Raw is risky: 19 children develop HUS in France from E. coli O26 linked to raw milk cheese

Gabrielle Jones, Sophie Lefevre, et al report in Eurosurveillance that from 25 March to 27 April 2019, 19 suspected Shiga toxin-producing Escherichia coli (STEC) associated paediatric haemolytic uraemic syndrome (HUS) cases were notified by French hospital paediatric departments to Santé publique France, compared with 5–10 cases during the same period in previous years [1].

Thirteen cases were confirmed as serogroup O26, with whole genome sequencing (WGS) underway for strain comparison. Initial epidemiological investigations using a trawling questionnaire identified the consumption of raw cow’s milk soft cheeses (Saint-Félicien and Saint-Marcellin) as the common link for eight of these 13 cases. Trace-back investigations using supermarket loyalty cards identified a common producer (producer A) of these cheeses for three cases and on the basis of this information a recall was initiated by French health authorities on 27 April 2019 [2]. As at 27 May 2019, investigations identified 16 outbreak cases including 14 paediatric HUS cases and two cases with uncomplicated diarrhoea (one child and one adult). Investigations are ongoing for one suspected case. The 16 outbreak cases reside in six administrative regions in France. All paediatric cases are under 5 years of age; the median age is 22 months (overall age range: 6 months–63 years). Eight cases are female. Date of symptom onset was between 31 March (week 13) and 29 April (week 18). All HUS cases were hospitalised. Thirteen cases received blood and/or platelet transfusion and seven underwent haemodialysis. Six cases had neurological complications, all of them received transfusions and three also had haemodialysis.

The families of all 16 outbreak cases and the suspected case were interviewed about their at-risk exposures during the 10 days before symptom onset. Families of 16 cases (15 outbreak cases and one suspected case) reported the consumption of Saint-Félicien or Saint-Marcellin raw cow’s milk cheeses by either the case (n = 12) or household members (n = 4). One outbreak case did not report consumption of these cheeses. For the 16 cases with reported consumption of these cheeses, trace-back investigations using loyalty cards and supply data from the different shops where the caretakers reported purchasing the cheeses identified a link with producer A for 13 (all outbreak cases).

Producer A manufactured only Saint-Félicien and Saint-Marcellin cheeses. To date, no positive STEC O26 cheese or milk samples have been identified. Investigations, including sampling of the cheeses and trace-back of the milk supply chains, are ongoing.

Four outbreak cases had not consumed the cheeses themselves but a household member had. This suggests the affected child may have been infected via cross contamination (knives, cutting board, hands, etc.). None of the household members reported symptoms of illness, indicating that the cases were unlikely to have been infected by person-to-person transmission. Investigations are ongoing in an attempt to further document the exposures of these cases (consumption of cheeses or other food items cut by the knives or on the same cutting board as the suspected cheeses). Only one in 16 outbreak cases reported a family member with self-limiting diarrhoea (no stool analysis).

Note: If that many people developed HUS, hundreds could have potentially been sickened.

Just cook it doesn’t cut it: 6-year-old in France dies from E. coli

(Thanks to our French colleague, Albert, who forwarded this)

Matthew, a child “full of life, very intelligent despite his disability ” according to his mother, Angélique Gervraud, died February 22, 2019 at the Children’s Hospital of Bordeaux. He had been sick for more than a month after eating an undercooked burger at the beginning of January 2019 says his mom in a forum posted on his Facebook page.

It’s probably poorly cooked mince that has contaminated Matthew, his mom is sure. “Matthew only ate that,” she explains. Matthew developed haemolytic uremic syndrome (HUS) usually linked to shiga-toxin producing E. coli.

And because food safety is simple – that’s sarcasm, which the French may not get —  the transmission of the disease can be avoided by simple actions, which advises the site Public Health France:

  • Cook meat thoroughly and especially minced meat at over 65 ° C(The Ministry of Health published a note to the attention of the professionals of the collective catering from February 2007, with the appearance of the first cases)
  • Avoid giving raw lai, and cheeses made from raw milk to young children. Prefer baked or pasteurized pressed cheese
  • Always wash your hands before cooking
  • Keep cooked and raw foods separately
  • Consume quickly and well warmed leftover food.
  • Do not give untreated water to children or the elderly.

