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Abstract

In February 2022, we observed an increase in the number of paediatric patients with haemolytic uraemic syndrome (HUS) associated with Shiga toxin-producing (STEC) in France. We interviewed cases or caretakers about food exposures, identified purchases on supermarket loyalty cards, conducted a case–control study, tested food samples and characterised isolates. We identified 59 cases of STEC O26:H11 or O103:H2 infections nationwide from 18 January to 5 April 2022. Fifty cases presented with HUS and two died. Data from supermarket loyalty cards identified frequent purchase of Brand A Type B frozen pizzas. A case–control study confirmed a strong association between the consumption of Brand A pizzas and illness (OR = 116.0; 95% confidence interval (CI): 26.8–501.9). Manufacturing of Brand A Type B pizzas did not include pre-baking of the dough. Isolates from pizza dough and flour samples were indistinguishable from the clinical outbreak strains. On 18 March, the manufacturer recalled the Type B pizzas. While flour is a known STEC vehicle, this outbreak is highly unusual, as cooking of frozen pizzas should eliminate STEC. Further research aiming to understand the origins and persistence of contamination should contribute to improving food safety practices.

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/content/10.2807/1560-7917.ES.2026.31.8.2500506
2026-02-26
2026-03-07
/content/10.2807/1560-7917.ES.2026.31.8.2500506
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Nationwide outbreak of Shiga toxin-producing Escherichia coli infections associated with frozen pizzas, France, 2022
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Catarina+Krug&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Krug Catarina</a>, <a href="/search?value1=Nathalie+Jourdan-Da+Silva&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jourdan-Da Silva Nathalie</a>, <a href="/search?value1=Mathieu+Tourdjman&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Tourdjman Mathieu</a>, <a href="/search?value1=Patricia+Mariani-Kurkdjian&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mariani-Kurkdjian Patricia</a>, <a href="/search?value1=Aur%C3%A9lie+Cointe&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cointe Aurélie</a>, <a href="/search?value1=Sophie+Lef%C3%A8vre&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lefèvre Sophie</a>, <a href="/search?value1=Sophie+B%C3%A9lichon&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bélichon Sophie</a>, <a href="/search?value1=Claire+Postic&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Postic Claire</a>, <a href="/search?value1=Marie+Fran%C3%A7on&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Françon Marie</a>, <a href="/search?value1=Hubert+Herber&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Herber Hubert</a>, <a href="/search?value1=Delphine+Sergentet&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sergentet Delphine</a>, <a href="/search?value1=Sarah+Ganet&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ganet Sarah</a>, <a href="/search?value1=Alicia+Faure-Bondat&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Faure-Bondat Alicia</a>, <a href="/search?value1=Marion+Debin&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Debin Marion</a>, <a href="/search?value1=Charly+Kengne-Kuetche&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kengne-Kuetche Charly</a>, <a href="/search?value1=Henriette+de+Valk&option1=author&noRedirect=true" class="nonDisambigAuthorLink">de Valk Henriette</a>, <a href="/search?value1=St%C3%A9phane+Bonacorsi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bonacorsi Stéphane</a>, <a href="/search?value1=Fran%C3%A7ois-Xavier+Weill&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Weill François-Xavier</a>, <a href="/search?value1=Gabrielle+Jones&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jones Gabrielle</a>, <a href="/search?value1=on+behalf+of+the+Outbreak+Investigation+Team&option1=author&noRedirect=true" class="nonDisambigAuthorLink">on behalf of the Outbreak Investigation Team</a></span>. Nationwide outbreak of Shiga toxin-producing Escherichia coli infections associated with frozen pizzas, France, 2022. <a href="/content/ecdc">Euro Surveill.</a> 2026;31(8):pii=2500506. <a href="https://doi.org/10.2807/1560-7917.ES.2026.31.8.2500506" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2026.31.8.2500506</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 08 Jul 2025;&nbsp;&nbsp; <span class="generated">Accepted</span>: 30 Oct 2025 </span> </p>
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