Raw pork liver a risk factor for hepatitis E in France

In France, the number of confirmed autochthonous hepatitis E (HE) cases has shown a substantial increase since 2006. In 2010, a descriptive study of acute autochthonous laboratory-confirmed HE cases was implemented in order to generate hypotheses about transmission modes and contamination sources.

raw.pork.liverAcute autochthonous HE cases confirmed by the National Reference Centre (CNR) were interviewed on exposures in the 2 to 10 weeks before illness onset. Clinical, biological and epidemiological characteristics were documented for 139 autochthonous cases.

Sixty-five per cent of them resided in southern France, 59% reported underlying conditions and 74% were infected by HEV subtype 3f. Consumption of raw pig-liver products during the incubation period was more frequent among cases in southern (47%) than in northern (25%) France. HE is a frequent infection, more prevalent in Southern France, where cases frequently report the consumption of raw pork-liver products. A case control study will determine the fraction of HE cases attributable to the consumption of such products and other risk factors.

Descriptive study of autochthonous cases of hepatitis E cases, France, 2010

Couturier E, De Valk H, Letort MJ, Vaillant V, Nicand E, Tessé S, Roque-Afonso AM

Saint-Maurice : Institut de veille sanitaire


Salmonella and campy happen in France too

In 2007, Amy and I spent a few weeks in France, and being the food safety nerd, I was struck by the indifference many of the people I met showed to foodborne illness.

DSC00006.JPGIt seemed to be a point-of-pride amongst the locals to not report foodborne illness.

I’m familiar with the French desire for food to be alive, sexy, and part of a life well-lived, but also saw a lot of people going to McDonald’s.

We stayed for a week at a friend’s cottage in a small town in the south, and we would visit the butcher, who cross-contaminated everything.

We had dinner at a neighbor’s place one night and he confessed, that butcher, “he made me so sick with his chicken.”

And when I got home, someone told me my don’t eat poop story made it onto Letterman, while Amy developed the look.

Researchers report that community incidence estimates are necessary to assess the burden and impact of infections on health and to set priorities for surveillance, research, prevention, and control strategies.

letterman2The current study was performed to estimate the community incidence of campylobacteriosis and nontyphoidal salmonellosis in France from the number of laboratory-confirmed cases reported to the national reference center (NRC). The probabilities of a case in the community visiting a doctor, having a stool sample requested, having a positive laboratory test, and having the case reported to the NRC were estimated using data of national surveillance systems, national hospitalization and health insurance databases, and specific surveys informing about these parameters. Credible intervals (CrI) were calculated using Monte Carlo simulation. In addition, we estimated the number of hospitalizations for both infections in France.

The annual community incidence rate in France is estimated at 842 cases per 100,000 (90%CrI 525–1690) for campylobacteriosis and 307 cases per 100,000 (90%CrI 173–611) for salmonellosis. The annual number of hospitalizations is estimated at 5182 for campylobacteriosis and 4305 for salmonellosis. The multiplication factors between cases ascertained by the surveillance system and cases in the community were 115 for campylobacteriosis and 20 for salmonellosis.

amy.the.look.2007They are consistent with estimates reported in other countries, indicating a high community incidence of campylobacteriosis and salmonellosis in France.

Community incidence of campylobacteriosis and nontyphoidal salmonellosis, France, 2008–2013

Foodborne Pathogens and Disease. 2015 ahead of print. doi:10.1089/fpd.2015.1964.

Van Cauteren Dieter, De Valk Henriette, Sommen Cecile, King Lisa A., Jourdan-Da Silva Nathalie, Weill François-Xavier, Le Hello Simon, Mégraud Francis, Vaillant Veronique, and Desenclos Jean C.



France goes QR code in Paris and Avignon

For every food hygiene official control, an inspection report is issued and indicates if the restaurant is compliant with food hygiene regulations. These official controls are here to ensure that food placed on the market is safe to eat. In case of non-compliances, corrective actions must be taken by the person who owns or manages the business.

qr.code.rest.inspection.gradeArticle 45 of the newly enacted French Law on the future of agriculture, food and forestry specifies that the results of official controls shall be made public in accordance with modalities which will be laid down by specific regulations, this is the transparency initiative.

This means food businesses’ compliance with the legal requirements will be visible to anyone, for the benefit of consumers but also of food business operators. That initiative will be a strong incentive for the food industry to continuously improve the sanitary conditions prevailing in their establishments, and will consequently allow them to be rewarded with positive outcomes of official controls.

Now the operators can download a QR-Code to display voluntarily on their storefront vitrine about this scheme. This QR-Code will be also given by the inspection services.

1,000 runners fall sick after mud race in France

There’s this fetish for running through mud.

TMSplashI don’t get it.

I’d rather play hockey and have someone shot a puck at my head at 90 mph.

