Each year, unspecified agents caused an estimated 38.4 million episodes of illness, resulting in 71,878 hospitalizations and 1,686 deaths.
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).
Food poisoning; gastroenteritis; diarrhea; population surveillance; incidence estimates; United States; epidemiology; bacteria; viruses; research
Each year, 31 pathogens caused 9.4 million episodes of foodborne illness, resulting in 55,961 hospitalizations and 1,351 deaths.
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 poisoning; gastroenteritis; diarrhea; population surveillance; incidence estimates; norovirus; viruses; bacteria; United States; research
Each year, >9 million foodborne illnesses are estimated to be caused by major pathogens acquired in the United States. Preventing these illnesses is challenging because resources are limited and linking individual illnesses to a particular food is rarely possible except during an outbreak. We developed a method of attributing illnesses to food commodities that uses data from outbreaks associated with both simple and complex foods. Using data from outbreak-associated illnesses for 1998–2008, we estimated annual US foodborne illnesses, hospitalizations, and deaths attributable to each of 17 food commodities. We attributed 46% of illnesses to produce and found that more deaths were attributed to poultry than to any other commodity. To the extent that these estimates reflect the commodities causing all foodborne illness, they indicate that efforts are particularly needed to prevent contamination of produce and poultry. Methods to incorporate data from other sources are needed to improve attribution estimates for some commodities and agents.
foodborne infections; epidemiology; Salmonella; Shiga toxin–producing Escherichia coli; bacteria; salmonella; E. coli; United States; outbreak data; plans; animals; commodities; commodity groups; food; foodborne illnesses; contamination
TOC summary: These infections may account for 896 disability-adjusted life years per 1 million inhabitants annually.
The public health effects of illness caused by foodborne pathogens in Greece during 1996–2006 was quantified by using publicly available surveillance data, hospital statistics, and literature. Results were expressed as the incidence of different disease outcomes and as disability-adjusted life years (DALY), a health indicator combining illness and death estimates into a single metric. It has been estimated that each year ≈370,000 illnesses/million inhabitants are likely caused because of eating contaminated food; 900 of these illnesses are severe and 3 fatal, corresponding to 896 DALY/million inhabitants. Ill-defined intestinal infections accounted for the greatest part of reported cases and 27% of the DALY. Brucellosis, echinococcosis, salmonellosis, and toxoplasmosis were found to be the most common known causes of foodborne illnesses, being responsible for 70% of the DALY. Overall, the DALY metric provided a quantitative perspective on the impact of foodborne illness that may be useful for prioritizing food safety management targets.
enteric infections; parasites; bacteria; foodborne disease; disability-adjusted life year; DALY; risk ranking; food safety management; Greece; synopsis
The number of U.S. deaths by unknown foodborne agents warrants additional efforts to identify causal agent.
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.
mortality; cause of death; infection; gastroenteritis; United States; perspective
To assess the relationship between emergency department (ED) and urgent care center (UCC) chief complaint data for gastrointestinal (GI) illness and reported norovirus (NV) outbreaks to develop an early warning tool for NV outbreak activity. The tool will provide an indicator of increasing NV outbreak activity in the community allowing for earlier public health action to mitigate NV outbreaks.
Norovirus infection results in considerable morbidity in the United States where an estimated 21 million illnesses, 70,000 hospitalizations, and 800 deaths are caused by NV annually (1). Additionally, NV is responsible for approximately 50% of foodborne outbreaks (1). Between January 2008 and June 2012, 875 NV outbreaks were reported to the Virginia Department of Health (VDH). To assist in detecting possible disease outbreaks such as NV, VDH utilizes the web-based Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE) to monitor and detect public health events across Virginia. ESSENCE performs automated parsing of chief complaint text into 10 syndrome categories, including a non-specific GI syndrome that serves as a proxy for GI illnesses like NV.
