Foodborne illness acquired in the United States--unspecified agents

Each year, 31 major known pathogens acquired in the United States caused an estimated 9.4 million episodes of foodborne illness. Additional episodes of illness were caused by unspecified agents, including known agents with insufficient data to estimate agent-specific illness, known agents not yet recognized as causing foodborne illness, substances known to be in food but of unproven pathogenicity, and unknown agents. To estimate these additional illnesses, we used data from surveys, hospital records, and death certificates to estimate illnesses, hospitalizations, and deaths from acute gastroenteritis and subtracted illnesses caused by known gastroenteritis pathogens. If the proportions acquired by domestic foodborne transmission were similar to those for known gastroenteritis pathogens, then an estimated 38.4 million (90% credible interval [CrI] 19.8-61.2 million) episodes of domestically acquired foodborne illness were caused by unspecified agents, resulting in 71,878 hospitalizations (90% CrI 9,924-157,340) and 1,686 deaths (90% CrI 369-3,338).     

Estimating foodborne gastroenteritis, Australia

We estimated for Australia the number of cases, hospitalizations, and deaths due to foodborne gastroenteritis in a typical year, circa 2000. The total amount of infectious gastroenteritis was measured by using a national telephone survey. The foodborne proportion was estimated from Australian data on each of 16 pathogens. To account for uncertainty, we used simulation techniques to calculate 95% credibility intervals (CrI). The estimate of incidence of gastroenteritis in Australia is 17.2 million (95% confidence interval 14.5-19.9 million) cases per year. We estimate that 32% (95% CrI 24%-40%) are foodborne, which equals 0.3 (95% CrI 0.2-0.4) episodes per person, or 5.4 million (95% CrI 4.0-6.9 million) cases annually in Australia. Norovirus, enteropathogenic Escherichia coli, Campylobacter spp., and Salmonella spp. cause the most illnesses. In addition, foodborne gastroenteritis causes approximately 15,000 (95% CrI 11,000-18,000) hospitalizations and 80 (95% CrI 40-120) deaths annually. This study highlights global public health concerns about foodborne diseases and the need for standardized methods, including assessment of uncertainty, for international comparison.     

Surveillance for foodborne disease outbreaks--United States, 2008

Foodborne agents cause an estimated 48 million illnesses annually in the United States, including 9.4 million illnesses from known pathogens. CDC collects data on foodborne disease outbreaks submitted from all states and territories through the Foodborne Disease Outbreak Surveillance System. During 2008, the most recent year for which data are finalized, 1,034 foodborne disease outbreaks were reported, which resulted in 23,152 cases of illness, 1,276 hospitalizations, and 22 deaths. Among the 479 outbreaks with a laboratory-confirmed single etiologic agent reported, norovirus was the most common, accounting for 49% of outbreaks and 46% of illnesses. Salmonella was the second most common, accounting for 23% of outbreaks and 31% of illnesses. Among the 218 outbreaks attributed to a food vehicle with ingredients from only one of 17 defined food commodities, the top commodities to which outbreaks were attributed were poultry (15%), beef (14%), and finfish (14%), whereas the top commodities to which outbreak-related illnesses were attributed were fruits and nuts (24%), vine-stalk vegetables (23%), and beef (13%). Outbreak surveillance provides insights into the agents that cause foodborne illness, types of implicated foods, and settings where transmission occurs. Public health, regulatory, and food industry professionals can use this information to target prevention efforts against pathogens and foods that cause the most foodborne disease outbreaks.     

Preliminary FoodNet data on the incidence of foodborne illnesses--selected sites, United States, 2001

An estimated 76 million persons contract foodborne illnesses each year in the United States. CDC's Emerging Infections Program Foodborne Diseases Active Surveillance Network (FoodNet) collects data about 10 foodborne diseases in nine U.S. sites to quantify and monitor foodborne illnesses. This report describes preliminary surveillance data for 2001 and compares them with 1996-2000 data. The data show a decrease in the major bacterial foodborne illnesses, indicating progress toward meeting the national health objectives of reducing the incidence of foodborne diseases by 2010. However, the data do not show a sustained decline in some infections, indicating that increased efforts are needed to reduce further the incidence of foodborne illnesses.     

