Over the past years Shiga-like toxin-producing Escherichia coli (STEC) O157:H7 emerged as an important cause of severe gastrointestinal illnesses and haemolytic–uraemic syndrome (HUS) with up to 10% of children infected with STEC developing HUS. We conducted a geographical ecological study using the district as the statistical unit. For each district, we estimated the incidence of HUS among children <15 years for the period 1996–2001 from national HUS surveillance data and data obtained on cattle density. We used multivariate Poisson regression to quantify the relation, adjusted for covariates, between paediatric HUS incidence and exposure to cattle. In univariate analysis, a positive association was observed between several cattle-density indicators and HUS incidence. In multivariate analysis, HUS paediatric incidence was associated with dairy cattle density and the ratio of calves to children <15 years (P<0·001). Our findings are consistent with previous studies in other countries and support the recommendation to limit exposure of children to dairy cattle and manure to reduce the risk of STEC infection.