Sporadic Shiga Toxin-Producing Escherichia coli-Associated Pediatric Hemolytic Uremic Syndrome, France, 2012-2021

Abstract

Shiga toxin-producing Escherichia coli-associated pediatric hemolytic uremic syndrome (STEC-HUS) remains an important public health risk in France. Cases are primarily sporadic, and geographic heterogeneity has been observed in crude incidence rates. We conducted a retrospective study of 1,255 sporadic pediatric STEC-HUS cases reported during 2012-2021 to describe spatiotemporal dynamics and geographic patterns of higher STEC-HUS risk. Annual case notifications ranged from 109 to 163. Most cases (n = 780 [62%]) were in children <3 years of age. STEC serogroups O26, O80, and O157 accounted for 78% (559/717) of cases with serogroup data. We identified 13 significant space-time clusters and 3 major geographic zones of interest; areas of southeastern France were included in >5 annual space-time clusters. The results of this study have numerous implications for outbreak detection and investigation and research perspectives to improve knowledge of environmental risk factors associated with geographic disparities in STEC-HUS in France.

Keywords: Escherichia coli; France; STEC; Shiga toxin–producing Escherichia coli; bacteria; bacterial infections; epidemiologic surveillance; food safety; hemolytic uremic syndrome; space-time clustering.

Figure 1

Annual reported number of sporadic Shiga toxin–producing Escherichia coli–associated pediatric hemolytic uremic syndrome cases, France, 2012–2021. A) All cases; B) cases of infection with serogroups O26, O80, and O157.

Figure 2

Age-standardized annual incidence rates of reported sporadic Shiga toxin–producing Escherichia coli–associated pediatric hemolytic uremic syndrome cases, for all cases and cases of infection with serogroups O26, O80, and O157, France, 2012–2021.

Figure 3

Number of reported sporadic Shiga toxin–producing Escherichia coli–associated pediatric hemolytic uremic syndrome cases, by age group and sex, and incidence rate, by age group (black dots), France, 2012–2021. Data were missing on sex for 3 cases (1 case each in patients <1 year, 3 years, and 4 years of age).

Figure 4

Monthly age-standardized incidence rates of reported sporadic Shiga toxin–producing Escherichia coli–associated pediatric hemolytic uremic syndrome cases, France, 2012–2021.

Figure 5

Geographic distribution of age-standardized incidence rates of all reported sporadic Shiga toxin–producing Escherichia coli–associated pediatric hemolytic uremic syndrome cases, France, 2012–2021. A) 2012; B) 2013; C) 2014; D) 2015; E) 2016; F) 2017; G) 2018; H) 2019; I) 2020; J) 2021.

Figure 6

Geographic distribution of age-standardized incidence rates of reported sporadic Shiga toxin–producing Escherichia coli–associated pediatric hemolytic uremic syndrome cases caused by serogroups O26, O80, and O157, France, 2012–2021. A–C) Serogroups O26 (A), O80 (B), and O157 (C) during 2012–2016. D–F) Serogroups O26 (D), O80 (E), and O157 (F) during 2017–2021.

Figure 7

Significant clusters detected by space–time scanning of all reported sporadic Shiga toxin–producing Escherichia coli–associated pediatric hemolytic uremic syndrome cases, France, 2012–2021.

Figure 8

Significant clusters detected by annual space–time scanning of all reported sporadic Shiga toxin–producing Escherichia coli–associated pediatric hemolytic uremic syndrome cases, France, 2012–2021. A) 2012; B) 2013; C) 2015; D) 2016; E) 2018; F) 2019; G) 2020; H) 2021; I) 2012–2021.

Figure 9

Cluster recurrence index of all reported sporadic Shiga toxin–producing Escherichia coli–associated pediatric hemolytic uremic syndrome cases, France, 2012–2021.