Update as of December 19, 2018

Two children under the age of three with hemolytic uremic syndrome (HUS) who live in the same region were reported to Santé publique France by a pediatric hospital department. The National E. coli Reference Center and its associated laboratory (Institut Pasteur, Paris, and the Microbiology Laboratory at Robert Debré Hospital, Paris) confirmed that the children were infected with Escherichia coli (E. coli) O26 bacteria sharing the same characteristics.

Investigations conducted by Santé publique France and the Directorate General for Food (DGAL) showed that the common factor between these two children was the consumption of raw-milk Reblochon cheese from the same production batch. Tests conducted by the producer on this batch at the start of the manufacturing process had not detected contamination by E. coli O26. However, retrospective tests on a sample of cheese retained by the producer revealed contamination by E. coli O26.

Following these results, health authorities, in consultation with the producer, decided to withdraw and recall the production batch marketed under two brands, Pochat and Beulet (two product codes).

Santé publique France continues its surveillance

Santé Publique France, in collaboration with the National Reference Center for Escherichia coli, is continuing enhanced surveillance of hemolytic uremic syndrome (HUS), which can occur following the consumption of products contaminated with Escherichia coli O26, to detect any new cases linked to this consumption.

Investigations of clustered HUS cases

Investigations into clusters of pediatric HUS cases involve several components. An initial epidemiological component involves interviewing parents about their children’s risk exposures: food consumption, contact with animals, contact with other cases of E. coli infection, contact with well or surface water, etc. A second microbiological component uses laboratory analyses to identify the strain that infected the child and to determine whether strains from other infected children share the same characteristics.

At the same time, traceability investigations into the foods consumed by the cases are conducted by the General Directorate of Food (DGAl) and the relevant Departmental Directorates for Population Protection (DDPP). These traceability investigations aim to trace the foods back to their producers, which may help identify the source of the infection.

What is HUS?

HUS is a rare disease in France: between 100 and 150 cases are reported through the surveillance system each year.

It is a serious illness that initially presents with diarrhea, often bloody, abdominal pain, and sometimes vomiting. These symptoms may progress (in 5 to 8% of cases), after about a week, to hemolytic uremic syndrome. The child then exhibits signs of severe fatigue, pallor, decreased urine output (with urine becoming darker), and sometimes seizures.

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."

Foodborne Outbreaks in 2018

This was the third cluster of foodborne infections in 2018 leading to the withdrawal and recall of raw-milk Reblochon cheeses from various producers in France.

In the spring, a nationwide outbreak of pediatric HUS linked to the consumption of Reblochon led to the implementation of withdrawal and recall measures for all Reblochon cheeses produced at a single manufacturing site.

In November, an outbreak of salmonellosis linked to the consumption of Reblochon was investigated, leading to recall measures for the affected cheeses.

Santé publique France reminds the public that, as a precaution, the consumption of raw milk and raw-milk cheeses is not recommended for young children; instead, they should opt for hard-pressed cheeses (such as Emmental, Comté, etc.), processed spreadable cheeses, and cheeses made from pasteurized milk.

The same recommendation applies to pregnant women, immunocompromised individuals, and the elderly.

More information on HUS and Escherichia coli:

• Hemolytic Uremic Syndrome Fact Sheet.

• Hemolytic Uremic Syndrome Report. Ministry of Solidarity and Health.

• Recall of Reblochons sold under the Pochat and Beulet brands, stamped FR 74.116.050 CE, contaminated with Escherichia coli. Press release.