title: World Health Organization Estimates of the Global and Regional Disease Burden of 22 Foodborne Bacterial, Protozoal, and Viral Diseases, 2010: A Data Synthesis.
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.
  
  
  RESULTS
  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.
authors.affiliation: The Australian National University, Canberra, Australia.
authors.forename: Martyn D
authors.initials: MD
authors.lastname: Kirk
authors.affiliation: Danish Technical University, Copenhagen, Denmark.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Pires
authors.affiliation: Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.affiliation: Food and Agriculture Organization, Rome, Italy.
authors.forename: Marisa
authors.initials: M
authors.lastname: Caipo
authors.affiliation: Centre for International Health, University of Otago, Dunedin, New Zealand.
authors.forename: John A
authors.initials: JA
authors.lastname: Crump
authors.affiliation: Ghent University, Merelbeke, Belgium.|Université catholique de Louvain, Brussels, Belgium.|Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Brecht
authors.initials: B
authors.lastname: Devleesschauwer
authors.affiliation: University of Wisconsin, Madison, Madison, Wisconsin, United States of America.
authors.forename: Dörte
authors.initials: D
authors.lastname: Döpfer
authors.affiliation: Public Health Agency of Canada, Guelph, Ontario, Canada.
authors.forename: Aamir
authors.initials: A
authors.lastname: Fazil
authors.affiliation: Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Christa L
authors.initials: CL
authors.lastname: Fischer-Walker
authors.affiliation: Danish Technical University, Copenhagen, Denmark.
authors.forename: Tine
authors.initials: T
authors.lastname: Hald
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Aron J
authors.initials: AJ
authors.lastname: Hall
authors.affiliation: Centre for Enteric Diseases, National Institute for Communicable Diseases, and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Karen H
authors.initials: KH
authors.lastname: Keddy
authors.affiliation: Institute of Environmental Science and Research, Christchurch, New Zealand.
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Lake
authors.affiliation: Instituto de Investigación Nutricional, Lima, Peru.|US Naval Medical Research Unit No. 6, Callao, Peru.
authors.forename: Claudio F
authors.initials: CF
authors.lastname: Lanata
authors.affiliation: University of Zürich, Zürich, Switzerland.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Torgerson
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, The Netherlands.|University of Florida, Gainesville, Gainesville, Florida, United States of America.|Utrecht University, Utrecht, The Netherlands.
authors.forename: Arie H
authors.initials: AH
authors.lastname: Havelaar
authors.affiliation: The Australian National University, Canberra, Australia.|Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Angulo
mesh_terms: D017281:Cost of Illness; D005517:Foodborne Diseases / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology / Q000469:parasitology; D014943:Global Health; D006801:Humans; D015994:Incidence; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D014944:World Health Organization