sprouts grown from imported fenugreek seeds (1). Besides the ability to produce Shiga toxin, specifically stx2a, the strain had the genetic characteristics and phylogenetic backbone of an enteroaggregative E. coli (EAEC) pathotype (2) but lacked other classical STEC virulence markers eae and hlyA (3). In addition, the outbreak strain carried plasmid-borne blaCTX-M-15 and blaTEM-1 genes. The epidemiologic investigation revealed that a contaminated batch of fenugreek seeds imported into the European Union from Egypt was the most probable source of the pathogen causing the outbreak (4).

After the 2011 outbreak in Germany and France, only a few sporadic cases of infection with Shiga toxin–producing EAEC O104:H4 were reported, most related to travel to Turkey or North Africa (5–8). We describe the sporadic occurrence of Shiga toxin–producing EAEC O104:H4 isolates in the Netherlands, originating from 2 clinical cases from 2019 and 2020 and 1 food isolate from 2017. In addition, we report a clinical case from Austria in 2021.

French E. coli outbreak linked to cucumbers from Belgium

Food Safety News

More than 30 people were sick in France in late 2021 as part of an outbreak traced to contaminated cucumbers.

In September 2021, the Hauts-de-France Regional Health Agency was notified of a suspected foodborne outbreak among students in the Lille area. Two hospitalized children were diagnosed with hemolytic uremic syndrome (HUS). HUS is a severe complication associated with E. coli infection that causes kidney failure. The agency asked Santé publique France for support in investigating the incident.

In total, 35 cases of gastroenteritis, half of whom had bloody diarrhea and fever, were identified. Ten people were hospitalized.

Identified cases were 29 children in four schools and five elderly adults who received meals through a local delivery program. One case was the parent of a pupil. Five children and one adult had meals delivered to them at home.

The median age of patients was 8 with a range of 4 to 89 years old and almost two thirds were female.

School cafeterias and the meal delivery service were all supplied by the same municipal canteen.

France – Food produced or distributed by the farm: milk, yoghurts, fresh or mature cheeses (brousse, ricotta, pecorino, tomme…). – STEC E.coli

Gov france

Identification information of the recalled product

  • Product category Feed
  • Product subcategory Milk and dairy products
  • Product brand name Unbranded
  • Model names or references Various products
  • Identification of products
    see attached product list
  • Products List Product_list.pdf Attachment
  • Marketing start/end date Until 07/22/2022
  • Storage temperature Product to be stored in the refrigerator
  • Further information Over the period at risk, the products sold by the Aupillon farm were mainly distributed in the Var and Bouches-du-Rhône, in retail stores and restaurants. The points of sale affected by the distribution of suspect products proceed to withdraw them and inform consumers by means of small posters put up at the points of sale concerned.
  • Geographic area of ​​sale Departments: BOUCHES-DU-RHONE (13), VAR (83)
  • Distributors Various retailers.

Practical information regarding the recall

  • Reason for recall Contamination of products by E.COLI STEC bacteria and epidemiological link with cases of pediatric HUS in PACA and OCCITANIE.
  • Risks incurred by the consumer Toxigenic Shiga Escherichia coli (STEC)

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.

Research – Collective food poisoning (TIAC) ​​with E. coli O157 producing Shiga toxins, associated with the consumption of raw cucumbers

Sante Publique

On September 9, 2021, the Regional Health Agency (ARS) of Hauts-de-France was informed of a suspicion of collective food poisoning (TIAC) ​​affecting half-board students, educated in several schools in a municipality. of the Lille metropolis. 

On September 13, 2021, two cases of haemolytic and uremic syndrome (HUS) were diagnosed in two hospitalized children attending school in this town. Public Health France Hauts-de-France was asked by the Hauts-de-France ARS to provide support for the investigations and management of this TIAC. A total of 35 cases of gastroenteritis, with bloody diarrhea and fever (>38°C) in half of the cases, were identified. Ten cases were hospitalized and two children developed HUS. 

The cases identified were half-board students in four school groups (29 cases), a parent of a student and elderly people benefiting from the municipality’s home meal delivery service (5 cases). The case canteens were all supplied by the central municipal kitchen. 

The shape of the epidemic curve was in favour of a common and point source of contamination during meals on September 2 or 3, 2021. The case-control survey, carried out in schools, concluded that only the consumption of cucumbers in salad, served with the meal on September 2, was statistically and significantly associated with the occurrence of the disease.

A strain of E. highly pathogenic Shiga toxin-producing (STEC) O157 coli was isolated from the stool cultures of eight cases, including the two children who developed HUS and in the offending cucumber salad. Genomic analysis of the strains confirmed the genetic clustering of clinical and food strains that belonged to the same genomic cluster. The veterinary investigation revealed that a failure in the decontamination process, associated with incomplete peeling of the contaminated cucumbers, contributed to the occurrence of this TIAC. 

The cucumbers in question came from Belgium and the Belgian health authorities were informed via the dedicated European alert circuits. No other episodes of clusters of STEC infection related to this TIAC have been reported to the ARS over the period while cucumbers from the same batch had been widely distributed in communities and commercial catering services in the Hauts-de-France region. The food vehicle, incriminated in this TIAC, is part of the plants at risk because of its raw mode of consumption. It is important to remind vulnerable populations and collective catering services that preventing the risk of STEC infection, linked to the consumption of raw vegetables, requires washing, disinfection and peeling.