In 2017, 164 cases of HUS were reported in children under 15 years of age. There are a hundred in France in general every year.

Jigsaw puzzle: France reports Salmonella poona cases in infants

Outbreak News Today reports that health officials in France are reporting four Salmonella Poona cases in infants whose strains are genetically linked.

The babies, two months to ten months in age, were sickened between the end of August 2018 and the end of December 2018. Three babies were hospitalized for their salmonellosis and all have been released.

Early investigations reveal a common food source with the four infants–powdered milk of the same brand produced by the same factory in Spain.

Investigations are currently being conducted with the Spanish authorities and the manufacturer to define the management measures to be put in place.

‘Something is going on’ Salmonella Typhimurium infections in France jump from 50 to 2500 per year in a decade

(As usual, something may be lost in translation)

Salmonella contamination, found in cold cuts, mainly pork, exploded in 10 years in France, because of the progression of a new strain, called “monophasic typhimurium variant”.

(I particularly like the graphic, right, of the pregnant woman, with five bottles of wine in the fridge and a couple of beers).

On October 30th, lots of dry sausages contaminated with this salmonella were removed from supermarket shelves. Withdrawals and recalls have already taken place in the spring, on sausages that had sickened a dozen young children in the south of France. Dry sausages were also concerned.

Dr. François-Xavier Weill, director of the national center of reference for Salmonella, at the Institut Pasteur, at the origin of this discovery with his teams . It is here, in Paris, that the bacteria are identified, after analysis of the samples sent by the analysis laboratories. This is how the rise in food infections has been spotted.

“While it was detected that about 50 in 2007, we are at 2500 per year now,” says François-Xavier Weill. As a result, this bacterium, which causes gastroenteritis and fever, which can reach sepsis in the most fragile, has risen to the third position of salmonella, which gives the most poisoning. “We sounded the alarm, we said we’re paying attention, something is happening”. 

“Manufacturers must continue their work to limit the risks of the farm to the fork, explains Nathalie Jourdan-da Silva, doctor epidemiologist at Public Health France, agency that gave the alert in 2012 in one of its publications. But there is no risk zero, especially since this salmonella, identified in the swine industry, has since expanded to the beef sector. 

And the father of Amy’s French family was in Paris the other day, and he looked up and saw Charlie Watts, the drummer for the Rolling Stones, so this song is in honor of the time the Stones moved to southern France as tax exiles from the UK and recorded Exile on Main Street.

14 sick from Salmonella in raw milk cheese in France

Since the identification by Public Health France of cases of salmonella infection of people who consumed reblochon raw milk produced by the company La Fromagerie La Tournette, health authorities in connection with the company are mobilized to take all necessary measures for the protection of consumers (something may be lost in translation).

Following the traceability survey that has just been conducted, it was decided as a precautionary measure to withdraw from the sale and recall some reblochons whole and half reblochons raw milk manufactured on this site (sanitary mark FR 74.128 .050 EC) whose expiry dates are between 17/11 and 16/12/2018. Epidemiological, environmental and food traceability investigations are continuing to clarify the origin of the contamination.

Ya can’t stop what’s coming: E. coli happens in France too

Enterohemorrhagic Escherichia coli serogroup O80, involved in hemolytic uremic syndrome associated with extraintestinal infections, has emerged in France. We obtained circularized sequences of the O80 strain RDEx444, responsible for hemolytic uremic syndrome with bacteremia, and noncircularized sequences of 35 O80 E. coli isolated from humans and animals in Europe with or without Shiga toxin genes.

RDEx444 harbored a mosaic plasmid, pR444_A, combining extraintestinal virulence determinants and a multidrug resistance–encoding island. All strains belonged to clonal complex 165, which is distantly related to other major enterohemorrhagic E. coli lineages. All stx-positive strains contained eae-ξ, ehxA, and genes characteristic of pR444_A.

Among stx-negative strains, 1 produced extended-spectrum β-lactamase, 1 harbored the colistin-resistance gene mcr1, and 2 possessed genes characteristic of enteropathogenic and pyelonephritis E. coli. Because O80–clonal complex 165 strains can integrate intestinal and extraintestinal virulence factors in combination with diverse drug-resistance genes, they constitute dangerous and versatile multidrug-resistant pathogens.