ED and UCC chief complaints parsed into the ESSENCE GI syndrome category were compared to confirmed and suspected NV outbreaks across four years. In this study, the analysis periods were defined as week 21 through week 20 of the subsequent year. GI syndrome visits as a proportion of all ED and UCC visits and NV outbreak counts were aggregated by week. Time-series, correlation, and logistic regression analyses were performed. Low NV outbreak activity weeks were defined as those with 4 or fewer outbreaks, and high NV outbreak activity weeks were those with 5 or more outbreaks. Based on low NV outbreak activity weeks, baseline and threshold values for the weekly percent of GI syndrome visits were calculated for each analysis period. Baseline calculation was the average weekly percent of GI syndrome visits from week 21 to week 31 and threshold value was baseline plus two standard deviations. Weekly percent of GI syndrome visits was compared to the threshold value to serve as an indicator of increasing NV outbreak activity.
The study period was from May 18, 2008 to May 19, 2012 (Fig 1). A total of 1,425,728 GI syndrome visits and 804 confirmed and suspected NV outbreaks were analyzed. Weekly visits to ED and UCC facilities with GI syndrome were highly correlated with outbreaks of NV in the community (r =0.809, p <.0001). Median and mean number of NV outbreaks per week were 2 and 4, respectively (range 0–23). NV outbreaks were more prominent during the winter months with peaks occurring between weeks 3–9. Median and mean percent of GI syndrome visits per week were 10.2% and 10.5%, respectively (range 8.9%–12.8%). Weeks with high NV outbreak activity were more likely to occur when the weekly percent of GI syndrome visits had surpassed the threshold value (OR =110.7, 95% CI: 31.9–384.8). On average, weekly percent of GI syndrome visits surpassed the threshold value 1.25 weeks prior to the start of high NV outbreak activity weeks (range 0–3).
These results support the use of syndromic surveillance GI illness data as an early warning indicator of increasing NV outbreak activity in Virginia. This study identified that GI syndrome visits crossed a calculated threshold value on average 1.25 weeks before the initiation of high NV outbreak activity. Although NV outbreaks occur year round, this study attempted to identify an indicator to trigger meaningful risk communication to the community immediately prior to high NV outbreak activity with the goal of reducing the magnitude of NV outbreaks. This early warning tool for NV outbreak activity will be implemented in the following year to validate its effectiveness and timeliness in mitigating NV outbreaks in Virginia.
Percent of Emergency Department and Urgent Care Center Visits with GI Syndrome and Reported Norovirus Outbreaks, Virginia, May 2008-May 2012.
Syndromic surveillance; ESSENCE; Norovirus; GI illness
A total of 12 federal agencies, plus their state counterparts, contribute to the regulatory snarl that governs the safety of the American food supply. With so much federal oversight, one might expect U.S. foods to be virtually risk-free. But this is hardly the case; contaminated food is responsible for 75 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year. Recent reports from the General Accounting Office and the National Research Council claim that creation of a single agency with centralized authority is the best solution to U.S. food safety problems. Some experts agree that regulatory gaps in food safety highlight the need for centralized leadership, and that more money is necessary to fund the number of inspectors needed to adequately inspect the food supply before it reaches consumers. The single-agency concept has garnered congressional, industry, and scientific support, but the idea isn't without its skeptics, who believe that consolidating food safety under a single agency eliminates checks and balances offered by the current system and, more importantly, runs the risk of politicizing the agency.
During 2009–2010, a total of 1,527 foodborne disease outbreaks were reported by the Centers for Disease Control and Prevention (CDC) (2013). However, in a 2011 CDC report, Scallan et al. estimated about 48 million people contract a foodborne illness annually in the United States. Public health officials are concerned with this under-reporting; thus, the purpose of this study was to identify why consumers and healthcare professionals don’t report foodborne illness. Focus groups were conducted with 35 consumers who reported a previous experience with foodborne illness and with 16 healthcare professionals. Also, interviews with other healthcare professionals with responsibility of diagnosing foodborne illness were conducted. Not knowing who to contact, being too ill, being unsure of the cause, and believing reporting would not be beneficial were all identified by consumers as reasons for not reporting foodborne illness. Healthcare professionals that participated in the focus groups indicated the amount of time between patients’ consumption of food and seeking treatment and lack of knowledge were barriers to diagnosing foodborne illness. Issues related to stool samples such as knowledge, access and cost were noted by both groups. Results suggest that barriers identified could be overcome with targeted education and improved access and information about the reporting process.