Preliminary FoodNet data on the incidence of foodborne illnesses--selected sites,United States, 2002

In the United States, an estimated 76 million persons contract foodborne illnesses each year. CDC's Emerging Infections Program Foodborne Diseases Active Surveillance Network (FoodNet) collects data on 10 foodborne diseases in nine U.S. sites. FoodNet follows trends in foodborne infections by using laboratory-based surveillance for culture-confirmed illness caused by several enteric pathogens commonly transmitted through food. This report describes preliminary surveillance data for 2002 and compares them with 1996-2001 data. The data indicate a sustained decrease in major bacterial foodborne illnesses such as Campylobacter and Listeria, indicating progress toward meeting the national health objectives of reducing the incidence of foodborne infections by 2010 (objectives 10-1a to 10-1d). However, the data do not indicate a sustained decline in other major foodborne infections such as Escherichia coli O157 and Salmonella, indicating that increased efforts are needed to reduce further the incidence of foodborne illnesses.     

Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food--selected sites, United States, 2003

In the United States, an estimated 76 million persons contract foodborne and other acute diarrheal illnesses each year. CDC's Emerging Infections Program Foodborne Diseases Active Surveillance Network (FoodNet) collects data on diseases caused by enteric pathogens transmitted commonly through food in nine U.S. sites. FoodNet quantifies and monitors the incidence of these infections by conducting active surveillance for laboratory-diagnosed illness. This report describes preliminary surveillance data for 2003 and compares them with 1996-2002 data. The data indicate substantial declines in the incidence of infections caused by Campylobacter, Cryptosporidium parvum, Escherichia coli O157, Salmonella, and Yersinia enterocolitica. These data represent progress toward meeting the 2010 national health objectives of reducing the incidence of foodborne infections (objective nos. 10.1a, 10.1b, and 10.1d). However, increased efforts are needed to reduce further the incidence of foodborne illnesses, particularly among children.     

Preliminary FoodNet data on the incidence of foodborne illnesses--selected sites, United States, 1999

Each year in the United States, an estimated 76 million persons experience foodborne illnesses. CDC's Emerging Infections Program Foodborne Diseases Active Surveillance Network (FoodNet) collects data on nine foodborne diseases in selected U.S. sites to quantify and monitor foodborne illnesses. This report describes preliminary surveillance data for 1999 and compares them with data from 1996-1998. The data suggest that the incidence of the foodborne illnesses under surveillance declined during 1999 compared with 1996 primarily as a result of decreases in campylobacteriosis and shigellosis and indicate substantial regional variation in the incidence of foodborne diseases.     

Foodborne Illness,Australia, Circa 2000 and Circa 2010

Foodborne disease is a major public health problem worldwide. To examine changes in foodborne illness in Australia, we estimated the incidence, hospitalizations, and deaths attributed to contaminated food circa 2010 and recalculated estimates from circa 2000. Approximately 25% of gastroenteritis cases were caused by contaminated food; to account for uncertainty we used simulation techniques to estimate 90% credible intervals. We estimate that circa 2010, 4.1 million foodborne gastroenteritis cases occurred, and circa 2000, 4.3 million cases occurred. Circa 2010, contaminated food was estimated to be responsible for 30,840 gastroenteritis-associated hospitalizations, 76 associated deaths, and 5,140 nongastrointestinal illnesses. Cases of salmonellosis and campylobacteriosis increased from 2000 to 2010 and were the leading causes of gastroenteritis-associated hospitalizations; Listeria monocytogenes and nontyphoidal Salmonella spp. infections were the leading causes of death. Although the overall incidence of foodborne illnesses declined over time in Australia, cases of foodborne gastroenteritis are still common.Keywords: foodborne illness, foodborne disease, gastroenteritis, epidemiology, estimate, incidence, hospitalization, death, norovirus, salmonella, campylobacter, toxin, bacteria, parasites, viruses, AustraliaFoodborne illness is a major public health problem and a common cause of illness and death worldwide. Outbreaks linked to contaminated food can affect the public’s trust and financially harm implicated businesses and associated food industries. Estimates of the effects of foodborne illnesses and individual pathogens provide evidence for policy interventions and food safety regulation. In addition, estimates of changes in the incidence of foodborne illnesses and hospitalizations over time provide information on the effectiveness of changes to food safety standards and regulation.Many agents can cause foodborne illness; some of these agents are transmitted to humans by other routes as well as by food. Most foodborne illnesses manifest as gastroenteritis, but other presentations, such as meningitis and hepatitis may also result from infection, and sequelae may occur weeks after the acute infection.Many countries have estimated the incidence of foodborne diseases (1–5). In Australia in 2000, foodborne incidence, hospitalizations, and deaths were estimated to cost 1.25 billion Australian dollars annually (6,7). However, since 2000, surveillance has substantially improved, data availability has increased, and methods have been refined. To inform current public health decisions and policies in Australia, we used new methods and datasets to estimate the incidence of infectious gastroenteritis and associated hospitalizations and deaths in Australia circa 2010. We then applied these refined methods to circa 2000 data so that estimates from the 2 periods could be directly compared.     

