French prosecutors have opened a preliminary criminal investigation after E. coli infections linked to a pizza factory for Nestlé’s Buitoni brand (NESN.S) could have led to the death of one person.
An investigation was opened on Thursday for the manslaughter of one person, injuries to 14 others and breaches of food safety rules, said a spokesperson for the Paris prosecutor’s office.
Santé Publique France and the National Reference Center (CNR) E. coli and its associated laboratory (Institut Pasteur, Paris, and Microbiology Laboratory of the Robert Debré Hospital, Paris), in collaboration with the Directorate General for Food, the Directorate General for Competition, Consumption and Fraud Prevention, and in coordination with the Directorate General for Health, have been investigating since 02/10/2022 an increase in the number of cases of pediatric infections of the haemolytic uremic syndrome (HUS ) and shigatoxin-producing Escherichia coli (STEC).
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 Fraîch’Up range of the Buitoni brand contaminated with STEC bacteria. On 03/18/2022, the company proceeded with the withdrawal-recall of all the pizzas of the Fraîch’Up range, marketed since June 2021 and the authorities asked the people holding these pizzas not to consume them and to destroy them. .
The total number of HUS cases linked to the consumption of these pizzas has stabilized since the withdrawal-recall. Other reports of STEC infection are being investigated as part of routine surveillance. To date, these reports are not linked to grouped cases or consumption of Fraîch’Up pizzas.
As of 05/04/2022, 56 confirmed cases have been identified, of which 54 are linked to STEC O26 strains and 2 to STEC O103 strains.
These 56 cases occurred in 55 children and 1 adult, who presented symptoms between 01/18/2022 (week 3) and 04/05/2022 (week 14) (Figure 1). 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 56 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), Provence-Alpes-Côte d’Azur (3 cases), Auvergne-Rhône-Alpes (2 cases), Occitanie (2 cases), Center Val-de-Loire (2 cases ), Bourgogne Franche-Comté (1 case) and Normandy (1 case) (Figure 2).
The 55 sick children are aged from 1 to 17 years old with a median age of 6 years; 25 (45%) are women; 48 (87%) had HUS, 7 (13%) STEC gastroenteritis. Two children died. The adult did not present with HUS.
Figure 1: Epidemic curve: number of confirmed cases of HUS and STEC infections, by week of onset of symptoms – Metropolitan France, weeks 3 to 14, 2022 (N=54: week of onset of symptoms not specified for 2 cases )
“In the United States, Escherichia coli O157:H7 causes ≈73,000 infections and 60 deaths per year (1). The 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 under 15, so it only detects the most severe cases of E. coli infection – LINK
So why is flour the likely vector for this outbreak of E. coli?
According to the CDC, flour does not look like a raw food, but most flour is raw. This means it has not been processed to kill germs that cause food poisoning, such as E. coli. These harmful germs can contaminate grain while it is still in the field or flour while it is being made. Steps like grinding grain and bleaching flour don’t kill harmful germs, and those germs can end up in the flour or baking mixes you buy at the store. You can get sick if you eat uncooked dough or dough made with flour that contains germs.
We have seen these outbreaks of E. coli in flour several times over the last few years of the “baker’s dozen”.
Nestle Toll House Cookie Dough: As of Tuesday, June 30, 2009, 72 people infected with a strain of E. coli O157:H7 with a particular DNA fingerprint have been reported in 30 states. Of these, 51 were confirmed by advanced DNA testing as carriers of the epidemic strain; these confirmatory test results are pending on others. The number of sick people 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). Sick people range in age from 2 to 65; however, 65% are under 19; 71% are women. Thirty-four people were hospitalized, 10 developed haemolytic uraemic syndrome (HUS); none died. Reports of these infections exceeded the expected baseline in May and are continuing through June.
Plain flour: As of September 5, 2016, 63 people infected with the epidemic strains of STEC O121 or STEC O26 have been reported in 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). The illnesses began on dates ranging from December 21, 2015 to September 5, 2016. Ill people range in age from 1 year to 95 years, with a median age of 18 years. Seventy-six percent of the sick people were women. Seventeen sick 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 epidemic strain of E. coli O26 have been reported in 9 states: California (1), Connecticut (1), Massachusetts (2), Missouri (1), New Jersey (1), New York (7), Ohio (5), Pennsylvania (2) and Rhode Island (1). The illnesses began on dates ranging from December 11, 2018 to May 21, 2019. Ill people range in age from 7 to 86, with a median age of 24. Seventy-one percent of the sick people were women. Of 20 people with information, 3 (15%) were hospitalized. No deaths have been reported.
The cake mix: As of July 27, 2021, 16 people infected with the epidemic strain of E. coli O121 have been reported in 12 states: Illinois (2), Indiana (1), Iowa (2), Massachusetts (1), Michigan (1), Nebraska (2), Ohio (2), Oregon (1), Carolina South (1), Utah (1), Virginia (1) and Washington (1). The illnesses began on dates ranging from February 26, 2021 to June 21, 2021. Ill people are between 2 and 73 years old, with a median age of 13, and 100% are female. Of 16 people for whom information is available, 7 were hospitalized. One person developed a type of kidney failure called hemolytic uremic syndrome (HUS), and no deaths were reported.
1. Mead PS, Slutsker L, Dietz V, McCaig LF, Bresee JS, Shapiro C, et al. Foodborne illness in the United States. Emergency Infect Dis. 1999;5:607–25. 10.3201/id0505.990502.
2. Dundas S, Todd WT, Stewart AI, Murdoc PS, Chaudhuri AKR, Hutchinson SJ. The central outbreak of Escherichia coli O157:H7 in Scotland: risk factors for haemolytic uremic syndrome and death in hospitalized patients. Clin Infect Dis. 2001;33:923–31. 10.1086/322598.
And, there have been more outbreaks and recalls.