Deadly outbreaks and reports of a serious condition caused by E. coli infection have been highlighted at a conference on infectious diseases.
Posters at the European Scientific Conference on Applied Infectious Disease Epidemiology (ESCAIDE) covered outbreaks in France and Belgium and Hemolytic Uremic Syndrome (HUS) in England. HUS is a severe complication associated with E. coli infections that can cause kidney failure, multiple organ failure, brain damage and often death.
ESCAIDE is organized by the European Centre for Disease Prevention and Control (ECDC).
Raw milk cheese outbreak
In France, Shiga toxin-producing E. coli (STEC) surveillance is based on voluntary pediatric HUS notifications and microbiological surveillance.
In January 2025, the National Reference Center for E. coli alerted Santé publique France of four STEC isolates non-serotypable by PCR in elderly people with HUS in December 2024.
Overall, 17 confirmed and four possible patients fell ill from Dec. 9, 2024, to Jan. 29, 2025. Patients had a median age of 72 but ranged from 34 to 89 years old. There were 13 females and eight males. Whole genome sequencing (WGS) identified the atypical outbreak strain as serotype O17/O44/O77/O106:H18:K92.
All patients were hospitalized for HUS. Eight had neurological complications and three people died. Consumption of a raw cow’s milk cheese prior to illness was reported for 15 of 17 investigated cases. Traceback identified a common manufacturer and recall/withdrawal action of morbier from the company Perrin-Vermotbegan on Jan. 24. The outbreak strain was isolated from cheese at a patient’s home.
Scientists said it was the first documented STEC outbreak exclusively in adults in France and highlighted the outbreak potential of atypical STEC strains and severe clinical impact. It also supported the decision to extend STEC-HUS surveillance to all ages beginning in January 2025.
Belgian incident
In August 2025, cases of gastroenteritis, some STEC-confirmed, were reported in different nursing homes in Belgium.
Among 1,195 residents in 11 nursing homes, researchers identified 66 patients, including 32 confirmed and 10 deaths. Surveyed patients had a median age of 89 and eight had bloody diarrhea. WGS on 20 samples revealed E. coli O157. Sixteen of 19 sick people consumed raw ground meat.
Raw ground (minced) beef served on Aug. 13 was the probable source of infection. It was delivered to 104 institutions nationwide, including all affected nursing homes. No leftovers from the suspected batch were available for microbiological testing.
The outbreak prompted advice to facilities caring for at-risk groups to avoid serving raw or undercooked beef products.
HUS in England
Finally, a study has found hundreds of HUS cases previously unknown to the UK Health Security Agency (UKHSA). In England, HUS surveillance is incorporated into the UKHSA’s enhanced surveillance system for STEC. It is a notifiable disease with registered medical practitioners required to report suspected cases to UKHSA within 24 hours.
Scientists used a dataset for patient admissions in public hospitals in England. They looked at confirmed HUS cases from January 2009 to December 2023 and matched them to records in UKHSA’s surveillance system using the unique patient identifier, or postcode and date of birth.
In total, 1,834 confirmed HUS cases were in the dataset. More than 60 percent were unknown to UKHSA. Under-ascertainment was not associated with age group, sex, geographical region of treatment, or year of report.
Overall, 37 percent of HUS cases had confirmed STEC infection. Around half of HUS patients were up to 9 years old and they had the highest STEC confirmation rate.
“We found no case characteristics to target improvement in case reporting. We recommend raising awareness to test HUS cases for STEC confirmation; particularly in older adults where STEC may not be suspected,” said researchers.
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