France has reported a decline in cases of severe symptoms that can develop after E. coli infection.
Hemolytic uremic syndrome (HUS) is a serious complication associated with E. coli infection that causes kidney failure.
According to data from Santé publique France, there were 143 HUS infections in 2023 compared to 252 in 2022. In 2022, there were several serious outbreaks, including one related to Nestlé Buitoni’s frozen pizza.
According to Italian data, 68 HUS cases were recorded from July 2023 to June 2024. The Italian Hemolytic Uremic Syndrome Registry is operated by the Italian Society of Pediatric Nephrology and the National Institute of Health (ISS).
Santé publique France’s surveillance data on HUS only covers people under 15 years of age. Almost 70% of infections in 2023 were children under 3 years old, but patients ranged in age from 1 month to 14 years. Men and women were equally affected.
Median length of hospital stay for the 30 cases with available information was 6 days, but ranged from 1 to 30 days. Two deaths were recorded. Of the 132 cases, 56 had E. coli O26, 11 had E. coli O80, 7 had E. coli O157, 6 had E. coli O177, and 5 had E. coli O145.
2 food poisoning outbreaks
Fifteen epidemiological investigations have been launched following suspicions of mass infection. 11 included fewer than five cases. For eight investigations, microbiological and epidemiological studies were unable to draw conclusions about a common source of contamination. In two cases, microbial results ruled out an association.
An epidemiological link was suspected in the two studies, but was not confirmed. In three suspected clusters involving five or more people, two investigations confirmed food origin, and one investigation found no common source of contamination.
In April 2023, Santé Publique France began an investigation after receiving reports of two children under the age of 5 suffering from HUS in Ile-de-France and Hauts-de-France, whose families The intake of fermented milk was noted in the food questionnaire.
In one case, fermented milk was purchased from a moving truck. In other cases, it was purchased from a local grocery store. In Ile-de-France, three other family members had stool samples positive for STEC O26:H11. Strain STEC O26:H11 was isolated from a fermented milk sample and sequencing confirmed the same genomic profile as the human strain.
A product recall was announced in May. Belgium has identified two people with similar strains. Ingestion of fermented milk was reported in one case, but information regarding its origin was unknown. For other patients, no association with raw fermented milk was reported.
In November, three children were hospitalized with HUS within a week, two of whom attended the same nursery school. A few days later, two other children at the nursery were hospitalized with suspected STEC infections.
Overall, 13 children aged 6 months to 4 years were infected with E. coli O26:H11, and 6 developed HUS. Investigations identified ingestion of raw milk Morbier cheese provided in daycare centers as the most likely source of contamination for the initial cases, followed by human-to-human transmission.
Nationwide surveillance identified six other cases in five regions between August and December 2023, whose strains belonged to this genomic cluster. In four of these cases, ingestion of Morbier was confirmed. 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 of Food Products (DGAL) recommends against serving raw milk cheese to groups of young children under the age of five.
Campylobacter statistics
Santé publique France also reported Campylobacter data for 2023. The National Reference Center for Campylobacter and Helicobacter (CNR) has identified 9,352 strains as Campylobacter.
This covers 9,255 infected people, including 95 people infected with multiple strains. Age at time of infection ranged from less than 1 year to 105 years. Incidence was highest in the 0 to 9 year age group. Overall, the incidence was higher in men than in women.
The most frequent species was Campylobacter jejuni with over 8,000 isolates, followed by Campylobacter coli and Campylobacter fetus. The peak of infection was observed during the summer period from June to August. This seasonality was also observed in previous years.
Resistance to the fluoroquinolone ciprofloxacin is approximately 60% in both Campylobacter jejuni and E. coli. Resistance to erythromycin is still very low in Campylobacter jejuni but slightly higher in Campylobacter coli. Resistance to tetracyclines remains at high levels in Campylobacter coli but is low in Campylobacter jejuni. The majority of strains exhibited resistance profiles to at least one of the five antibiotics tested. However, very few strains were resistant to all five.
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