Emerging Multidrug-Resistant Hybrid Pathotype Shiga Toxin–Producing Escherichia coli O80 and Related Strains of Clonal Complex 165, Europe

Cointe A, Birgy A, Mariani-Kurkdjian P, Liguori S, Courroux C, Blanco J, et al. Emerging multidrug-resistant hybrid pathotype Shiga toxin–producing Escherichia coli O80 and related strains of clonal complex 165, Europe. Emerg Infect Dis. 2018 Dec [date cited]. https://doi.org/10.3201/eid2412.180272

https://wwwnc.cdc.gov/eid/article/24/12/18-0272_article

Thank you, WGS: Listeria linked to smoked salmon in Denmark and France

In Denmark, on 23 August 2017, Statens Serum Institut (SSI) identified a genetic cluster of four human Listeria monocytogenes sequence type (ST) 8 isolates by core genome multilocus sequence typing (cgMLST) [1]. The allele calling was performed in BioNumerics (v7.6.2, Applied Maths, Belgium). We initiated an epidemiological investigation and notified the Danish Central Outbreak Management Group (collaboration between the Danish Veterinary and Food Administration (DVFA), the National Food Institute at the Technical University of Denmark (DTU) and SSI). On 25 August, two additional human isolates were found to belong to the same genetic cluster.

A confirmed case was defined as a person clinically diagnosed with listeriosis after 1 January 2017 with laboratory-confirmed L. monocytogenes ST8 clustering using cgMLST (≤ 5 allelic distance, single linkage). Cases diagnosed before 1 January 2017 with an isolate belonging to this cluster were defined as probable cases.

As of 25 August 2017, the genetic cluster comprised six cases; five confirmed and one probable. The age of the cases ranged from 59 to 96 years (median 80 years) and four were women. All patients had underlying illness and no travel history. One patient died within 30 days of diagnosis. Epidemiological investigations including a standard questionnaire on exposures showed that all five confirmed cases had consumed cold-smoked and/or cured salmon in the 30 days before disease onset. Four cases had bought the salmon in retail chain X. No other food-item was reported as consumed in high frequencies among cases. Epidemiological follow-up for the probable case did not include information on fish consumption.

On 29 August 2017, a comparison between the human outbreak isolates and 16 L. monocytogenes ST8 food- and environmental isolates identified in Denmark from 2014 to August 2017 showed that the human isolates clustered with a food isolate from cold-smoked salmon, cut and packaged at company Y in Poland (zero to two allelic differences using cgMLST). L. monocytogenes had been detected on 31 July 2017 at levels of 110 CFU/g (threshold: 100 CFU/g) at the end of shelf life. The product was widely sold in Denmark and had been sampled by the DVFA in retail chain X, as part of a consumer exposure survey (i.e. analyses project on retail packages). Because the L. monocytogenes concentration had been just above the accepted limit and found at the end of the product shelf life a recall of this batch was not conducted. However, due to the positive finding, follow-up sampling had been performed on the 9 and 10 August 2017 from the central storage unit of retail chain X. L. monocytogenes had been isolated from two batches analysed before end of shelf life. In one sample from the same batches, which was also analysed at the end of the shelf life, on 28 August 2017 a L. monocytogenes level of 240 CFU/g was found. Isolates from the follow-up samples had zero to four allelic differences to the human outbreak isolates using cgMLST.

The human outbreak sequences were also compared to all L. monocytogenes ST8 genomes derived from clinical samples in Denmark from 2012 onwards. Although ST8 genomes from Danish patients in the period 2012–2017 showed high diversity, the outbreak isolates clearly formed a distinct cgMLST cluster with 16 allelic differences to the nearest isolates outside the genetic outbreak cluster and a maximum of nine allelic differences within the cluster (Figure 2a). We investigated the relatedness of outbreak isolates further by single-nucleotide polymorphisms (SNP) analysis performed by both SSI and DTU using two analysis pipelines: Northern Arizona SNP Pipeline (NASP) [2] and CSI Phylogeny version 1.4 from Center for Genomics Epidemiology (CGE), DTU [3] leading to the same conclusion.

