Update

Santé publique France and the National Reference Center (CNR) for Escherichia coli (Institut Pasteur - Paris), along with its partner laboratory (Microbiology Laboratory at Robert Debré Hospital - Paris), are investigating an increase in the number of cases of hemolytic uremic syndrome (HUS) and severe Escherichia coli infection reported since early February 2022.

As of February 24, 2022, 13 cases of HUS, linked to Escherichia coli bacteria with similar characteristics, have been identified. These cases occurred in 5 regions of metropolitan France: Nouvelle-Aquitaine (5 cases), Hauts-de-France (3 cases), Île-de-France (3 cases), Brittany (1 case), and Pays de la Loire (1 case). The affected children, aged 1 to 15 years with a median age of 8 years, developed symptoms between January 18, 2022, and February 11, 2022. One child has died.

Santé publique France, in collaboration with the CNR, the Directorate General for Food, the Directorate General for Competition, Consumer Affairs, and Fraud Control, in coordination with the Directorate General for Health, are investigating all cases of pediatric HUS reported since January 1, 2022 (31 currently under investigation) nationwide to confirm or rule out a link between these cases. This is being done to identify a possible common source of contamination and implement appropriate measures.

The investigations focus on two main areas:

• an epidemiological component, which involves surveying parents about their children’s risk exposures to this type of infection, particularly the foods consumed, and, where applicable, tracing the origin of these foods;

• a microbiological component aimed at identifying the bacterial strain that infected each child and determining whether these strains share similar characteristics.

At this stage, the epidemiological investigation is not ruling out any leads.

Health authorities are therefore currently investigating several potential sources of contamination for each case:

• the ingestion of contaminated food consumed raw or undercooked;

• contamination via soiled hands brought to the mouth after touching animals carrying the bacteria or their contaminated environment;

• contact with an infected person who excretes the bacteria in their stool.

HUS surveillance partners (particularly the network of pediatric nephrologists and intensive care specialists) have been alerted so that any new identified case can be investigated as soon as possible.

Symptoms associated with HUS

Hemolytic uremic syndrome (HUS) is an infectious disease most often foodborne, rare in France, but potentially serious. This syndrome is frequently caused by a bacterium belonging to the Escherichia coli (E. coli) family. An E. coli infection presents with diarrhea, often accompanied by blood, abdominal pain, and sometimes vomiting, which can progress to a severe form of the infection after about a week.

Each year, between 100 and 165 children with hemolytic uremic syndrome are reported to Santé publique France, which has maintained a surveillance system for this disease since 1996.

Prevention of HUS

In the context of preventing hemolytic uremic syndrome in children, two categories of food are particularly risky: ground meat and raw milk products. Simple precautions outlined on the website of the Ministry of Solidarity and Health can help prevent the spread of the disease.

As with any foodborne illness, prevention involves following these rules:

• Hands must be washed systematically before preparing meals.

• Vegetables, fruits, and herbs must be thoroughly washed, especially when consumed raw.

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

• Cooked dishes and leftovers must be promptly refrigerated, thoroughly reheated, and consumed quickly.

• Kitchen utensils (especially if they have previously come into contact with raw foods), as well as work surfaces, must be thoroughly washed.

• Children should not drink untreated water (well water, stream water, etc.) and should avoid swallowing it while swimming (in lakes, ponds, etc.).

Health authorities, who are monitoring the situation on a daily basis, are fully mobilized to identify the source of this contamination and implement appropriate health measures.