Outbreak of pediatric hemolytic uremic syndrome caused by Escherichia coli O26 in mainland France linked to the consumption of Reblochon cheese: update as of June 15, 2018
Between February and May 2018, several children with hemolytic uremic syndrome (HUS), some of whom were infected with Escherichia coli (E. coli) O26 bacteria sharing the same characteristics, were identified by the National E. coli Reference Center and its associated laboratory (Institut Pasteur, Paris, and the Microbiology Laboratory at Robert Debré Hospital, Paris). Investigations conducted by Santé publique France confirmed an epidemiological link between these cases and the consumption of raw-milk Reblochons produced at the Chabert company’s Cruseilles (Haute-Savoie) facility. These investigations led to the withdrawal from sale and recall of all raw-milk Reblochons manufactured at the Cruseilles facility.
Epidemiological Update as of June 15
As of June 15, 2018, 15 children aged one to five are included in the investigation of this outbreak. All fifteen children may have consumed Reblochon cheese from the suspected batches. Among them:
Twelve were infected with the same strain of E. coli O26;
Of these 12 children, one had diarrhea and 11 developed HUS, one of whom died;
Of the three other children, two were infected with a strain of E. coli O26 different from that of the other 12 children, and for one child, no strain could be isolated.
The cases are distributed nationwide (PACA, Auvergne-Rhône-Alpes, Pays de la Loire, Hauts-de-France, Île-de-France, Centre-Val de Loire, Nouvelle-Aquitaine, Grand Est, Normandy, and Brittany).
The case investigations consisted of two components: an epidemiological component, which involved interviewing parents about their children’s food consumption and, where applicable, tracing the origin of the Reblochons consumed. A microbiological component, on the other hand, which aims to identify the strain that infected the child through laboratory analysis and to determine whether it shares characteristics with the epidemic strain.
Investigations at the implicated producer are continuing to confirm product contamination and identify its source.
Surveillance of pediatric hemolytic uremic syndrome in France
HUS is a rare disease in France: between 100 and 160 cases are reported annually through the surveillance system. It is a serious disease, as it is the leading cause of acute kidney failure in children aged 1 month to 3 years. In the international literature, the mortality rate ranges from 3% to 5% (1% according to French surveillance data). This disease is most often caused by a bacterium belonging to the Escherichia coli family, certain strains of which are more virulent and produce toxins called "shigatoxins."
Contamination occurs:
by ingesting contaminated food consumed raw or undercooked: unpasteurized milk or dairy products, undercooked beef (especially ground beef), contaminated raw vegetables, contaminated drinking water;
by touching the mouth with dirty hands after handling animals carrying the bacteria or their contaminated environment;
through contact with an infected person who excretes the bacteria in their stool.
In France, surveillance of hemolytic uremic syndrome and infections caused by Shiga toxin-producing Escherichia coli relies on several surveillance systems that identify the vast majority of cases:
surveillance of HUS in children under 15 years of age: since 1996, a network of volunteer pediatric nephrology departments has been reporting cases to Santé publique France;
the National Reference Center for E. coli;
mandatory reporting of foodborne outbreaks.
Each year, Santé publique France produces a report on HUS surveillance in children under 15 years of age. In 2017, 164 cases of pediatric HUS were reported to Santé publique France, and no outbreaks were identified.
