POSSIBLE PERSON-TO-PERSON TRANSMISSION OF ESCHERICHIA-COLI O111 - ASSOCIATED HEMOLYTIC-UREMIC SYNDROME

Over a 3-month period, ten children (aged 1-13 years) from a 15-km rad ius in southern Picardy developed typical D+ hemolytic uremic syndrome (HUS). Polymerase chain reaction, using two pairs of verocytotoxin 1- (VT1) and VT2-specific oligonucleotide primers and an internal control was used to detect VT genes directly from stools samples. VT2 gene wa s detected in seven of nine patients' stools and in 5 of 14 contacts' stool samples. A VT2-producing Escherichia coli (VTEC) O111 was isolat ed from five of nine children's stools and in 3 adults' stools of the 14 tested. A retrospective case-control study was performed which show ed a higher rate of absence in school A, where the first four cases we re detected, compared with a control school. The odds ratio for the wh ole school was 2.77 (confidence interval 1.46-5.26), and 15 (confidenc e interval 2.54-115.6) if only the nursery classes were considered. A culture of all food samples from households was always negative for VT EC. A retrospective cohort study performed in 89% of children attendin g school A showed no linkage between food or drink and gastroenteritis . These findings emphasize the potential for person-to-person transmis sion of VT2-producing E. coli O111, since the only salient risk factor was close contact.