French authorities have stepped up their investigations related to an E. coli outbreak in the country linked to pizzas made by Nestlé.

The latest figures from Santé publique France show 56 cases and two deaths from Buitoni brand Fraîch’Up pizzas.

The Paris prosecutor’s office opened a criminal inquiry into the incident this past week. Charges include the involuntary manslaughter of one person, the injuring of 14 others and marketing a product dangerous to health.

An investigation had already been launched on March 22 and searches of the Nestlé factory in Caudry took place, authorized by the public health department of the Paris prosecutor’s office, on April 13.

A judicial inquiry is led by an investigating judge and was opened at the request of the public prosecutor to carry out such a highly complex investigation.

More than 50 children sick
Of the 56 infections, 54 were caused by E. coli O26 and two by E. coli O103, according to Santé publique France, the country’s public health agency. Warnings were issued about the potential presence of E. coli O26 in dough used to make the pizzas but it is unclear why the two E. coli O103 cases are linked to the outbreak.

All but one of the patients are children from 1 to 17 years old with a median age of 6. In France, Shiga toxin-producing E. coli (STEC) surveillance is based on HUS in children younger than 15, so it only catches the most severe cases of E. coli infection.

People fell sick from Jan. 18 to April 5 and from the 55 children sick, 48 have developed hemolytic uremic syndrome (HUS), a type of kidney failure associated with E. coli infections that can result in lifelong, serious health problems and death.

Consumer complaints have also mentioned the Four á Pierre pizza brand, which is made at the same plant and the Bella Napoli mark, produced in Italy, according to French media reports but there has been no official confirmation these pizzas have made anyone sick.

Santé publique France, the Directorate General for Food (DGAL), Directorate General for Competition, Consumption and the Repression of Fraud (DGCCRF), and Directorate General for Health have been investigating the increase in HUS and E. coli since early February.

Fraîch’Up pizzas sold since June 2021 were withdrawn and recalled in mid-March. They were distributed to several African countries plus Andorra, Belgium, Luxembourg, Switzerland and Slovenia.