Foodborne infections in France

To quantify the impact of foodborne diseases on health, and set priorities for data collection, prevention and control of these diseases, we compiled and analyzed information from surveillance systems and other sources on the morbidity and mortality due to foodborne infectious diseases in mainland France in the last decade of the 20th century. Illness due to 13 bacteria, two viruses, and eight parasites were studied. The number of foodborne infections, hospitalizations, and deaths were estimated from multiple data sources. For each agent, several estimates were derived from the different sources. Estimates were ranked according to their plausibility, based on an assessment of the validity of the data source, and are presented as a "plausible interval" consisting of a low and high estimate. We estimate that these pathogens caused 10,200-17,800 hospitalizations per year. Salmonella is the most frequent cause (5,700-10,200 cases), followed by Campylobacter (2,600-3,500 cases) and Listeria (304 cases). Toxoplasmosis accounts for the majority of hospitalizations (426 cases) attributable to the studied parasitic infections. The number of deaths related to foodborne infection was estimated between 228 and 691. Bacterial pathogens account for the majority (191 to 652) of deaths of which 92 to 535 are attributable to salmonellosis, ranking as the first cause of death, and 78 to listeriosis, the second cause. Salmonella, Campylobacter, and Listeria are the main causes of severe foodborne illness in France. For several pathogens, data are insufficient to derive exact estimates of the disease burden. Nevertheless, it has been possible to derive plausible estimates for the majority, and to rank them according to their impact on public health.     

Preliminary FoodNet data on the incidence of foodborne illnesses--selected sites, United States, 2000

Each year in the United States, an estimated 76 million persons contract foodborne illnesses. CDC's Emerging Infections Program Foodborne Diseases Active Surveillance Network (FoodNet) collects data about nine foodborne diseases in eight U.S. sites to quantify and monitor foodborne illnesses. This report describes preliminary surveillance data for 2000 and compares them with 1996-1999 data. The data indicate the relative frequency of diagnosed infections, demonstrate substantial regional variation, and suggest trends in incidence. FoodNet provides data for monitoring foodborne illnesses and interventions designed to reduce them.     

Foodborne illness acquired in the United States--major pathogens

Estimates of foodborne illness can be used to direct food safety policy and interventions. We used data from active and passive surveillance and other sources to estimate that each year 31 major pathogens acquired in the United States caused 9.4 million episodes of foodborne illness (90% credible interval [CrI] 6.6-12.7 million), 55,961 hospitalizations (90% CrI 39,534-75,741), and 1,351 deaths (90% CrI 712-2,268). Most (58%) illnesses were caused by norovirus, followed by nontyphoidal Salmonella spp. (11%), Clostridium perfringens (10%), and Campylobacter spp. (9%). Leading causes of hospitalization were nontyphoidal Salmonella spp. (35%), norovirus (26%), Campylobacter spp. (15%), and Toxoplasma gondii (8%). Leading causes of death were nontyphoidal Salmonella spp. (28%), T. gondii (24%), Listeria monocytogenes (19%), and norovirus (11%). These estimates cannot be compared with prior (1999) estimates to assess trends because different methods were used. Additional data and more refined methods can improve future estimates.     

Food irradiation: a safe and useful technology.

Prevention of disease is a core public health mission. Food-borne illness is a major source of preventable morbidity and mortality. Each year, an estimated 76 million illnesses, 325,000 hospitalizations, and 5200 deaths due to food-borne illness occur in the United States. Research findings show that irradiating food can both greatly reduce illness from food-borne pathogens and extend food shelf life by delaying ripening, inhibiting spoilage, and minimizing contamination. However, because the food industry has historically been reluctant to sell irradiated foods, food irradiation remains an underutilized technology.     