foodborne illness; diagnosis; healthcare professional; consumer
Foodborne illnesses caused by microbial and chemical contaminants in food are a substantial health burden worldwide. In 2007, human vibriosis (non-cholera Vibrio infections) became a notifiable disease in the United States. In addition, Vibrio species are among the 31 major known pathogens transmitted through food in the United States. Diverse surveillance systems for foodborne pathogens also track outbreaks, illnesses, hospitalization and deaths due to non-cholera vibrios. Considering the recognition of vibriosis as a notifiable disease in the United States and the availability of diverse surveillance systems, there is a need for the development of easily deployed visualization and analysis approaches that can combine diverse data sources in an interactive manner. Current efforts to address this need are still limited. Visual analytics is an iterative process conducted via visual interfaces that involves collecting information, data preprocessing, knowledge representation, interaction, and decision making. We have utilized public domain outbreak and surveillance data sources covering 1973 to 2010, as well as visual analytics software to demonstrate integrated and interactive visualizations of data on foodborne outbreaks and surveillance of Vibrio species. Through the data visualization, we were able to identify unique patterns and/or novel relationships within and across datasets regarding (i) causative agent; (ii) foodborne outbreaks and illness per state; (iii) location of infection; (iv) vehicle (food) of infection; (v) anatomical site of isolation of Vibrio species; (vi) patients and complications of vibriosis; (vii) incidence of laboratory-confirmed vibriosis and V. parahaemolyticus outbreaks. The additional use of emerging visual analytics approaches for interaction with data on vibriosis, including non-foodborne related disease, can guide disease control and prevention as well as ongoing outbreak investigations.
bioinformatics; data visualization; foodborne diseases; human-computer interaction; surveillance; Vibrio species; visual analytics
Although recognized as the leading cause of epidemic acute gastroenteritis across all age groups, norovirus has remained poorly characterized with respect to its endemic disease incidence. Use of different methods, including attributable proportion extrapolation, population-based surveillance, and indirect modeling, in several recent studies has considerably improved norovirus disease incidence estimates for the United States. Norovirus causes an average of 570–800 deaths, 56,000–71,000 hospitalizations, 400,000 emergency department visits, 1.7–1.9 million outpatient visits, and 19–21 million total illnesses per year. Persons >65 years of age are at greatest risk for norovirus-associated death, and children <5 years of age have the highest rates of norovirus-associated medical care visits. Endemic norovirus disease occurs year round but exhibits a pronounced winter peak and increases by ≤50% during years in which pandemic strains emerge. These findings support continued development and targeting of appropriate interventions, including vaccines, for norovirus disease.
norovirus; viruses; incidence; norovirus disease; epidemic acute gastroenteritis; United States
Analysis of foodborne outbreaks shows how advances in viral diagnostics are clarifying the causes of foodborne outbreaks and determining the high impact of norovirus infections.
Efforts to prevent foodborne illness target bacterial pathogens, yet noroviruses (NoV) are suspected to be the most common cause of gastroenteritis. New molecular assays allow for better estimation of the role of NoV in foodborne illness. We analyzed 8,271 foodborne outbreaks reported to the Centers for Disease Control and Prevention from 1991 to 2000 and additional data from 6 states. The proportion of NoV-confirmed outbreaks increased from 1% in 1991 to 12% in 2000. However, from 1998 to 2000, 76% of NoV outbreaks were reported by only 11 states. In 2000, an estimated 50% of foodborne outbreaks in 6 states were attributable to NoV. NoV outbreaks were larger than bacterial outbreaks (median persons affected: 25 versus 15), and 10% of affected persons sought medical care; 1% were hospitalized. More widespread use of molecular assays will permit better estimates of the role of NoV illness and help direct efforts to control foodborne illness.
research; food; norovirus; disease outbreaks; burden of illness
To document and assess the variation in state legislation relating to foodborne disease surveillance and outbreak response for all 50 states and the District of Columbia by creating a database and appendix of laws and regulations that will be made available to researchers and policymakers.
Foodborne illnesses sicken 48 million and kill 3,000 Americans every year, presenting an enduring threat to the public’s health. In just the past three years alone, the United States has experienced at least four major multistate outbreaks in food. Despite this growing problem, efforts to prevent foodborne illness pose a particular public health challenge due in part to the widely variable laws governing foodborne illness surveillance and outbreak response. The recent passage of the Food Safety Modernization Act (FSMA) presents an opportunity for researchers, program managers, and policy makers to assess and correct the legal barriers that may hinder states in effectively implementing the FSMA’s vision with regard to increased state and local capacity for surveillance and outbreak response.
