Disease burden of foodborne pathogens in the Netherlands, 2009

https://doi.org/10.1016/j.ijfoodmicro.2012.03.029Get rights and content

Abstract

To inform risk management decisions on control, prevention and surveillance of foodborne disease, the disease burden of foodborne pathogens is estimated using Disability Adjusted Life Years as a summary metric of public health. Fourteen pathogens that can be transmitted by food are included in the study (four infectious bacteria, three toxin-producing bacteria, four viruses and three protozoa). Data represent the burden in the Netherlands in 2009. The incidence of community-acquired non-consulting cases, patients consulting their general practitioner, those admitted to hospital, as well as the incidence of sequelae and fatal cases is estimated using surveillance data, cohort studies and published data. Disease burden includes estimates of duration and disability weights for non-fatal cases and loss of statistical life expectancy for fatal cases. Results at pathogen level are combined with data from an expert survey to assess the fraction of cases attributable to food, and the main food groups contributing to transmission.

Among 1.8 million cases of disease (approx. 10,600 per 100,000) and 233 deaths (1.4 per 100,000) by these fourteen pathogens, approximately one-third (680,000 cases; 4100 per 100,000) and 78 deaths (0.5 per 100,000) are attributable to foodborne transmission. The total burden is 13,500 DALY (82 DALY per 100,000). On a population level, Toxoplasma gondii, thermophilic Campylobacter spp., rotaviruses, noroviruses and Salmonella spp. cause the highest disease burden. The burden per case is highest for perinatal listeriosis and congenital toxoplasmosis. Approximately 45% of the total burden is attributed to food. T. gondii and Campylobacter spp. appear to be key targets for additional intervention efforts, with a focus on food and environmental pathways. The ranking of foodborne pathogens based on burden is very different compared to when only incidence is considered. The burden of acute disease is a relatively small part of the total burden. In the Netherlands, the burden of foodborne pathogens is similar to the burden of upper respiratory and urinary tract infections.

Highlights

► DALYs are proposed for risk ranking of foodborne pathogens. ► The burden of T. gondii and Campylobacter spp. is highest in the population. ► The burden of Listeria spp. and T. gondii is highest for individuals. ► Foodborne accounts for approximately half of the total disease burden. ► Foods of animal origin cause two-thirds of the burden by foods.

Introduction

Foodborne diseases encompass acute and chronic syndromes of widely different duration and severity as well as mortality caused by a multitude of hazards. Risk-based food safety management requires a consistent, quantitative assessment of the relative public health importance of foodborne diseases. Currently, statistics on the public health impact of foodborne diseases focus on the burden of illness in a population, i.e. the incidence of non-fatal illness and of fatal cases (Adak et al., 2002, Scallan et al., 2011b). Burden of disease metrics, such as the Disability Adjusted Life Year (DALY) integrate incidence data with indices of severity and duration (Murray et al., 2002). This facilitates comparison between diseases. Since its use in the groundbreaking Global Burden of Disease (GBD) study (Murray and Lopez, 1996), the DALY has gained wide adherence, aiding national and international decision making processes, including in the domain of foodborne diseases (Batz et al., 2011, Gkogka et al., 2011, Lake et al., 2010).

Assessing the burden of foodborne disease is complex because many different pathogens can be transmitted by food, leading to widely different health outcomes. Furthermore, these pathogens cannot only be transmitted by food but also by other pathways. The objective of this study was therefore to:

  • a)

    Quantify the incidence in the community and the burden (DALY) of pathogens that can be transmitted by food for the Netherlands; and

  • b)

    Estimate the fraction of (fatal and non-fatal) cases and DALY transmitted in the Netherlands by five major pathways (including food) and by eleven food groups.

Results will allow policy makers to quantitatively rank different foodborne pathogens at the population and individual level and are of interest to risk assessors as well as risk managers in governments and industry.

Section snippets

Pathogens

We evaluate seven pathogens causing infectious gastroenteritis (GE), including three bacteria (thermophilic Campylobacter spp., Shiga-toxin producing Escherichia coli O157 (STEC O157), non-typhoidal Salmonella spp.), two viruses (norovirus and rotavirus) and two protozoa (Cryptosporidium spp., Giardia spp.); three GE toxin-producing bacteria (Bacillus cereus, Clostridium perfringens and Staphylococcus aureus), and four pathogens causing systemic infections (Listeria monocytogenes, hepatitis A

Disease incidence

Table 1 presents the incidence estimates for GE per pathogen in the Netherlands for the year 2009, according to health care usage. There were approximately 4.8 million cases of gastroenteritis (290 per 1000 person years), leading to 220,000 GP visits (13 per 1000 pyr) and 22,000 hospitalisations (1.3 per 1000 pyr). The 10 GE pathogens included in this study explained 44% of all cases of GE at the population level, 71% of all cases at GP level, and 44% of hospitalised cases. By far the highest

Discussion

This study provides an integrated public health perspective on the burden of foodborne disease in the Netherlands. The burden of fourteen food-related pathogens and their sequelae in the Netherlands was approximately 13,500 DALY in 2009, lower than the burden of pneumonia (72,000) but similar to urinary tract infections (15,600) and upper respiratory infections (10,100).2

Acknowledgements

The authors are grateful to the members of the supervisory committee who provided valuable feedback during this project: Gouke Bonsel, Erwin Duizer, Arjen van de Giessen, Joke van der Giessen, Martin Gommer, Marion Koopmans, Rob van Oosterom, Ana-Maria de Roda-Husman, Inge Stoelhorst, Gijs Theunissen and Ardine de Wit. They also thank Agnetha Hofhuis for supplying raw data from their studies.

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