BACKGROUND:Foodborne diseases are important causes of illness and death. The first estimates of their burden were published by WHO in 2015. We updated WHO estimates of the global, regional, subregional, and national foodborne disease burden caused by 42 infectious and chemical hazards in 2021, including time trends for 2000-21. METHODS:We provide a high-level summary of foodborne disease burden, expressed as incidence, deaths, and disability-adjusted life-years (DALYs). Data for burden estimation were provided from a WHO-commissioned series of systematic reviews on the incidence, aetiology, sequelae, and case fatality or mortality of the hazards. Data were analysed using hierarchical meta-regression modelling with geographical clustering and a global linear time trend, disease-specific computational models, and uncertainty propagation through Monte Carlo simulations to calculate 95% uncertainty intervals. Attribution to foodborne transmission was principally based on a structured expert judgement process. Economic impact was measured as lost productivity. FINDINGS:For 2021, foodborne transmission of the 42 hazards caused 866 million (95% uncertainty interval 680-1090) illnesses, 1·52 million (0·783-2·51) deaths, and 57·1 million (39·4-81·1) DALYs. Inorganic arsenic, lead, and non-typhoidal Salmonella enterica (diarrhoeal and invasive disease) resulted in the most DALYs. The greatest burden of foodborne disease was in the African and South-East Asia regions. The incidence in children younger than 5 years was 2·7 times higher than in people aged 5 years or older, resulting in 4·3 times the rate of DALYs. The total burden from all hazards decreased over time. In 2021, these 42 hazards resulted in productivity losses of US$310 billion in nominal terms, and US$647 billion after adjusting for purchasing power parity. INTERPRETATION:Foodborne diseases causes a burden similar to that from tuberculosis, HIV and AIDS, or malaria. The high burden of both communicable and non-communicable foodborne diseases requires countries to prioritise developing strategies to improve the safety of the food supply. FUNDING:WHO.

Identifying the sources of foodborne diseases is crucial for guiding national food safety strategies and supporting policies that promote safe and sustainable food production. Here we present global estimates of the proportions of burden of disease attributable to foodborne transmission, other major transmission pathways, and specific food categories for 29 viral, bacterial, parasitic, and chemical hazards, based on a structured expert judgement (SEJ) study commissioned by the World Health Organization (WHO) and supervised by the WHO Foodborne Disease Burden Epidemiology Reference Group (FERG) for 2021-2025. One-hundred forty-six experts provided 1463 assessments across 17 subregions within six WHO regions. The assessments were analyzed using Cooke's Classical Model and reviewed by FERG. Results showed that 13 of the 29 hazards were mainly (>50%) attributable to foodborne transmission, with non-typhoidal Salmonella (59-74%) and Campylobacter (45-71%) estimated to be predominantly foodborne in nearly all subregions. While plant-based foods were important sources of several pathogens, such as hepatitis A virus (63-74%) and Cryptosporidium (60-95%), foods of animal origin, including poultry, beef, eggs, seafood, and dairy products, remain critical intervention targets for several others, e.g., Campylobacter (86-97%), Salmonella (77-92%), Shiga toxin-producing E. coli (67-96%), and Listeria monocytogenes (50-85%). Regional differences in attributions highlight the influence of local epidemiological patterns, food systems, sanitation, and cultural practices. These estimates provide a global, uncertainty-quantified knowledge base to guide context-specific food safety interventions and future empirical data collection. Given persistent data gaps, SEJ remains a feasible approach to generate evidence supporting efforts to reduce the burden of foodborne diseases.

Identifying the most important sources and transmission routes of foodborne pathogens is crucial for developing food safety strategies at both national and regional levels. Various source attribution approaches and methods have been applied worldwide. This review aims to provide an overview of available studies that estimate the attribution of foodborne illnesses globally, regionally, and nationally, compiled by pathogen and region. We conducted a search in PubMed to identify peer-reviewed source attribution studies of one or more foodborne pathogens published from January 2010 to July 2023. Additionally, we consulted experts of the Foodborne Disease Burden Epidemiology Reference Group (FERG) for 2021-2025 and screened reference lists of included articles to identify further relevant studies. The extracted studies were categorized by pathogen, source attribution method, country, and region. We identified 62 studies published during the specified period, covering 34 pathogens across 26 countries, and extracted source attribution estimates. The most frequently studied pathogens were Salmonella, Campylobacter, and Escherichia coli. The methods most used were microbial subtyping, outbreak analysis, and mixed methods. Extracted data show substantial variation in results across methods and countries, highlighting the challenges of reaching a consensus on the relative contributions of foodborne disease sources at both regional and global levels based on empirical data. All extracted estimates are available in supplementary materials.

Estimates of national burdens of the foodborne disease (FBD) inform country-level food safety policies, ranking infectious and non-infectious FBD hazards in terms of health and socioeconomic impact to mitigate FBD burdens. Using relevant publications on FBD burdens from scientific literature, this review contends that four major imperatives (health, economic, planetary boundaries, governance) argue for a sustainable programme to quantify national FBD burdens. FBD disproportionately affects children under five years of age, and low- and middle-income countries. The economic costs are significant and include medical care, child development, lost productivity and international trade losses. Climatic changes and environmental contamination cause socio-ecological disruptions, increasing risk factors for FBD. Good governance promotes food safety initiatives, addressing in part under-diagnosis and underreporting. Strengthening national policies on FBD surveillance and burden estimation can promote food safety policies and address the global and national imperatives for FBD control. Evidence-based educational and regulatory interventions for FBD can promote improvements in the health and socioeconomic circumstances of the most vulnerable.

