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French E. coli outbreak linked to Belgian cucumbers

More than 30 people fell ill in France at the end of 2021 as part of an outbreak caused by contaminated cucumbers.

In September 2021, the Haute-France Regional Health Authority was notified of a suspected outbreak of foodborne illness among students in the Lille region. Two hospitalized children were diagnosed with hemolytic uremic syndrome (HUS). HUS is a serious complication associated with E. coli infection that leads to kidney failure. The agency asked the French Public Utilities Association to support an investigation into the incident.

A total of 35 gastroenteritis cases were identified, half of which presented with bloody diarrhea and fever. 10 people were hospitalized.

The identified cases are 29 children from four schools and 5 seniors who received meals through a local delivery program. One case is the parent of a student. Five children and one adult delivered meals to them at home.

The median age of the patients was 8 years, the age ranged from 4 to 89 years, and almost two-thirds were women.

School canteen and meal delivery services are provided by the same municipal canteen.

A case-control study in an affected school identified consumption of cucumber salad for home delivery in September and the following day as a possible source of illness.

As approximately 1,000 meals are provided per day, the number of sick people may be underestimated.

Control dishes served on two days in September were analyzed, refrigerated in the central kitchen.

E. E. coli and cucumber from Belgium
at 8 Shiga toxin-producing Escherichia coli (STEC) O157 was isolated from fecal samples of two patients, including two HUS cases, and a cucumber salad sample. Genomic analysis of the isolates confirmed that all human and food strains belonged to the same cluster, indicating the same origin.

Investigation found failure in the decontamination process and incomplete removal of surface contamination from unpeeled cucumbers as contributing factors to the outbreak. As part of the decontamination process, a chlorine solution with an expiry date of 2018 was used prior to preparation.

Belgium planted the cucumbers involved and notified the country’s health authorities. Inspections by Belgian officials did not reveal any problems with the wholesalers, nor did they take samples, as there were no stocks of cucumbers from the batches linked to the outbreak. This batch comes from two different Belgian producers. Samples from one manufacturer in a different batch were negative for E. coli, so officials were unable to locate the source of the contamination.

Although the same batch of cucumbers was also distributed in other local areas of Hauts-de-France, no other related STEC infections were reported. Traceability work revealed that around 120 establishments in Haute France received the same batch of cucumbers that were prepared in the central kitchen in connection with the outbreak. In most cases, cucumbers have been eaten without raising health concerns. They are not sold directly to the public.

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