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Review
. 2015 Dec 3;12(12):e1001921.
doi: 10.1371/journal.pmed.1001921. eCollection 2015 Dec.

World Health Organization Estimates of the Global and Regional Disease Burden of 22 Foodborne Bacterial, Protozoal, and Viral Diseases, 2010: A Data Synthesis

Martyn D Kirk  1 , Sara M Pires  2 , Robert E Black  3 , Marisa Caipo  4 , John A Crump  5 , Brecht Devleesschauwer  6   7   8 , Dörte Döpfer  9 , Aamir Fazil  10 , Christa L Fischer-Walker  3 , Tine Hald  2 , Aron J Hall  11 , Karen H Keddy  12 , Robin J Lake  13 , Claudio F Lanata  14   15 , Paul R Torgerson  16 , Arie H Havelaar  17   18   19 , Frederick J Angulo  1   11
Affiliations
Review

World Health Organization Estimates of the Global and Regional Disease Burden of 22 Foodborne Bacterial, Protozoal, and Viral Diseases, 2010: A Data Synthesis

Martyn D Kirk et al. PLoS Med. .

Erratum in

Abstract

Background: Foodborne diseases are important worldwide, resulting in considerable morbidity and mortality. To our knowledge, we present the first global and regional estimates of the disease burden of the most important foodborne bacterial, protozoal, and viral diseases.

Methods and findings: We synthesized data on the number of foodborne illnesses, sequelae, deaths, and Disability Adjusted Life Years (DALYs), for all diseases with sufficient data to support global and regional estimates, by age and region. The data sources included varied by pathogen and included systematic reviews, cohort studies, surveillance studies and other burden of disease assessments. We sought relevant data circa 2010, and included sources from 1990-2012. The number of studies per pathogen ranged from as few as 5 studies for bacterial intoxications through to 494 studies for diarrheal pathogens. To estimate mortality for Mycobacterium bovis infections and morbidity and mortality for invasive non-typhoidal Salmonella enterica infections, we excluded cases attributed to HIV infection. We excluded stillbirths in our estimates. We estimate that the 22 diseases included in our study resulted in two billion (95% uncertainty interval [UI] 1.5-2.9 billion) cases, over one million (95% UI 0.89-1.4 million) deaths, and 78.7 million (95% UI 65.0-97.7 million) DALYs in 2010. To estimate the burden due to contaminated food, we then applied proportions of infections that were estimated to be foodborne from a global expert elicitation. Waterborne transmission of disease was not included. We estimate that 29% (95% UI 23-36%) of cases caused by diseases in our study, or 582 million (95% UI 401-922 million), were transmitted by contaminated food, resulting in 25.2 million (95% UI 17.5-37.0 million) DALYs. Norovirus was the leading cause of foodborne illness causing 125 million (95% UI 70-251 million) cases, while Campylobacter spp. caused 96 million (95% UI 52-177 million) foodborne illnesses. Of all foodborne diseases, diarrheal and invasive infections due to non-typhoidal S. enterica infections resulted in the highest burden, causing 4.07 million (95% UI 2.49-6.27 million) DALYs. Regionally, DALYs per 100,000 population were highest in the African region followed by the South East Asian region. Considerable burden of foodborne disease is borne by children less than five years of age. Major limitations of our study include data gaps, particularly in middle- and high-mortality countries, and uncertainty around the proportion of diseases that were foodborne.

Conclusions: Foodborne diseases result in a large disease burden, particularly in children. Although it is known that diarrheal diseases are a major burden in children, we have demonstrated for the first time the importance of contaminated food as a cause. There is a need to focus food safety interventions on preventing foodborne diseases, particularly in low- and middle-income settings.

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Conflict of interest statement

The findings and conclusions of this report are those of the authors and do not necessarily represent the official views, decisions or policies of the World Health Organization, US Centers for Disease Control and Prevention, the Department of the Navy, Department of Defense, the US Government or other institutions listed. CFL, AJH, and FJA are employees of the US Government. MDK, REB, MC, BD, DD, AF, TH, KHK, RL, CFL, PRT, AHH, and FJA serve as members of the World Health Organization advisory body—the Foodborne Disease Epidemiology Reference Group—without remuneration. MDK is a member of the Editorial Board for PLOS ONE. PRT is a member of the Editorial Board for PLOS Neglected Tropical Diseases.

Figures

Fig 1
Fig 1. Disability Adjusted Life Years for each pathogen acquired from contaminated food ranked from lowest to highest with 95% Uncertainty Intervals, 2010.
Note figure is on a logarithmic scale. The figure shows the median (white dot); Inter-Quartile Range = 50%UI = 25%/75% percentiles (thick black line); 90% UI = 5%/95% percentiles (thin black line); 95% UI = 2.5%/97.5% percentiles (thin grey line). Note, figure does not include four foodborne intoxications due to Clostridium botulinum, C. perfringens, S. aureus, and Bacillus cereus due to a lack of data for global estimation. In addition, data for non-typhoidal Salmonella enterica infections and invasive non-typhoidal S. enterica have been combined.
See this image and copyright information in PMC

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Publication types

Grants and funding

This study was commissioned and paid for by the World Health Organization (WHO). Copyright in the original work on which this article is based belongs to WHO. The authors have been given permission to publish this article. We acknowledge the support from the Bill & Melinda Gates Foundation that funded CFL, CFW, and REB through the Child Health Epidemiology Reference Group (CHERG). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.