On 30 August 2017, DVFA advised retail chain X to recall all cold-smoked salmon produced at company Y. This advice was based on the elevated number of L. monocytogenes (240 CFU/g) found in the product at the end of shelf-life and the link to the outbreak. Retail chain X voluntarily recalled both cold-smoked and cured salmon produced at company Y. As part of the recall procedure, retail chain X informed company Y on the situation. Information from company Y, provided by the Polish food authorities via the European Union Rapid Alert System for Food and Feed (RASFF), showed that the implicated batches were exclusively sold via retail chain X and only in Denmark.

The French National Reference Centre (NRC) for Listeria (Institut Pasteur, Paris), compared the sequences of the Danish human isolates against its database, using cgMLST as previously described [1,4]. A human isolate from a French resident belonged to the same cluster (L2-SL8-ST8-CT771) as the Danish isolates. This French probable case, a female patient in her mid-80s, was diagnosed in June 2016. Epidemiological investigations carried out by Santé Publique France were inconclusive, since food consumption history was not available at the time of diagnosis nor could information on travel to Denmark be retrieved, as the person had since died.

On 6 September 2017, an official control by the Ministry of Economy was carried out at a French retailer where a kosher chilled cured salmon was sampled for analysis. The sample was contaminated with L. monocytogenes at the level of 460 CFU/g and the salmon producer was company Y. An isolate was sent to the French NRC for typing and showed to belong to the same cgMLST type as the Danish outbreak. Further investigations on the food product confirmed that it had not been further processed after production in Poland. The product was recalled and no human cases were linked to its consumption as of beginning of December 2017.

The other nine countries that replied to the EPIS-FWD UI-426 notification (Austria, Finland, Germany, Luxembourg, the Netherlands, Norway, Slovenia, Sweden, United Kingdom) did not report any human or food isolates linked to the Danish outbreak. However, after submission of this report, at the end of November, we were informed through EPIS about three genetically linked human isolates in Germany.

Discussion

Here we report on a listeriosis outbreak and highlight the value of rapidly comparing the genomes of human and food/environmental isolates at the national and international levels.

The fact that the contaminated salmon products identified in Denmark and France were from different batches suggests environmental contamination possibly at the production facility at company Y. It is too early to assess whether any measures taken at company Y have been effective in controlling the outbreak. However, experiences from previous investigations suggest that once L. monocytogenes is detected in one product, the whole production site should be subject to a thorough inspection, and sampling with special attention to all the possible contamination/cross contamination issues before implementing corrective measures [5,6]. Moreover, the risk for L. monocytogenes persistent strains in the production environment requires the close monitoring for several years to ensure the elimination of these [7,8].

Since WGS was introduced for routine surveillance in Denmark, a number of listeriosis outbreaks have been detected and solved, including outbreaks involving cold-smoked ready-to-eat sliced fish products [5]. The present investigation further reinforces the suspicion that ready-to-eat fish products are important sources of L. monocytogenes infections in Denmark, as well as in other countries.

Though only involving a low number of isolates, WGS L. monocytogenes surveillance and communication between countries allowed us to detect and rapidly solve this salmon-associated outbreak, leading to food product recall in two European countries. Compared with previous typing methods, WGS has a higher discriminatory power and the ability to determine genetic distance between isolates. The introduction of WGS for surveillance of food-borne infections has shown that it improves outbreak detection and facilitates outbreak investigations and likely helps reduce the number of infections [4,9-16]. The EPIS-FWD communication platforms allowed for the communication to link cases across borders. However, currently cross-border outbreaks are only detected when case numbers in at least one country exceed normal levels and are notified internationally. Therefore, a possible future system for easy exchange of and comparison of WGS data, e.g. by the use of an agreed cgMLST nomenclature, across borders will enable the identification of more dispersed outbreaks as well as cross-border links between food samples and human infections. This report highlights that by the application of cross-disciplinary and real-time cross-border comparison of WGS data, L. monocytogenes infections can be prevented and thereby providing safer food for at-risk groups such as the elderly, immunodeficient individuals and pregnant women.