Estimate of Burden and Direct Healthcare Cost of Infectious Waterborne Disease in the United States

Provision of safe drinking water in the United States is a great public health achievement. However, new waterborne disease challenges have emerged (e.g., aging infrastructure, chlorine-tolerant and biofilm-related pathogens, increased recreational water use). Comprehensive estimates of the health burden for all water exposure routes (ingestion, contact, inhalation) and sources (drinking, recreational, environmental) are needed. We estimated total illnesses, emergency department (ED) visits, hospitalizations, deaths, and direct healthcare costs for 17 waterborne infectious diseases. About 7.15 million waterborne illnesses occur annually (95% credible interval [CrI] 3.88 million–12.0 million), results in 601,000 ED visits (95% CrI 364,000–866,000), 118,000 hospitalizations (95% CrI 86,800–150,000), and 6,630 deaths (95% CrI 4,520–8,870) and incurring US $3.33 billion (95% CrI 1.37 billion–8.77 billion) in direct healthcare costs. Otitis externa and norovirus infection were the most common illnesses. Most hospitalizations and deaths were caused by biofilm-associated pathogens (nontuberculous mycobacteria, Pseudomonas, Legionella), costing US $2.39 billion annually.     

Estimates of incidence and costs of intestinal infectious diseases in the United States

The incidence of acute episodes of intestinal infectious diseases in the United States was estimated through analysis of community-based studies and national interview surveys. Their differing results were reconciled by adjusting the study population age distributions in the community-based studies, by excluding those cases that also showed respiratory symptoms, and by accounting for structural differences in the surveys. The reconciliation process provided an estimate of 99 million acute cases of either vomiting or diarrhea, or both, each year in this country, half of which involved more than a full day of restricted activity. The analysis was limited to cases of acute gastrointestinal diseases with vomiting or diarrhea but without respiratory symptoms. Physicians were consulted for 8.2 million illnesses; 250,000 of these required hospitalization. In 1985, hospitalizations incurred $560 million in medical costs and $200 million in lost productivity. Nonhospitalized cases (7.9 million) for which physicians were consulted incurred $690 million in medical costs and $2.06 billion in lost productivity. More than 90 million cases for which no physician was consulted cost an estimated $19.5 billion in lost productivity. The estimates excluded such costs as death, pain and suffering, lost leisure time, financial losses to food establishments, and legal expenses. According to these estimates, medical costs and lost productivity from acute intestinal infectious diseases amount to a minimum of about $23 billion a year in the United States.     

A Public Health Informatics Solution to Improving Food Safety in Restaurants: Putting the Missing Piece in the Puzzle

Foodborne illnesses remain an important public health challenge in the United States causing an estimated 48 million illnesses, 128,000 hospitalizations, and 3,000 deaths per year. Restaurants are frequent settings for foodborne illness transmission. Public health surveillance – the continual, systematic collection, analysis, and interpretation of reports of health data to prevent and control illness – is a prerequisite for an effective food control system. While restaurant inspection data are routinely collected, these data are not regularly aggregated like traditional surveillance data. However, there is evidence that these data are a valuable tool for understanding foodborne illness outbreaks and threats to food safety. This article discusses the challenges and opportunities for incorporating routine restaurant inspection data as a surveillance tool for monitoring and improving foodborne illness prevention activities. The three main challenges are: 1) lack of a national framework; 2) lack of data standards and interoperability; and 3) limited access to restaurant inspection data. Tapping into the power of public health informatics represents an opportunity to address these challenges. Advancing the food safety system by improving restaurant inspection information systems and making restaurant inspection data available to support decision-making represents an opportunity to practice smarter food safety.     

Sequelae of Foodborne Illness Caused by 5 Pathogens,Australia, Circa 2010

In Australia circa 2010, 4.1 million (90% credible interval [CrI] 2.3–6.4 million) episodes of foodborne gastroenteritis occurred, many of which might have resulted in sequelae. We estimated the number of illnesses, hospitalizations, and deaths from Guillain-Barré syndrome, hemolytic uremic syndrome, irritable bowel syndrome, and reactive arthritis that were associated with contaminated food in Australia. Data from published studies, hospital records, and mortality reports were combined with multipliers to adjust for different transmission routes. We used Monte Carlo simulation to estimate median estimates and 90% CrIs. In Australia, circa 2010, we estimated that 35,840 (90% CrI 25,000–54,000) illnesses, 1,080 (90% CrI 700–1,600) hospitalizations, and 10 (90% CrI 5–14) deaths occurred from foodborne gastroenteritis–associated sequelae. Campylobacter spp. infection was responsible for 80% of incident cases. Reducing the incidence of campylobacteriosis and other foodborne diseases would minimize the health effects of sequelae.     

