– OPINION –

“In the United States, Escherichia coli O157: H7 causes ≈73,000 infections and 60 deaths annually (1). Infection progresses to hemolytic uremic syndrome (HUS) in 2% to 15% of cases (2). “

UPDATE: In France, STEC surveillance is based only on HUS in children younger than 15, so it only catches the most severe cases of E. coli infection – LINK

According to Sante Publique reports, as of 04/25/2022, 55 confirmed cases have been identified, of which 53 are linked to STEC O26 strains, and 2 to STEC O103 strains. Earlier reports on 04/13/2022, indicated that another 26 other cases of HUS and STEC infections notified to Public Health France with investigations are ongoing. The 54 sick children are aged from 1 to 17 years with a median age of 7 years; 24 (44%) are female; 47 (87%) presented with HUS, 7 (13%) with STEC gastroenteritis. Two children died. The adult did not present with HUS.

The epidemiological, microbiological and traceability investigations carried out since that date have confirmed a link between the occurrence of these grouped cases and the consumption of frozen pizzas from the Nestlé Buitoni brand Fraîch’Up contaminated with STEC bacteria.

There is something wrong with the Santa Publique E. coli numbers. Given that there are now at least 47 with hemolytic uremic syndrome (HUS), you would expect to see that the total number of ill would be closer to 500. It appears that Santa Publique is counting the HUS cases primarily, leaving the STEC gastroenteritis cases relatively uncounted. There should not be a 87% HUS to 14% STEC gastroenteritis ration – it should at the minimum be reversed, as cited above and as shown in the below E. coli flour outbreaks in the US.

These 55 cases occurred in 54 children and 1 adult, who presented symptoms between 18/01/2022 (week 3) and 25/03/2022 (week 12). The epidemic peak is in week 7 (14/02 to 20/02) and week 9 (28/02 to 06/03), with 10 cases each of these weeks. These 55 cases occurred in 12 regions of metropolitan France: Hauts-de-France (12 cases), Ile-de-France (9 cases), New Aquitaine (8 cases), Pays de la Loire (7 cases), Brittany (6 cases), Grand Est (3 cases), Auvergne-Rhône-Alpes (2 cases), Occitanie (2 cases), Provence-Alpes-Côte d’Azur (2 cases), Center Val-de-Loire (2 cases), Bourgogne Franche-Comté (1 case) and Normandy (1 case).

So, why is flour the likely vector of this E. coli Outbreak?

According to the CDC, flour doesn’t look like a raw food, but most flour is raw. That means it hasn’t been treated to kill germs that cause food poisoning, such as E. coli. These harmful germs can contaminate grain while it’s still in the field or flour while it’s being made. Steps like grinding grain and bleaching flour don’t kill harmful germs — and these germs can end up in flour or baking mixes you buy at the store. You can get sick if you eat unbaked dough or batter made with flour containing germs.

We have seen these flour E. coli Outbreaks several times over the last “Baker’s Dozen” years.

Nestle Toll House Cookie Dough: As of Tuesday, June 30, 2009, 72 persons infected with a strain of E. coli O157: H7 with a particular DNA fingerprint have been reported from 30 states. Of these, 51 have been confirmed by an advanced DNA test as having the outbreak strain; these confirmatory test results are pending on the others. The number of ill persons identified in each state is as follows: Arizona (2), California (3), Colorado (6), Connecticut (1), Delaware (1), Georgia (1), Iowa (2), Illinois ( 5), Kentucky (2), Massachusetts (4), Maryland (2), Maine (3), Minnesota (6), Missouri (1), Montana (1), North Carolina (2), New Hampshire (2), New Jersey (1), Nevada (2), New York (1), Ohio (3), Oklahoma (1), Oregon (1), Pennsylvania (2), South Carolina (1), Texas (3), Utah ( 4), Virginia (2), Washington (6), and Wisconsin (1). Ill persons range in age from 2 to 65 years; however, 65% are less than 19 years old; 71% are female. Thirty-four persons have been hospitalized, 10 developed hemolytic uremic syndrome (HUS); none have died. Reports of these infections increased above the expected baseline in May and continue into June.

Flour: As of September 5, 2016, 63 people infected with the outbreak strains of STEC O121 or STEC O26 were reported from 24 states: Alabama (1), Arkansas (1), Arizona (3), California (3), Colorado (4) , Iowa (2), Illinois (4), Indiana (1), Massachusetts (3), Maryland (1), Michigan (4), Minnesota (7), Missouri (1), Montana (2), Nebraska (1) , New York (4), Oklahoma (3), Oregon (1), Pennsylvania (2), Tennessee (1), Texas (2), Virginia (3), Washington (5) and Wisconsin (4). Illnesses started on dates ranging from December 21, 2015 to September 5, 2016. Ill people range in age from 1 year to 95, with a median age of 18. Seventy-six percent of ill people were female. Seventeen ill people were hospitalized. One person developed hemolytic uremic syndrome, a type of kidney failure, and no deaths were reported

All Purpose Flour: As of July 11, 2019, a total of 21 people infected with the outbreak strain of E. coli O26 were reported from 9 states: California (1), Connecticut (1), Massachusetts (2), Missouri (1), New Jersey (1), New York (7), Ohio (5), Pennsylvania (2) and Rhode Island (1). Illnesses started on dates ranging from December 11, 2018 to May 21, 2019. Ill people range in age from 7 to 86 years, with a median age of 24. Seventy-one percent of ill people were female. Of 20 people with information available, 3 (15%) were hospitalized. No deaths were reported.

Cake Mix: As of July 27, 2021, 16 people infected with the outbreak strain of E. coli O121 have been reported from 12 states: Illinois (2), Indiana (1), Iowa (2), Massachusetts (1), Michigan (1) , Nebraska (2), Ohio (2), Oregon (1), South Carolina (1), Utah (1), Virginia (1) and Washington (1). Illnesses started on dates ranging from February 26, 2021 to June 21, 2021. Sick people range in age from 2 to 73 years, with a median age of 13, and 100% are female. Of 16 people with information available, 7 have been hospitalized. One person has developed a type of kidney failure called hemolytic uremic syndrome (HUS), and no deaths have been reported.

1. Mead PS, Slutsker L, Dietz V, McCaig LF, Bresee JS, Shapiro C, et al. Food-related illness in the United States. Emerg Infect Dis. 1999; 5: 607–25. 10.3201 / eid0505.990502.
2. Dundas S, Todd WT, Stewart AI, Murdoc PS, Chaudhuri AKR, Hutchinson SJ. The central Scotland Escherichia coli O157: H7 outbreak: risk factors for hemolytic uremic syndrome and death among hospitalized patients. Clin Infect Dis. 2001; 33: 923–31. 10.1086 / 322598.

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