In France, surveillance of infections caused by Shiga toxin-producing E. coli (STEC) is based on monitoring typical hemolytic uremic syndrome (HUS) in children under the age of 15. This network of 31 volunteer pediatric nephrologists was established in 1996 in collaboration with the French Society of Pediatric Nephrology and is coordinated by the French Institute for Public Health Surveillance (InVS). This surveillance allows for tracking changes in the incidence of typical HUS, describing the clinical characteristics of patients, determining the proportion of STEC infections, and detecting clusters of HUS and STEC infections. After eight years of operation, an evaluation was conducted to assess the relevance of this network and to make any necessary modifications. The simplicity, acceptability, data quality, and responsiveness of the surveillance network were determined through a survey of pediatric nephrologists in the network and through the analysis of the 623 surveillance reports received by the InVS. The completeness and representativeness of the network were assessed through two surveys: one conducted among the network’s pediatric nephrologists, and the other among the 260 hospital departments likely to treat pediatric HUS cases. To complement this evaluation and assess the feasibility of expanding surveillance to include STEC infections, a survey of 980 hospital and private laboratories was conducted to identify diagnostic practices for STEC infections. The evaluation of the surveillance network showed that 0.5% of reports did not meet the case definition and that the average time between diagnosis and reporting decreased from 42 days for 1996–1999 to 10 days for 2000–2003. The completeness of the network was estimated at 66% [95% CI: 58–70%]. Between 1996 and 2003, 15 clusters of HUS and STEC infections were detected, and most of them were promptly investigated. Annual summaries of surveillance data are read and used by 81% and 74% of the nephrologists participating in the surveillance, respectively. Surveillance of typical HUS in children under 15 years of age is therefore a simple and useful system for monitoring trends in STEC infections in France. However, adjustments should be considered: including other pediatric hospital departments in the current network would improve the comprehensiveness and representativeness of the surveillance; early case reporting to the InVS, meanwhile, would allow for better detection of clusters of cases and the rapid initiation of an investigation. The results of the survey of hospital and private laboratories and the current state of testing practices for enterohemorrhagic E. coli and STEC do not support extending surveillance from typical HUS to STEC infections. This survey did, however, identify specific actions to improve the diagnosis of STEC infections, and more specifically that of typical HUS. (R.A.)