Cluster of Hemolytic Uremic Syndrome (HUS) Cases in Aquitaine, June 2012. Update as of July 3, 2012

InVS Update as of July 3, 2012

Cluster of Hemolytic Uremic Syndrome (HUS) Cases in Aquitaine, June 2012

The French Institute for Public Health Surveillance (InVS) was notified on June 21 by the Bordeaux University Hospital of four cases of hemolytic uremic syndrome (HUS) that occurred between June 14 and 20, 2012, in children residing in the departments of Pyrénées-Atlantiques (2 children) and Gironde (2 children).

Investigations and control measures

The close temporal and geographical proximity of several cases of this rare condition (approximately 100 pediatric HUS cases are reported annually by the national HUS surveillance network) suggested a common source of contamination.

An investigation, coordinated by the InVS (Department of Infectious Diseases and CIRE Aquitaine) in collaboration with the relevant Regional Health Agencies (ARS), the General Directorate for Food, and the relevant Departmental Directorates for Population Protection, was immediately launched to identify the source of contamination and implement appropriate control measures.

The investigation of the cases that triggered the alert identified that, in the days preceding the onset of symptoms, three of the four children had consumed fresh Jean Rozé brand ground beef purchased at Intermarché stores.
The traceability investigation conducted on the ground beef consumed by the three children identified a common manufacturer in Lot-et-Garonne (47). The batches of ground beef suspected of causing these human cases were identified based on the purchase dates provided by the families of the patients. The ground beef with best-by dates ranging from May 28 to June 15 was thus recalled by the manufacturer.
A press release was issued on June 23 by the processed meat company in Estillac (47) to inform consumers who may have kept these ground beef patties in their freezers that they should not consume them and should return them to the store where they were purchased.
The batches affected by the recall were as follows:

Modified atmosphere packaging under the JEAN ROZE, NETTO, and TOP BUDGET brands

Product codes: fresh ground beef 15% fat / fresh ground beef 20% fat

Best-by date: May 28 to June 15, 2012

Bearing the veterinary identification number: FR – 47.091.002 - CE

Sold in the self-service fresh food section from May 22 to June 15 in Intermarché and Netto stores located in the following departments of the Southwest region: 12, 16, 17, 19, 24, 31, 32, 33, 40, 46, 47, 64, 65, 81, 82, 87.

A press release providing an update on the situation was issued on June 25, 2012, by the Aquitaine Regional Health Agency (ARS), and information on the procedures to follow for diagnosing HUS of infectious origin, potentially caused by E. coli, was distributed in Aquitaine and Poitou-Charentes to emergency departments, SAMU (emergency medical services), and Poison Control Centers (CAP).

Update as of July 3, 2012

As of July 3, 2012, 8 cases of HUS and 4 cases of bloody diarrhea had been reported in Aquitaine and Poitou-Charentes since May 28.

The onset dates of symptoms (diarrhea) for the 8 cases of HUS ranged from June 6 to June 22. Seven resided in Aquitaine (4 in Gironde, 1 in Landes, 2 in Pyrénées-Atlantiques) and one in Charente-Maritime. These included 5 boys and 3 girls, aged 2.5 to 14 years. Infection with E. coli O157 was confirmed in 6 of the children via stool culture and/or serology. Testing is still ongoing for the other 2 children. All reported consuming ground beef before the onset of symptoms, including 5 who consumed fresh ground beef from brands sold at Intermarché or Netto stores.
The 4 cases of bloody diarrhea presented their first symptoms between June 12 and 24. All resided in Aquitaine (3 in Gironde and 1 in the Pyrénées-Atlantiques). They included 3 women and 1 man, aged 10 to 42. An infection with E. coli O157 was confirmed in one case via stool culture; testing for the other three individuals is ongoing. All four cases reported consuming ground beef from brands sold at Intermarché or Netto stores prior to the onset of symptoms.

Consumption of ground beef from brands sold at Intermarché or Netto stores occurred prior to the recall measures for all cases of HUS and bloody diarrhea.

Figure 1

Distribution of HUS and bloody diarrhea cases by day of symptom onset, Aquitaine and Poitou-Charentes, June 2012

Hemolytic Uremic Syndrome (HUS) and Shiga Toxin-Producing Escherichia coli (STEC)

HUS is a disease most commonly caused in children by a bacterium belonging to the Escherichia coli (E. coli) family, certain strains of which are more virulent and produce toxins called “shigatoxins” (STEC: shigatoxin-producing E. coli). Contamination can occur through the ingestion of contaminated food (undercooked meat, raw milk products, raw vegetables and fruits), through soiled hands after touching animals carrying the bacteria or their environment, or through contact with an infected person who excretes the bacteria in their stool.

STEC infections initially present with diarrhea (often bloody), abdominal pain, and sometimes vomiting. In 5 to 8% of cases (after about a week), these symptoms can progress to HUS. The child then exhibits signs of severe fatigue, pallor, decreased urine output that becomes darker in color, and sometimes seizures.

Hemolytic Uremic Syndrome (HUS) and Shiga Toxin-Producing Escherichia coli (STEC)

HUS is a disease most commonly caused in children by a bacterium belonging to the Escherichia coli (E. coli) family, certain strains of which are more virulent and produce toxins called “shigatoxins” (STEC: shigatoxin-producing E. coli). Contamination can occur through the ingestion of contaminated food (undercooked meat, raw milk products, raw vegetables and fruits), through soiled hands after touching animals carrying the bacteria or their environment, or through contact with an infected person who excretes the bacteria in their stool.

STEC infections initially present with diarrhea (often bloody), abdominal pain, and sometimes vomiting. In 5 to 8% of cases (after about a week), these symptoms can progress to HUS. The child then exhibits signs of severe fatigue, pallor, decreased urine output that becomes darker in color, and sometimes seizures.