HUS reports down in Italy but stable in France; some linked to raw milk

HUS reports down in Italy but stable in France; some linked to raw milk

by Sue Jones
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Italy and France have reported updated statistics on a potentially fatal complication of E. coli infection.

The complication, hemolytic uremic syndrome (HUS) is a type of kidney failure that can result in lifelong, serious health problems and death.

Italian data is from the start of September 2020 to the end of August 2021 when 49 cases were recorded. There were 84 cases from September 2019 to August 2020. French figures cover 2020 when 167 cases were reported.

Italian picture
In Italy, patients were from 11 different regions and only one was diagnosed with HUS after returning from abroad. Of all cases, 47 were in patients younger than 15 years old.

The number of HUS cases reported from September to December 2020 almost halved to 10 from an average of 19 in the previous 10 years.

“It is plausible to assume that measures to control the COVID-19 pandemic, taken in autumn-winter of 2020, may have also significantly contributed to reducing HUS incidence in the pediatric population. Indeed, a sharp decline had previously been observed also for the three month period between March and May 2020,” said Italian officials.

Shiga toxin-producing E. coli (STEC) infection was confirmed in 45 of the 49 recorded HUS cases with a third from E. coli O26. For 36 of the 45 positive cases, the serogroup was also identified and in 29 of the HUS cases for which this information was available, one of the top-5 STEC serogroups (O26, O157, O111, O145, O103) was detected, while in one case, co-infection with strains belonging to two serogroups (O145 and O177) was reported.

STEC O177 was diagnosed more frequently in the past 12 months with two cases, compared to an average of three in the previous 10 years. This increase could be attributed to use of more sensitive diagnostic methods, according to the report. STEC O80 was detected only once despite accounting for an increasing number of cases in recent years.

French data
In France, the number of infections stayed almost the same in 2020 at 167 compared to 168 in 2019, according to data published by Sante publique France.

French surveillance excludes cases occurring during or in the days following a trip outside the country and only covers children under the age of 15.

More than two-thirds of children affected were younger than 3 years old. The median length of hospital stay for all cases was eight days but ranged from one to 69 days.

The highest regional incidence rates were in the west of the country in Brittany, Pays de la Loire and Normandy.

From 142 HUS cases with information, 51 were from E. coli O26, 29 because of O80 and only two were caused by O157.

A total of 17 epidemiological investigations were carried out in 2020 including two suspected foodborne outbreaks of STEC without clinical complications. Some grouped cases of HUS were linked to consumption of unpasteurized, raw milk cheese and another cluster might have been caused by swimming in a lake.

Between May 4 and June 22, 2020, seven HUS patients reported consuming the same type of cheese made from raw cow’s milk. For five cases, STEC O26:H11 was isolated. Traceability efforts led to a single manufacturer but couldn’t identify a common batch of cheese eaten by the sick people.

The company had favorable test results on all batches of cheese identified in investigations and an inspection confirmed the STEC risk management procedures were compliant. Based on this and no new cases, there were no product recalls or withdrawals.

Sante publique France advice is that the consumption of raw milk and cheeses made from raw milk is not recommended for young children, pregnant women, immunocompromised people and the elderly. More manufacturers of raw milk cheeses are starting to put this guidance on the labels of their products.

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