Fifteen children and one adult have fallen ill in an E. coli outbreak in France linked to cheese made with unpasteurized milk.

Fourteen infants developed hemolytic uremic syndrome (HUS). HUS is a severe complication associated with E. coli infections that causes kidney failure and usually occurs a week or more after the onset of diarrhea. One child and a 63-year-old adult had diarrhea with no other complications.

Santé publique France, the national public health agency, revised the case count as part of its investigation into the Shiga toxin producing E. coli O26 outbreak. In an update at the start of this month, 10 children were reported as part of the outbreak and two cases were under investigation.

The 15 children and the adult infected with E. coli (STEC) O26 with the same genomic characteristics between March 31 and April 29 were identified by the National Reference Center for E. coli, the Pasteur Institute and the microbiology laboratory at Robert Debré Hospital in Paris.

Eight of the patients are female. The children infected are 6 months to 4 years old and live in six regions of France.

Food consumption investigations by Santé publique France and the General Directorate of Food identified a link between consumption of Saint Marcellin and Saint Félicien raw milk cheese and onset of infection.

Fifteen of 16 families reported consumption of these cheeses and for 13 families, a link with the same producer, Fromagerie Alpine, was identified. No positive STEC O26 cheese or milk samples have been identified.

Saint Marcellin and Saint Félicien cheese made by Fromagerie Alpine were recalled in late April with extended recall action taken at the beginning of May. While most products have gone past their best-before dates some had dates lasting until early June.

France records between 100 and 160 HUS cases as part of its disease surveillance system each year. In 2017, 164 cases of pediatric HUS were reported to Santé publique France but no outbreak was identified.

French authorities reminded the public that, as a precaution, raw milk and cheese made from raw milk should not be eaten by young children, pregnant women, immunocompromised people and the elderly. Healthy adults can also become infected from bacteria, viruses and parasites that can be found in unpasteurized dairy products, but their risk for serious illness is somewhat lower.

More than 30 countries received the cheese that was part of the recall in France, including the United States and Canada, but no other illnesses have been linked to the cheese. In the United States, the implicated cheese was destroyed before being offered for sale, according to federal officials. In Canada it was recalled from retailers.

Distribution included Andorra, Austria, Belgium, Czech Republic, Côte d’Ivoire, Democratic Republic of Congo, Denmark, Germany, Hungary, Ireland, Italy, Lithuania, Luxembourg, Malaysia, Maldives, Netherlands, New Zealand, Philippines, Poland, Portugal, Qatar, Singapore, Slovenia, South Africa, Spain, Sweden, Switzerland, Ukraine, United Arab Emirates and United Kingdom.

Six Listeria infections

Meanwhile, Santé publique France has confirmed there are two deaths and six cases of Listeriosis linked to raw milk cheese made by Fromagere de la Brie.

A spokesman from the agency told Food Safety News that because there are only a few patients, it can’t give any demographic information for patients to ensure they cannot be identified.

All of the patients needed hospital treatment and investigations are continuing to see if other cases have occurred.

The company was ordered to stop production and recall raw and pasteurized dairy products in April.

Earlier this month, a 64-year-old woman died in l’Yonne and a female living in Pas-de-Calais lost her baby because of listeriosis. Both cases are being investigated to determine any potential link to the recalled raw milk cheese.

The United States was one of more than 30 countries that received cheese from France potentially contaminated with Listeria. No illnesses have been reported from any other country.

Cheese was sent to Australia, Austria, Belgium, Denmark, Germany, Hong Kong, Ireland, Italy, Japan, Jersey, Luxembourg, Macao, Mauritius, Myanmar, Netherlands, Norway, Oman, Philippines, Poland, Romania, Senegal, Singapore, South Africa, Spain, Sweden, Switzerland, Taiwan, Thailand, United Arab Emirates and United Kingdom.

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