Of the almost 8,400 runners who took part in Mud Day activities on 20 June in Nice on the French Riviera, about 1,000 have been stricken with gastroenteritis. Probably Campylobacter or Salmonella.

Chlamydia in women gutting chickens in France

Eight cases of psittacosis due to Chlamydia psittaci were identified in May 2013 among 15 individuals involved in chicken gutting activities on a mixed poultry farm in France.

Chlamydia psittaciAll cases were women between 42 and 67 years-old. Cases were diagnosed by serology and PCR of respiratory samples. Appropriate treatment was immediately administered to the eight hospitalised individuals after exposure to birds had been discovered. In the chicken flocks, mainly C. gallinacea was detected, a new member of the family Chlamydiaceae, whereas the ducks were found to harbour predominantly C. psittaci, the classical agent of psittacosis. In addition, C. psittaci was found in the same flock as the chickens that the patients had slaughtered. Both human and C. psittaci-positive avian samples carried the same ompA genotype E/B of C. psittaci, which is widespread among French duck flocks.

Repeated grassland rotations between duck and chicken flocks on the farm may explain the presence of C. psittaci in the chickens. Inspection by the veterinary service led to temporary closure of the farm. All birds had to be euthanised on site as no slaughterhouses accepted processing them. Farm buildings and grasslands were cleaned and/or disinfected before the introduction of new poultry birds.

Outbreak of Psittacosis in a Group of Women Exposed to Chlamydia Psittaci-Infected Chickens

Eurosurveillance, Volume 20, Issue 24, 18 June 2015

K Laroucau, R Aaziz, L Meurice, V Servas, I Chossat, H Royer, B de Barbeyrac, V Vaillant, J L Moyen, F Meziani, K Sachse, P Rolland


Cluster of two cases of botulism due to Clostridium baratii type F in France, November 2014

The first two cases in France of botulism due to Clostridium baratii type F were identified in November 2014, in the same family. Both cases required prolonged respiratory assistance.

Clostridium baratii type FOne of the cases had extremely high toxin serum levels and remained paralysed for two weeks. Investigations strongly supported the hypothesis of a common exposure during a family meal with high level contamination of the source. However, all analyses of leftover food remained negative.

Euro Surveill. 2015;20(6)

Castor C, Mazuet C, Saint-Leger M, Vygen S, Coutureau J, Durand M, Popoff MR, Jourdan Da Silva N.


25 sickened: Listeriosis outbreak linked to consumption of raw milk brie cheese in France

As Australia reviews its ban on raw milk cheese – with the usual arguments about good and bad bacteria and artisinal crafsmanship  — the Institute of Health in France reports that on Oct 1, 2012, six human cases of Lm infection with the AscI/ApaI PFGE pattern 210792-210792 over the previous 6 weeks were identified by the National reference center for Listeria. PFGE-typing using restriction enzyme SmaI identified 2 distinct profiles, D and Q.

brie-nov2012b1On Oct 22, additional PFGE-matching cases were identified. An outbreak investigation was initiated to identify the source of contamination and guide public health actions. We defined a case as a Lm infection with a PCR-genoserogroup IVb and the PFGE AscI/ApaI 210792-210792 profile diagnosed in France between Aug 1, 2012 and Feb 11, 2013. SmaI Q-associated cases were considered epidemic whereas SmaI non-Q-associated cases were considered non-epidemic. Cases’ food consumption history was collected using a standard questionnaire. We conducted a case-case study, aiming at comparing the food consumption history of both epidemic and sporadic listeriosis cases identified during the same period, as well as traceback and traceforward investigations.

The implicated cheese factory was inspected. Food and environmental samples were collected.

Twenty-five cases were identified (11 epidemic cases). Dates of diagnosis ranged from Sep 4, 2012 to Nov 20, 2012. Consumption of raw milk brie cheese was significantly associated with the outbreak SmaI Q strain (Odds Ratio 35, IC95% [5-366]). Traceback and traceforward investigations identified Cheesemaker. A as the likely source of infection. Cheesemaker inspection did not identify any hygiene violation. Food and environmental samples did not yield the outbreak strain. A point-source contamination of the raw milk is suspected to have occurred.

(Thanks to Albert Amgar for forwarding the document.)

Hepatitis E prevalent in French raw pork liver products

Hepatitis A is a commonly known pathogen in the food safety world – hepatitis E isn’t. There have  been a few papers detailing illnesses and outbreaks linked to the uncommon viral pathogen (mostly all out of Europe and Asia).The November issue of Emerging infectious Diseases has a paper that shows high prevalence of hep E in French raw pork liver products (used by some fancy restaurants).Screen Shot 2014-10-09 at 2.06.51 PM

Frequent hepatitis E virus contamination in food containing raw pork liver, Franc

Emerging Infectious Diseases, Volume 20, Number 11, November 2014

Nicole Pavio, Thiziri Merbah, and Anne Thébault



Food products containing raw pork liver are suspected to be vehicles for transmission of hepatitis E virus. Four categories of food products, comprising 394 samples, were analyzed to determine hepatitis E virus prevalence. Virus was detected in 3%–30% of the different categories. Phylogenetic analysis showed high identity with human and swine sequences.

