Two children have died in Denmark after complications from being infected with Shiga toxin-producing E. coli.

The children, one who lived in Funen and the other from the Copenhagen area, were between 5 and 9 years old and died as a result of the hemolytic uremic syndrome (HUS), a type of kidney failure associated with E. coli infection.

The two patients fell ill in August and September and were infected with different types of Shiga toxin-producing E. coli (STEC) so there was no common source of infection and they are not linked, according to the Statens Serum Institut (SSI).

STEC and HUS in Denmark

An investigation has not been able to find the source of the two sporadic HUS cases.

Most STEC infections in Denmark occur in the summer from July to September and also the majority of HUS cases are recorded during this period.

HUS is rare with six to 10 cases usually seen per year in Denmark. Deaths due to HUS are also rare. Since 2014, there have been 63 cases and five deaths. However, in 2018, 21 isolated cases were reported, which is the highest number ever and two of these people died.

So far this year there have been eight cases, the last three of which are from August and September. A total of 282 STEC infections have been registered in 2019 compared to 310 at the same time last year.

E. coli investigation closed; ongoing work for Salmonella illnesses

Meanwhile, an investigation into an outbreak of E. coli O157 that sickened 10 people in Denmark has ended.

No related cases of STEC O157 have been reported since the beginning of July, so the outbreak investigation was closed with the source remaining unknown.

Six people needed hospital treatment but none of them developed HUS. Patients were six men and four women with a median age of 29. Half of them are between 16 and 37 years old, with a range of 8 to 63 years old. Most people fell ill in the first two weeks of June.

The O157: H7 outbreak strain encoded the Shiga toxin (Stx) 1a and Stx2a genes. Stx2a is more often associated with severe disease and HUS.

Finally, a different outbreak investigation into Salmonella illnesses is still ongoing.

The Salmonella Coeln outbreak counts 26 cases with the latest reports of illness onset from August, so it is not considered over yet. The previous illness count was 23. Eleven people have needed hospital treatment.

Despite detailed interviews with patients and other investigations it has not been possible to point at a common food source as the cause.

Patients included 14 females and 12 males aged eight to 87 years old with sample dates from May 31 to August 19. Twelve live in Hovestaden, four each in Sjælland and Nordjylland and three each from Syddanmark and Midtjylland.

Salmonella Coeln is rare in Denmark with only two to four registered cases per year, which are usually linked to travel abroad.

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