As part of its surveillance activities, Santé publique France monitors infection trends in collaboration with the National Reference Center for Escherichia coli, Shigella, and Salmonella, as well as clinicians in the pediatric HUS surveillance network, in order to detect clusters of infection and initiate investigations.

What is hemolytic uremic syndrome?

Hemolytic uremic syndrome (HUS) follows an infection with Shiga toxin-producing Escherichia coli (STEC). This rare but serious complication primarily affects the kidneys and occurs in 5 to 8% of cases.

The risk of developing HUS is higher at the extremes of the age spectrum, particularly in young children.

Each year, approximately 160 children are diagnosed with HUS. Since 1996, Santé publique France has established a surveillance system for this disease in collaboration with pediatric nephrology departments.

The infection manifests within 3–4 days of exposure (up to 10 days), with diarrhea often containing blood, abdominal pain, and sometimes vomiting, which can progress to HUS in 5–8% of cases after about a week. People with HUS, particularly children, then exhibit signs of severe fatigue, pallor, decreased urine output (which becomes darker), and sometimes seizures. Hospital care may include, among other things, blood transfusions and/or dialysis. It is therefore essential to consult a doctor immediately if symptoms suggest HUS.

What are the preventive measures?

The E. coli bacteria responsible for HUS are present in the intestines of many ruminant animals (cows, calves, goats, sheep, etc.) and are excreted in feces, which can then contaminate the environment (water, manure, soil) and food. These bacteria tolerate cold well (they survive in a refrigerator or freezer) but are destroyed by thorough cooking.

Transmission of the bacteria can be prevented through simple precautions, particularly among children under 16 and the elderly:

In the kitchen

• Hands must be washed thoroughly before preparing meals;

• Meat, especially ground beef, as well as ground meat products, must be cooked thoroughly (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 (opt for hard-pressed cheeses [such as Emmental, Comté, Gruyère, Beaufort], spreadable processed cheeses, and cheeses made from pasteurized milk);

• Flour-based preparations (pizza, cookie dough, cake, pie, crepes, etc.) should not be eaten raw or undercooked;

• Vegetables, lettuce, fruits, and herbs, especially those to be eaten raw, must be thoroughly washed before consumption, after peeling if necessary;

• Raw foods must be stored separately from cooked or ready-to-eat foods;

• Prepared meals and leftovers must be refrigerated promptly and reheated thoroughly before consumption;

• Kitchen utensils (especially if they have previously come into contact with raw foods such as meat or cheese), as well as countertops, must be thoroughly washed to prevent cross-contamination.

During Activities and Leisure

• Children should not drink untreated water (from wells, rivers, streams, etc.) and should avoid swallowing it while swimming (in lakes, rivers, ponds, etc.);

• Very young children (under 5 years old) should avoid contact with cows, calves, sheep, goats, etc., and their environments; if contact with these animals occurs, handwashing (with soap and water) must be done systematically before the child puts their fingers in their mouth.