We conducted a systematic review and analysis of laws and regulations relating to foodborne illness surveillance and outbreak response in all 50 states and the District of Columbia, using the following methods: (1) we created a database to record state laws and regulations relating to foodborne illness surveillance and outbreak response in all 50 states and the District of Columbia; (2) we conducted a basic gap analysis of state foodborne illness surveillance and outbreak response laws and policies collected in the database; and (3) we conducted case study analyses of previous multistate outbreaks from 2008–2011.
Through compilation of the state foodborne illness surveillance and outbreak response laws and regulations and analysis of previous multistate outbreaks, we are able to present trends, variations, and gaps in the legislation that directly impacts the ability of public health officials to conduct foodborne outbreak investigations. We also present policy recommendations for strengthening state laws and regulations.
Surveillance; Foodborne disease; Outbreak response; Public health law; Legal preparedness
An estimated 4.0–6.9 million episodes of foodborne gastroenteritis occur in Australia each year.
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 ≈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.
Keywords: gastroenteritis; foodborne; burden; uncertainty
Few data exist about perceptions regarding the etiology of foodborne illness. Among public health staff throughout Tennessee, the three pathogens most commonly believed to cause foodborne illness in the United States actually account for only 12% of disease. Fewer than 3% of respondents correctly identified the leading cause of foodborne illness.
We estimated the possible effects of the next influenza pandemic in the United States and analyzed the economic impact of vaccine-based interventions. Using death rates, hospitalization data, and outpatient visits, we estimated 89,000 to 207,000 deaths; 314,000 to 734,000 hospitalizations; 18 to 42 million outpatient visits; and 20 to 47 million additional illnesses. Patients at high risk (15% of the population) would account for approximately 84% of all deaths. The estimated economic impact would be US$71.3 to $166.5 billion, excluding disruptions to commerce and society. At $21 per vaccinee, we project a net savings to society if persons in all age groups are vaccinated. At $62 per vaccinee and at gross attack rates of 25%, we project net losses if persons not at high risk for complications are vaccinated. Vaccinating 60% of the population would generate the highest economic returns but may not be possible within the time required for vaccine effectiveness, especially if two doses of vaccine are required.
Outbreak investigations can identify industrial gaps and regulatory measures to protect food.
Listeria monocytogenes, a bacterial foodborne pathogen, can cause meningitis, bacteremia, and complications during pregnancy. This report summarizes listeriosis outbreaks reported to the Foodborne Disease Outbreak Surveillance System of the Centers for Disease Control and Prevention during 1998–2008. The study period includes the advent of PulseNet (a national molecular subtyping network for outbreak detection) in 1998 and the Listeria Initiative (enhanced surveillance for outbreak investigation) in 2004. Twenty-four confirmed listeriosis outbreaks were reported during 1998–2008, resulting in 359 illnesses, 215 hospitalizations, and 38 deaths. Outbreaks earlier in the study period were generally larger and longer. Serotype 4b caused the largest number of outbreaks and outbreak-associated cases. Ready-to-eat meats caused more early outbreaks, and novel vehicles (i.e., sprouts, taco/nacho salad) were associated with outbreaks later in the study period. These changes may reflect the effect of PulseNet and the Listeria Initiative and regulatory initiatives designed to prevent contamination in ready-to-eat meat and poultry products.
foodborne illness; food vehicles; outbreaks; listeriosis; bacteria; Listeria monocytogenes; United States
To date, little has been written about the implementation of utilizing food safety informatics as a technological tool to protect consumers, in real-time, against foodborne illnesses. Food safety outbreaks have become a major public health problem, causing an estimated 48 million illnesses, 128,000 hospitalizations, and 3,000 deaths in the U.S. each year. Yet, government inspectors/regulators that monitor foodservice operations struggle with how to collect, organize, and analyze data; implement, monitor, and enforce safe food systems. Currently, standardized technologies have not been implemented to efficiently establish “near-in-time” or “just-in-time” electronic awareness to enhance early detection of public health threats regarding food safety. To address the potential impact of collection, organization and analyses of data in a foodservice operation, a wireless food safety informatics (FSI) tool was pilot tested at a university student foodservice center. The technological platform in this test collected data every six minutes over a 24 hour period, across two primary domains: time and temperatures within freezers, walk-in refrigerators and dry storage areas. The results of this pilot study briefly illustrated how technology can assist in food safety surveillance and monitoring by efficiently detecting food safety abnormalities related to time and temperatures so that efficient and proper response in “real time” can be addressed to prevent potential foodborne illnesses.
