Headlines - Outbreak of Salmonellosis Caused by Salmonella enterica Serotype Agona Among Infants in France

The National Reference Center (CNR) for Salmonella (Institut Pasteur, Paris) identified, in late November 2017, an unusual number of young children with Salmonella enterica serotype Agona infection. The identification of 8 cases in 8 days triggered an alert and epidemiological investigations began on December 1 among the parents of the affected infants.The epidemiological investigation is being conducted by Santé publique France in collaboration with the CNR, the Directorate General for Competition, Consumer Affairs, and Fraud Control (DGCCRF), and the Directorate General for Health (DGS). To date, the investigation has identified 37 infants (16 boys and 21 girls, median age 4 months (min: 2.5 weeks, max: 9 months)) with Salmonella Agona serotype salmonellosis, which occurred between mid-August and December 2, 2017. These cases are located in 10 different regions (including 4 in Bourgogne-Franche-Comté). All these strains belong to the same epidemic clone. To date, the families of 36 infants have been interviewed. Among these 36 infants, 35 consumed, within 3 days prior to the onset of their symptoms, the following brands of infant formula: Picot Pepti Junior (n=26 infants), Milumel Bio 1 palm oil-free (n=5), Picot Rice (n=2), Picot SL (n=1), and Picot Anti-Colic (n=1); these 5 formulas are manufactured at the same production site. One mother of an infant reports exclusive breastfeeding. Parents using a can of infant formula affected by this recall must switch formulas immediately. The French Society of Pediatrics (SFP) has issued recommendations for possible substitutes, which are available on the website of the Ministry of Solidarity and Health.For physicians, if a child presents with an episode of acute gastroenteritis after consuming products manufactured by Lactalis and subject to the recall, ordering a stool culture is recommended. If the stool culture is positive for Salmonella, the strain must be sent to the CNR Salmonella at the Pasteur Institute for typing, specifying that this request is made in connection with the S. Agona and powdered milk alert (this strain has specific biochemical characteristics recognizable by laboratory biologists: it produces neither H2S nor gas on Kligler-Hajna medium, which is unusual for non-typhoid Salmonella). To date, no new cases of S. Agona salmonellosis in an infant with symptom onset after December 2, 2017 (the date of the first withdrawal and recall measures) have been identified by the CNR.