PRO/AH/EDR> E. coli EHEC - Francia (06): (PR,LP) O26, Sindrome Emolitico Uremica pediatrica, latticini, allerta, richiamo

E. COLI EHEC - FRANCE (06): (PROVENCE-ALPES-COTE D'AZUR, OCCITANIE) O26, PEDIATRIC HEMOLYTIC UREMIC SYNDROME, DAIRY PRODUCTS, ALERT, RECALL 

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Date: Tue 26 Jul 2022 
Source: Food Safety News [edited] 
https://www.foodsafetynews.com/2022/07/french-e-coli-outbreak-linked-to-dairy/ 

At least a dozen children have been sickened in France with officials linking illnesses to a dairy company. Since early June [2022], 12 cases of hemolytic uremic syndrome (HUS) have been reported in the Provence-Alpes-Côte d'Azur and Occitanie regions. HUS is a severe complication associated with [Shiga toxin-producing] _E. coli_ infection that causes kidney failure and sometimes death. Seven boys and 5 girls aged 11 months to 9 years old are sick. They fell ill from 4 Jun to 18 Jul [2022]. 

In France, Shiga toxin-producing _E. coli_ (also called enterohemorrhagic _E coli_, EHEC) surveillance is based only on HUS in children younger than 15, so it catches only the most severe cases. Santé publique France, the directorate general for food (DGAL), and directorate general for health (DGS) are part of the investigation. 

The National Reference Center for _E. coli_ at Institut Pasteur in Paris has found 5 of the children have been infected by _E. coli_ O26 with the same characteristics, meaning the source is likely to be the same. This bacterium has also been detected in a product made by Fromagerie de L' Aupillon, based in the commune of Trets in the Bouches-du-Rhône region. All production dates of items made by the company have been recalled and withdrawn. This includes milk, yogurts, and cheese. They were mainly distributed in Var and Bouches-du-Rhône, in the Provence-Alpes-Côte d'Azur region, at retailers and restaurants. 

Officials asked people who have the products to not consume them. They added those who had visited the farm or bought unpasteurized milk-based products should pay particular attention to the development of any _E. coli_-related symptoms. The outbreak comes as Santé publique France reiterated preventive measures against _E. coli_, as every year during summer an increase in foodborne infections, including pediatric HUS, is observed. 

The agency advised washing hands before meal preparation, cooking meat thoroughly, avoiding giving raw milk products to children under the age of 5, avoiding eating flour-based items that are raw or undercooked, and cleaning kitchen utensils and surfaces to avoid cross contamination. The risk of developing HUS is higher for older people or young children. HUS occurs in 5-8% of EHEC cases. 

[Byline: Joe Whitworth] 

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Communicated by: 
ProMED 

[The areas involved are in the south of the country. 

Since EHEC surveillance is reported only in pediatric HUS cases, and slightly less than 10% of EHEC are associated with hemolytic uremic syndrome, it is likely that more than 100 cases of the infection have occurred. The following is a good basic review on HUS: 

Joseph A, Cointe A, Kurkdjian P M, et al. Shiga toxin-associated hemolytic uremic syndrome: a narrative review. Toxins. 2020; 12(2): 67; https://doi.org/10.3390/toxins12020067.