France has reported a decrease in the number of cases of a serious condition that can develop after an E. coli infection.
Hemolytic uremic syndrome (HUS) is a serious complication associated with E. coli infections that causes kidney failure.
Data from Santé publique France shows 143 HUS cases in 2023, compared to 252 in 2022. There were several serious outbreaks in 2022, including one linked to Nestlé Buitoni frozen pizzas.
Italian data shows that 68 cases of HUS were registered between July 2023 and June 2024. The Italian registry for hemolytic uremic syndrome is managed by the Italian Society of Pediatric Nephrology and the National Institute of Health (ISS).
Santé publique France surveillance data on HUS only covers people under the age of 15. Nearly 70 percent of cases in 2023 were children under 3 years old, but patients ranged from 1 month to 14 years old. Men and women were affected equally.
For 30 cases for which information was available, the median duration of hospital stay was six days, but ranged from 1 to 30 days. Two deaths were recorded. Of the 132 cases, 56 were E. coli O26, 11 were E. coli O80, seven were E. coli O157, six were E. coli O177 and five were E. coli O145.
Two foodborne outbreaks
Fifteen epidemiological investigations were opened following suspicions of clusters of infections. Eleven include fewer than five cases. In eight studies, the microbiological and epidemiological work did not allow a conclusion to be drawn about a common source of contamination. In two cases, the microbial results ruled out a link.
Two studies suspected an epidemiological link, but did not confirm this. In three suspected clusters of more than five cases, two studies confirmed a food origin, and one study failed to identify a common source of contamination.
In April 2023, Santé publique France launched an investigation following the report of two children under the age of 5 suffering from HUS in Île-de-France and Hauts-de-France, for whom families recorded fermented milk consumption on food questionnaires.
In one case, fermented milk was purchased via a mobile truck; in another it was purchased at a local supermarket. In Île-de-France, stool samples from three other family members were positive for STEC O26:H11. A STEC O26:H11 strain was isolated from a fermented milk sample and sequencing confirmed the same genomic profile as human strains.
A product recall was issued in May. Belgium identified two people with similar strains. In one case, consumption of fermented milk was reported, but no information about its origin was known. No association with raw fermented milk was reported for the other patient.
In November, three children with HUS were hospitalized in less than a week, two of whom attended the same daycare center. A few days later, two other children from this daycare center were admitted to hospital due to a suspected STEC infection.
A total of 13 children between the ages of six months and four years were infected with E. coli O26:H11, and six developed HUS. Research found that consumption of raw Morbier cheese served in the nursery was the most likely source of infection of the first cases, followed by likely person-to-person transmission.
National surveillance identified six additional cases in five regions between August and December 2023, whose strains belonged to this genomic cluster. Consumption of Morbier was confirmed for four of them. STEC O26:H11 was isolated from cheese with the same genomic profile as the sick children. A withdrawal and recall was issued in December 2023.
The Directorate General for Food (DGAL) advises against serving raw milk cheeses to groups of young children under the age of 5.
Campylobacter statistics
Santé publique France also reported Campylobacter data for 2023. The National Reference Center (CNR) for Campylobacters and Helicobacters has identified 9,352 strains as Campylobacter.
This concerns 9,255 infected patients, including 95 people infected with multiple strains. Age at infection ranged from less than 1 to 105 years old. The incidence was highest in the age group 0 to 9 years. Overall, the incidence was higher in men than in women.
Campylobacter jejuni was the most common species, with more than 8,000 isolates, followed by Campylobacter coli and Campylobacter fetus. A peak of infections was observed during the summer period from June to August; these seasonal influences were also visible in previous years.
Resistance to ciprofloxacin from the fluoroquinolone family is approximately 60 percent for both Campylobacter jejuni and C. coli. Resistance to erythromycin remains very low for Campylobacter jejuni, but slightly higher for Campylobacter coli. Resistance to tetracycline remains high for Campylobacter coli, but is lower for Campylobacter jejuni. The majority of strains showed a resistance profile to at least one of the five antibiotics tested. However, very few strains were resistant to all five.
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