Category Archives: HUS

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

CDC

Abstract
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
    Batch
    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.

Report

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.

France – Investigation of grouped cases of haemolytic-uremic syndrome (HUS) and shiga-toxin-producing E. coli (STEC) infections linked to the consumption of Buitoni® brand Fraîch’Up pizzas. 

Sante Publique

Public Health France and the National Reference Center (CNR) E. coli and its associated laboratory (Institut Pasteur, Paris, and Microbiology Laboratory of the Robert Debré Hospital, Paris), in conjunction with the Directorate General for Food, the Directorate General for Competition, Consumer Affairs and Fraud Prevention, and in coordination with the Directorate General for Health, have been investigating since 02/10/2022 an increase in the number of cases of haemolytic uremic syndrome (HUS) pediatric infections and Shiga toxin-producing Escherichia coli (STEC) infections.

The epidemiological, microbiological and traceability investigations carried out since that date have confirmed a link between the occurrence of these grouped cases and the consumption of frozen pizzas from the Buitoni brand Fraîch’Up range contaminated with STEC bacteria. On 03/18/2022, the company proceeded with the withdrawal-recall of all the pizzas in the Fraîch’Up range, marketed since June 2021 and the authorities asked the people who hold these pizzas not to consume them and to destroy them.

The total number of HUS cases linked to the consumption of these pizzas seems to have stabilized since the withdrawal-recall.

Case of SHU in France: update on 04/13/22

As of 04/13/2022, 53 confirmed cases have been identified, of which 51 are linked to STEC O26 strains, and 2 to STEC O103 strains. For 26 other cases of HUS and STEC infections notified to Public Health France, investigations are ongoing.

These 53 cases occurred in 52 children and 1 adult, who presented symptoms between 18/01/2022 (week 3) and 16/03/2022 (week 11) (Figure 1). The epidemic peak is in week 7 (14/02 to 20/02) and week 9 (28/02 to 06/03), with 10 cases each of these weeks. These 53 cases occurred in 12 regions of metropolitan France: Hauts-de-France (11 cases), Ile-de-France (9 cases), New Aquitaine (8 cases), Pays de la Loire (7 cases), Brittany ( 6 cases), Auvergne-Rhône-Alpes (2 cases) [-1 case since the situation update of 06/04/2022 after additional result], Grand Est (2 cases), Occitanie (2 cases), Provence-Alpes- Côte d’Azur (2 cases) and Center Val-de-Loire (2 cases), Bourgogne Franche-Comté (1 case) [-1 case since the situation update of 04/06/2022 after additional result], Normandy ( 1 case) (Figure 2).

The 52 sick children are aged from 1 to 17 years with a median age of 7 years; 23 (44%) are female; 46 (88%) presented with HUS, 6 (12%) with STEC gastroenteritis. Two children died. The adult did not present with HUS [an adult previously reported in the situation update of 06/04/2022 was finally invalidated after additional results].

Figure 1: Epidemic curve: number of confirmed cases of HUS and STEC infections (N=51), by week of onset of symptoms – metropolitan France, weeks 3 to 11, 2022
Figure 1: Epidemic curve: number of confirmed cases of HUS and STEC infections (N=51), by week of onset of symptoms - metropolitan France, weeks 3 to 11, 2022
Figure 2: Geographical distribution of confirmed cases of HUS and STEC infections (N=53) linked to the consumption of Buitoni® brand Fraîch’Up pizzas, by region of residence in metropolitan France, weeks 3 to 11, 2022
Figure 2: Geographical distribution of confirmed cases of HUS and STEC infections (N=53) linked to the consumption of Buitoni® brand Fraîch'Up pizzas, by region of residence in metropolitan France, weeks 3 to 11, 2022

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.