Work-related death: a continuing epidemic

Worldwide, work-related illnesses and injuries kill approximately 1.1 million people per year. In 1992, an estimated 65,000 people in the United States died of occupational injuries or illness. Most estimates indicate that occupational diseases account for far more fatalities than occupational injuries. However, an accurate enumeration of occupational disease fatalities is hampered by a paucity of data, owing to underdiagnosis of occupational diseases and inadequacy of current surveillance systems. In this commentary, the authors review the epidemiology of death due to occupational disease and injury in the United States and discuss vulnerable populations, emerging trends, and prevention strategies for this ongoing public health problem.     

Hospitalization discharge diagnoses for kidney disease--United States, 1980-2005

Kidney disease is the ninth leading cause of death in the United States. Nearly 26 million persons in the United States have chronic kidney disease (CKD), and another 20 million are at increased risk for CKD. End-stage renal disease (ESRD), which can be caused by either CKD or acute renal failure (ARF), results in approximately 85,000 deaths each year in the United States. The total annual cost of treating ESRD in the United States was approximately $33 billion in 2005. Much of the care for CKD and ESRD is provided in the outpatient setting; however, the number of hospitalizations for ARF and chronic kidney failure (CKF) is substantial. In 2004, an estimated 221,000 hospitalizations with a first-listed discharge diagnosis of ARF and 19,000 with a first-listed discharge diagnosis of CKF occurred in the United States. To characterize national trends in kidney disease hospitalizations, CDC analyzed data from the National Hospital Discharge Survey (NHDS) for the period 1980-2005. This report summarizes the results of that analysis, which indicated that 1) numbers and rates of kidney disease hospital discharge diagnoses have increased since the early 1990s, especially among adults aged > or =65 years; 2) a shift has occurred in the type of kidney disease accounting for most of these reported hospitalizations (from CKF to ARF); and 3) an increasing number of kidney disease hospital discharges are associated with a concomitant diagnosis of diabetes mellitus or hypertension. These findings indicate a need for additional research to determine the cause of the increase in ARF discharge diagnoses and to quantify the progression from ARF to CKD and ESRD.     

Deaths due to unknown foodborne agents

This study reviews the available evidence on unknown pathogenic agents transmitted in food and examines the methods that have been used to estimate that such agents cause 3,400 deaths per year in the United States. The estimate of deaths was derived from hospital discharge and death certificate data on deaths attributed to gastroenteritis of unknown cause. Fatal illnesses due to unknown foodborne agents do not always involve gastroenteritis, and gastroenteritis may not be accurately diagnosed or reported on hospital charts or death certificates. The death estimate consequently omitted deaths from unknown foodborne agents that do not cause gastroenteritis and likely overstated the number of deaths from agents that cause gastroenteritis. Although the number of deaths from unknown foodborne agents is uncertain, the possible economic cost of these deaths is so large that increased efforts to identify the causal agents are warranted.     

Disease risks from foods, England and Wales, 1996-2000

Data from population-based studies and national surveillance systems were collated and analyzed to estimate the impact of disease and risks associated with eating different foods in England and Wales. From 1996 to 2000, an estimated 1,724,315 cases of indigenous foodborne disease per year resulted in 21,997 hospitalizations and 687 deaths. The greatest impact on the healthcare sector arose from foodborne Campylobacter infection (160,788 primary care visits and 15,918 hospitalizations), while salmonellosis caused the most deaths (209). The most important cause of indigenous foodborne disease was contaminated chicken (398,420 cases, risk [cases/million servings] = 111; case-fatality rate [deaths/100,000 cases] = 35, deaths = 141). Red meat (beef, lamb, and pork) contributed heavily to deaths, despite lower levels of risk (287,485 cases, risk = 24, case-fatality rate = 57, deaths = 164). Reducing the impact of indigenous foodborne disease is mainly dependent on controlling the contamination of chicken.