Cross-border outbreak of listeriosis caused by cold-smoked salmon, revealed by integrated surveillance and whole genome sequencing (WGS), Denmark and France, 2015 to 2017

Schjørring Susanne, Gillesberg Lassen Sofie , Jensen Tenna, Moura Alexandra, Kjeldgaard Jette S, Müller Luise, Thielke Stine, Leclercq Alexandre, Maury Mylene M, Tourdjman Mathieu, Donguy Marie-Pierre, Lecuit Marc, Ethelberg Steen, Nielsen Eva M. Cross-border outbreak of listeriosis caused by cold-smoked salmon, revealed by integrated surveillance and whole genome sequencing (WGS), Denmark and France, 2015 to 2017. Euro Surveill. 2017;22(50):pii=17-00762. https://doi.org/10.2807/1560-7917.ES.2017.22.50.17-00762

https://eurosurveillance.org/content/10.2807/1560-7917.ES.2017.22.50.17-00762

Lactalis of France ‘Salmonella was released from inside the buildings’

The head of the French company at the centre of an international baby milk scandal denied Friday that it was responsible for the contamination that triggered a recall of formula in over 80 countries, calling it “an accident”.

Lactalis, one of the world’s biggest dairy groups, was forced to recall 12 million packages of powdered baby milk in 83 countries in December and January after being linked to an outbreak of salmonella poisoning in children.

French officials began investigating the company after at least 36 infants fell sick from drinking milk sold under the Picot or Milumel brands. Cases of suspected contamination were also reported among children in Spain and Greece.

The outbreak was traced to a Lactalis factory in Craon, western France.

CEO Emmanuel Besnier told a French parliamentary inquiry that a renovation of the plant in early 2017 “released salmonella which was inside the buildings”.

“It was an accident. Nobody inside the factory was responsible,” he told lawmakers.

Lactalis has come in for heavy criticism after it emerged that the company’s own tests found salmonella on a production line but that it did not report the finding because the bacteria was not found in the milk itself.

The company is facing several lawsuits over the outbreak.

1 child dead, 14 sick from E. coli O26 in French ‘Our regions have talent’ raw milk cheese

Outbreak News Today reports on a statement from the French abouthe Escherichia coli ( E. coli ) O26 outbreak linked to the consumption of raw milk reblochons produced at the Cruseilles (Haute-Savoie) site of Chabert. French health officials are now reporting 14 children aged one to five years included in the investigation.

As of May 31, 6 children with HUS were infected with the same strain of E. coli O26, for which the consumption or reblochon incriminated is documented. These six children are domiciled in several regions of metropolitan France (Center-Val de Loire, PACA, Ile-de-France, Auverhne-Rhone-Aples, Pays-de-la-Loire); and for 8 other children, investigations are in progress. Of these, two had signs of gastroenteritis and six had HUS. One of the children with HUS died; the investigation around this case is in progress. To date, it cannot be dismissed or affirmed that these cases of HUS are linked to the consumption of reblochon: non-isolated and characterized strain, or consumption of reblochon incriminated not yet documented.

7 children sick with E. coli O26: France’s Leclerc recalls ‘Our regions have talent’ cheese

French food retailer Leclerc has issued a recall of a brand of cheese made with raw milk that has been linked by the authorities to cases of E.coli O26 among young children.s

Leclerc, France’s biggest supermarket chain by market share, said on its website that it was withdrawing Reblochon cheese supplied by cheesemaker Chabert in the Savoy region and sold under the “Nos regions ont du talent” (“Our regions have talent”) brand.

The move came after the French health authorities linked seven cases of E. coli O26 bacteria among children between one-and-a-half and three years to the cheese, which is a creamy speciality of the French Alps.

“The investigations conducted by the health authorities have confirmed an epidemiological link between these cases and the consumption of whole Reblochon cheese made with raw milk under the brand and sold by the Leclerc chain in several regions,” France’s health and agriculture ministries said in a joint statement.

The ministries said that six of the seven cases of infection involved hemolytic-uremic syndrome, a potentially serious condition that can cause kidney failure among young children.

Six children were taken to hospital and one is yet to return home, the health ministry added in an emailed response.

If six of the seven cases have HUS, there are dozens more that are sick.