HEV is the only hepatitis virus that can infect species other than primates. HEV infects many animal species, especially pigs, in which a very high prevalence has been described (2). Infections acquired in Western countries involve strains that are genetically similar to local swine strains, suggesting an autochthonous origin. Although water is the main vector of contamination in countries to which HEV is endemic, the origin of sporadic cases in other areas is more likely zoonotic. Direct contact with infected animals and consumption of infected meat are possible transmission pathways (2).

In 2011, four different categories of food products in France that were marketed by the food industry were identified as containing raw pork liver and sold to consumers to be eaten without cooking. These 4 categories were 1) figatellu and fitone, 2) dried salted liver, 3) quenelle and quenelle paste, and 4) dried or fresh liver sausages. HEV can be heat-inactivated by thorough cooking at 71°C for 20 min (9); however, consumers might not apply such precise thermal treatment. Thus, these food products might be able to transmit HEV. All 4 categories were local regional culinary specialties from eastern or southeastern France.

Screen Shot 2014-10-09 at 2.04.22 PM

Listeria still isn’t nice to pregnant women (and others)

This study describes trends in the incidence of pregnancy-related listeriosis in France between 1984 and 2011, and presents the major characteristics of 606 cases reported between 1999 and 2011 to the French Institute for Public Health Surveillance through the mandatory notification system.

amy.pregnant.listeriaThe incidence of pregnancy-related listeriosis decreased by a factor of 12 from 1984 to 2011. This reduction was a result of progressive implementation of specific Listeria monocytogenes control measures in food production. A lower incidence of pregnancy-related listeriosis was observed in regions with a lower prevalence of toxoplasmosis. Given that dietary recommendations in pregnancy target both toxoplasmosis and listeriosis prevention, we suppose that recommendations may have been delivered and followed more frequently in these regions.

Cases reported between 1999 and 2011 (n=606) were classified as maternal infections with ongoing pregnancy (n=89, 15%), fetal loss (n=166, 27%), or live-born neonatal listeriosis (n=351, 58%). The majority of live-born neonatal listeriosis cases (n=216, 64%) were preterm births (22–36 weeks of gestation), of whom 14% (n=30) were extremely preterm births (22–27 weeks of gestation). Eighty per cent of mothers reported having eaten high risk food during pregnancy. A better awareness of dietary recommendations in pregnant women is therefore necessary.

Eurosurveillance, Volume 19, Issue 38

D Girard, A Leclercq, E Laurent, M Lecuit, H de Valk, V Goulet



Listeriosis, caused by Listeria monocytogenes, is an important foodborne disease that can be difficult to control and commonly results in severe clinical outcomes. We aimed to provide the first estimates of global numbers of illnesses, deaths, and disability-adjusted life-years (DALYs) due to listeriosis, by synthesising information and knowledge through a systematic review.


We retrieved data on listeriosis through a systematic review of peer-reviewed and grey literature (published in 1990—2012). We excluded incidence data from before 1990 from the analysis. We reviewed national surveillance data where available. We did a multilevel meta-analysis to impute missing country-specific listeriosis incidence rates. We used a meta-regression to calculate the proportions of health states, and a Monte Carlo simulation to generate DALYs by WHO subregion.


We screened 11 722 references and identified 87 eligible studies containing listeriosis data for inclusion in the meta-analyses. We estimated that, in 2010, listeriosis resulted in 23 150 illnesses (95% credible interval 6061—91 247), 5463 deaths (1401—21 497), and 172 823 DALYs (44 079—676 465). The proportion of perinatal cases was 20·7% (SD 1·7).


Our quantification of the global burden of listeriosis will enable international prioritisation exercises. The number of DALYs due to listeriosis was lower than those due to congenital toxoplasmosis but accords with those due to echinococcosis. Urgent efforts are needed to fill the missing data in developing countries. We were unable to identify incidence data for the AFRO, EMRO, and SEARO WHO regions.


WHO Foodborne Diseases Epidemiology Reference Group and the Université catholique de Louvain.

The Lancet Infectious Diseases, doi:10.1016/S1473-3099(14)70870-9

Noordhout, Charline Maertens De, Brecht Devleesschauwer, Frederick J. Angulo, Geert Verbeke, Juanita Haagsma, Martyn Kirk, Arie Havelaar, and Niko Speybroeck