foodborne illness; surveillance; technology
Estimates of foodborne illness are important for setting food safety priorities and making public health policies. The objective of this analysis is to estimate domestically acquired, foodborne illness in Canada, while identifying data gaps and areas for further research. Estimates of illness due to 30 pathogens and unspecified agents were based on data from the 2000–2010 time period from Canadian surveillance systems, relevant international literature, and the Canadian census population for 2006. The modeling approach required accounting for under-reporting and underdiagnosis and to estimate the proportion of illness domestically acquired and through foodborne transmission. To account for uncertainty, Monte Carlo simulations were performed to generate a mean estimate and 90% credible interval. It is estimated that each year there are 1.6 million (1.2–2.0 million) and 2.4 million (1.8–3.0 million) episodes of domestically acquired foodborne illness related to 30 known pathogens and unspecified agents, respectively, for a total estimate of 4.0 million (3.1–5.0 million) episodes of domestically acquired foodborne illness in Canada. Norovirus, Clostridium perfringens, Campylobacter spp., and nontyphoidal Salmonella spp. are the leading pathogens and account for approximately 90% of the pathogen-specific total. Approximately one in eight Canadians experience an episode of domestically acquired foodborne illness each year in Canada. These estimates cannot be compared with prior crude estimates in Canada to assess illness trends as different methodologies were used.
To estimate the global illness and deaths caused by rotavirus disease, we reviewed studies published from 1986 to 2000 on deaths caused by diarrhea and on rotavirus infections in children. We assessed rotavirus-associated illness in three clinical settings (mild cases requiring home care alone, moderate cases requiring a clinic visit, and severe cases requiring hospitalization) and death rates in countries in different World Bank income groups. Each year, rotavirus causes approximately 111 million episodes of gastroenteritis requiring only home care, 25 million clinic visits, 2 million hospitalizations, and 352,000–592,000 deaths (median, 440,000 deaths) in children <5 years of age. By age 5, nearly every child will have an episode of rotavirus gastroenteritis, 1 in 5 will visit a clinic, 1 in 60 will be hospitalized, and approximately 1 in 293 will die. Children in the poorest countries account for 82% of rotavirus deaths. The tremendous incidence of rotavirus disease underscores the urgent need for interventions, such as vaccines, to prevent childhood deaths in developing nations.
diarrhea; rotavirus; mortality; deaths; morbidity; hospitalizations; disease burden; research
Diarrheal illness remains 1 of the top 5 causes of death in low-income and middle-income countries, especially for children <5 years of age. Introduction of universal childhood vaccination against rotaviruses has greatly reduced the incidence and severity of illness in upper-income and lower-income settings. For adults, norovirus is the leading cause of sporadic cases and outbreaks of diarrheal illness and is responsible for nearly 21 million episodes annually in the United States, of which 5.5 million are foodborne. Public health efforts to control and prevent norovirus illness have focused on rapid outbreak detection and source identification and control of transmission in institutional settings.
