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Surveillance of Hemolytic Uremic Syndrome in Children Less Than 15 Years of Age, a System to Monitor O157 and Non-O157 Shiga Toxin-Producing Escherichia coli Infections in France, 1996–2006

Espié, Emmanuelle DVM, PhD*; Grimont, Francine PharmD; Mariani-Kurkdjian, Patricia PharmD, PhD; Bouvet, Philippe PharmD; Haeghebaert, Sylvie RN§; Filliol, Ingrid PharmD, PhD; Loirat, Chantal MD; Decludt, Bénédicte MD*#; Minh, Nguyen Nhu Tran MD*; Vaillant, Véronique MD*; de Valk, Henriette MD*

The Pediatric Infectious Disease Journal: July 2008 - Volume 27 - Issue 7 - p 595-601
doi: 10.1097/INF.0b013e31816a062f
Original Studies

Background: Since the 1980s, Shiga toxin-producing Escherichia coli (STEC), especially E. coli O157:H7, has been an important cause of food borne disease in industrial countries. In France, as there was no routine screening for STEC in clinical laboratories, enhanced surveillance of hemolytic uremic syndrome (HUS) in children less than 15 years of age was established in 1996 to monitor trends in the incidence of STEC infections.

Methods: The surveillance system was based on a voluntary national network of pediatricians of 31 pediatric nephrology units in public hospitals.

Results: From 1996 to 2006, the mean annual incidence of HUS was 0.71 cases per 100,000 children less than 15 years of age and 1.87 cases per 100,000 children less than 5 years of age. STEC infections were confirmed in 66% of patients; STEC O157 was the most common serogroup identified in STEC-related HUS (83%). In this 11-year period, 96% of HUS cases were sporadic and only 2 outbreaks caused by STEC O157 and by a dual infection of STEC O26 and O80 were detected.

Conclusions: An evaluation of the surveillance of pediatric HUS showed that it is a simple and useful system for monitoring trends in STEC infections in France. It provides the information needed to measure the impact of new and changing vehicles of STEC transmission, and evaluate the effectiveness of prevention measures.

From the *Institut de Veille Sanitaire, Saint-Maurice, France; †Centre National de Référence des E. coli et Shigella, Institut Pasteur; ‡Laboratoire Associé au Centre National de Référence des E. coli et Shigella, Hôpital Robert Debré, Paris, France; §Cellule Interrégionale d'épidemiologie d'intervention, Lille, France; and ∥Service de Néphrologie Pédiatrique, Hôpital Robert Debre, Paris, France.

Accepted for publication January 22, 2008.


Address for correspondence: Emmanuelle Espié, Département des Maladies Infectieuses, Institut de Veille Sanitaire, 12 rue du Val d'Osne, 94415 Saint-Maurice, Cedex, France. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.