Officials with the French public health agency have revised down the number of cases in an E. coli outbreak linked to raw milk cheese. Federal law in France does not require that E. coli infections be reported to authorities, so case counts can be inaccurate.

French authorities earlier reported an outbreak of E. coli O26 with 13 pediatric hemolytic uremic syndrome (HUS) cases since March 21. 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.

Santé publique France, the national public health agency, has been investigating 16 children infected with E. coli O26.

Ten were confirmed to be part of the outbreak. Four other infections are isolated cases and involve strains different from the outbreak strain and different from one another. Analysis is ongoing for the other two children.

The 10 outbreak patients are 6 months to 4 years old and live in five separate regions of France.

Investigations of food consumption, conducted by Santé publique France and the Directorate General for Food (Direction générale de l’Alimentation) identified a link between consumption of Saint Marcellin and Saint Félicien raw milk cheese and the onset of the infection symptoms.

Family members of the 10 children reported consumption of these cheeses. For five families, the origin of the cheeses was documented as Fromagerie Alpine, based in Romans-sur-Isère.

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

Voluntary notifications of STEC infections in France and HUS surveillance in children younger than 15 years old are used to develop estimated case counts.

Saint Marcellin and Saint Félicien made by Fromagerie Alpine were recalled in late April, with the French Ministry of Agriculture and Food expanding the recall one week ago.

More than 30 countries received the recalled cheese, including the U.S. and Canada. In the United States the implicated cheese was destroyed before being offered for sale, according to federal officials. In Canada La Fromagerie Hamel had to recall Le Pic brand Saint-Félicien cheese from retailers. Consumers were urged to check their homes and destroy or return any of the recalled cheese they had on hand.

The European Centre for Disease Prevention and Control reported no other country had so far recorded cases with similar E. coli strain characteristics or illnesses linked to the cheese.