norovirus; rotavirus; viruses; foodborne illness; viral gastroenteritis; enteric infections; prevention; control; perspective
A demographic shift towards a larger proportion of elderly in the Dutch population in the coming decades might change foodborne disease incidence and mortality. In the current study we focused on the age-specific changes in the occurrence of foodborne pathogens by combining age-specific demographic forecasts for 10-year periods between 2020 and 2060 with current age-specific infection probabilities for Campylobacter spp., non-typhoidal Salmonella, hepatitis A virus, acquired Toxoplasma gondii and Listeria monocytogenes. Disease incidence rates for the former three pathogens were estimated to change marginally, because increases and decreases in specific age groups cancelled out over all ages. Estimated incidence of reported cases per 100,000 for 2060 mounted to 12 (Salmonella), 51 (Campylobacter), 1.1 (hepatitis A virus) and 2.1 (Toxoplasma). For L. monocytogenes, incidence increased by 45% from 0.41 per 100,000 in 2011 to 0.60 per 100,000. Estimated mortality rates increased two-fold for Salmonella and Campylobacter to 0.5 and 0.7 per 100,000, and increased by 25% for Listeria from 0.06 to 0.08. This straightforward scoping effort does not suggest major changes in incidence and mortality for these food borne pathogens based on changes in de population age-structure as independent factor. Other factors, such as changes in health care systems, social clustering and food processing and preparation, could not be included in the estimates.
incidence; mortality; future; ageing; The Netherlands; Salmonella spp.; Campylobacter spp.; Listeria monocytogenes; Toxoplasma gondii; hepatitis A virus
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.
Surveillance was enhanced and a retrospective interview study performed in 1998-99 to determine incidence, causes, and costs of foodborne illnesses in Uppsala, Sweden. Sixty-eight percent of the detected foodborne illness incidents were single cases, and 32% were outbreaks. Most (85%) of the incidents came to the attention of the municipal authorities through telephone calls from affected persons. Calicivirus, Campylobacter spp., and Staphyloccocus aureus were the most common etiological agents; meat, meat products, and mixed dishes were the most implicated food categories. The incidence of foodborne illness was estimated to be 38 cases per 1,000 inhabitants per year. The estimated average costs per illness were 2,164 Swedish Krona (SEK) ($246) to society and 500 SEK ($57) to the patient. The annual cost of foodborne illnesses in Sweden was estimated to be 1,082 million SEK ($123 million).
Fifteen million strokes occur worldwide each year with 5 million associated deaths and an additional 5 million people left permanently disabled. In the United States, about 780 000 people suffer a new or recurrent stroke each year. There were an estimated total 5.8 million stroke survivors as of 2008. Mortality from stroke is the third leading cause of death in America following heart disease and cancer. Chest infection may affect up to as many as one-third of stroke patients. This increases the morbidity and mortality of this patient population. Pneumonia causes the highest attributable mortality of all medical complications following stroke. A comprehensive multidisciplinary team approach is required at the hospital level. This requires active administrative commitment and participation. Implementation of evidence-based management strategies can improve outcomes and reduce costs. We sought to review the problem of post-stroke pneumonia and discuss strategies for prevention and intervention.
stroke; pneumonia; aspiration
Prion diseases are a family of rare, progressive, neurodegenerative disorders that affect humans and animals. The most common form of human prion disease, Creutzfeldt-Jakob disease (CJD), occurs worldwide. Variant CJD (vCJD), a recently emerged human prion disease, is a zoonotic foodborne disorder that occurs almost exclusively in countries with outbreaks of bovine spongiform encephalopathy.
This study describes the occurrence and epidemiology of CJD and vCJD in the United States.
Analysis of CJD and vCJD deaths using death certificates of US residents for 1979–2006, and those identified through other surveillance mechanisms during 1996–2008. Since CJD is invariably fatal and illness duration is usually less than one year, the CJD incidence is estimated as the death rate. During 1979 through 2006, an estimated 6,917 deaths with CJD as a cause of death were reported in the United States, an annual average of approximately 247 deaths (range 172–304 deaths). The average annual age-adjusted incidence for CJD was 0.97 per 1,000,000 persons. Most (61.8%) of the CJD deaths occurred among persons ≥65 years of age for an average annual incidence of 4.8 per 1,000,000 persons in this population. Most deaths were among whites (94.6%); the age-adjusted incidence for whites was 2.7 times higher than that for blacks (1.04 and 0.40, respectively). Three patients who died since 2004 were reported with vCJD; epidemiologic evidence indicated that their infection was acquired outside of the United States.
Surveillance continues to show an annual CJD incidence rate of about 1 case per 1,000,000 persons and marked differences in CJD rates by age and race in the United States. Ongoing surveillance remains important for monitoring the stability of the CJD incidence rates, and detecting occurrences of vCJD and possibly other novel prion diseases in the United States.