Belgium has reported a case of Salmonella in an infant linked to an outbreak in France.

The Federal Agency for the Safety of the Food Chain (FASFC) said it was informed of two sick babies in Belgium who had, among other things, consumed infant nutrition products of the Modilac brand bought in France, a few hours before the onset of symptoms.

Following an investigation, it appears the consumption of Modilac branded products was the cause of symptoms in one of the two sick children.

Four babies were sickened in France by Salmonella Poona with a link to consumption of Modilac branded products, marketed by Sodilac, a subsidiary of Savencia SA. Three other cases remain under investigation with sequencing ongoing.

The four confirmed patients, aged between two months and 10 months, fell ill between August and the end of December 2018. For probable cases, the age range extends to 18 months and illness onset up to January 2019.

Lactalis recalled 16,300 boxes of Picot AR milk as it was made at the same Spanish factory as the Modilac products but no illnesses have been linked to any Lactalis products.

Implicated Modilac products are not distributed on the Belgian market. They are distributed in France in pharmacies only and via charitable associations or marketed via online sales. Items have also been sent to Vietnam, Morocco, Algeria, and Tunisia.

FASFC asked parents who bought the products in France or online not to use them. The agency has contacted French authorities and the situation is being monitored.

The agency advised consumers to be aware that online shopping abroad is not always safe and people should look out for possible risks by checking the websites of foreign health authorities.

Santé Publique France, the public health agency, reported the four cases of Salmonella in infants with genome sequences (cgMLST) belonging to the same cluster.

The European Centre for Disease Prevention and Control (ECDC) said it had not found matches with the French isolate in its database. No other countries have reported matches so far but genome sequencing analyses are ongoing and additional cases may be reported.

Salmonella Poona is the 36th most common serotype in the European Surveillance System (TESSy). It was reported by 23 EU countries in 2013-2017 with 147 to 206 cases per year. In the five-year period, France accounted for 34 percent of cases, followed by the UK with 26 percent and the most common age group were children 0-4 years old (37 percent of all cases).