Part I of this Note describes the political and economic conditions that gave rise to the farmland and open space preservation enactments. It presents a brief political history of the support for this body of legislation and summarizes the economic arguments raised both for and against these preservation efforts. Part II describes the principal types of state farmland and open space preservation programs enacted during the past thirty years. Finally, Part III presents an empirical analysis of P.A. 116.

Compromised kidney function is associated with an array of environmental contaminants and pathogens that may be considered for regulation. However, there are few valuation estimates for kidney effects for use in benefit-cost analyses, particularly willingness-to-pay estimates. This paper is one of several surveys valuing morbidity developed by the OECD Surveys to elicit Willingness-to-pay to Avoid Chemicals-related negative Health Effects project, which aims to improve the basis for benefit-cost analyses. We report the results of a stated preference survey valuing reduced the risk of symptomatic chronic kidney disease, filling an important gap in the valuation literature and addressing a need for applied benefits analysis of chemical regulation. The survey was administered to representative samples in each of 10 countries: Canada, Chile, China, Denmark, Germany, Italy, Norway, Türkiye, the United Kingdom, and the United States. The mean (median) WTP for an average reduction of 3.5 in 1,000 of the risk of serious kidney disease over 5 years is $2,609 ($764), corresponding to a mean (median) value per statistical case (VSC) of chronic kidney disease of $805,000 ($224,000). The mean VSC varies between $700,000 for Canada and $1,200,000 for Türkiye.

Foodborne disease burden estimates inform public health priorities and can help the public understand disease impact. This article provides new estimates of the cost of U.S. foodborne illness. Our research updated disease modeling underlying these cost estimates with a focus on enhancing chronic sequelae modeling and enhancing uncertainty modeling. Our cost estimates were based on U.S. Centers for Disease Control and Prevention estimates of the numbers of foodborne illnesses, hospitalizations, and deaths caused by 31 known foodborne pathogens and unspecified foodborne agents. We augmented these estimates of illnesses, hospitalizations, and deaths with more detailed modeling of health outcomes, including chronic sequelae. For health outcomes, we relied on U.S. data and research where possible, supplemented by the use of non-U.S. research where necessary and scientifically appropriate. Cost estimates were developed from large insurance or hospital charge databases, public data sources, and existing literature and were adjusted to 2023 dollars. We estimated the cost of foodborne illness in the United States circa 2023 to be $75 billion. Deaths accounted for 56% and chronic outcomes for 31% of the mean cost. The costliest pathogen was nontyphoidal Salmonella at $17.1 billion followed by Campylobacter at $11.3 billion. Toxoplasma ($5.7 billion) and Listeria ($4 billion) followed due primarily to deaths and chronic outcomes from pregnancy-associated cases. Per-case cost ranged from $196 for Bacillus cereus to $4.6 million for Vibrio vulnificus. Unspecified agents accounted for 38% of the total cost of foodborne illness, but these illnesses were generally mild (per-case cost $781). These cost estimates can help inform food safety priorities. Our pathogen-specific per-case cost estimates can also help inform benefit-cost analysis required for new federal food safety regulations.

: Vibriosis, non-cholera infection by marine bacteria of the genus Vibrio, is a relatively uncommon infection associated with high morbidity and mortality relative to other bacterial food and waterborne pathogens. The range and impact of these common marine organisms is likely to increase as global water temperatures rise in association with global warming. We have conducted a scoping review of available literature (2000 - 2020), including individual case studies, in order to provide the most current overview of reported sequelae and complications of this disease, including amputation, necrotizing fasciitis, organ failure, respiratory complications, and uncommon serious outcomes. Notably, we have found the available data indicate that route of exposure (contact with water, ingestion) may not be as reliably associated with disease presentation (soft tissue infection, gastroenteritis, sepsis) as has commonly been proposed. This information can be used to inform more accurate burden estimates for this disease, which have, to date, not included severe tissue sequelae including amputation as an outcome associated with foodborne exposure to non-cholera Vibrio. We have also identified knowledge gaps and priority research areas that may provide data allowing further refinement of cost and burden models.

CD34 is a critical analyte in stem cell processing and is subject to proficiency testing (PT). Limited commercial CD34-PT are available from domestic (PT-D) and international (PT-InL) vendors. We describe our experience with two CD34-PT vendors over 11 years. To our knowledge, an institutional comparison of different commercial CD34-PT has not been previously reported. CD34-PT were purchased from a domestic (PT-D [USA], CAP) and international vendor (PT-InL [Europe], UK-NEQA). CD34-PT were analyzed by flow cytometry using a dual platform, modified ISHAGE protocol on day of receipt. Elements for comparison included %CD34, CD34/mcL, total CD34 events, and whether PT challenge was graded. Our results were compared to the study mean by paired t-test, linear regression, Z-score and chi-square. For PT-D, results were also compared to the certificate of analysis (CoA). PT vendors were also compared relative to standard deviation (SD), % coefficient variation (%CV) and ISHAGE CD34 minimum count success rate (>200 CD34+ per sample). We participated in 64 CD34-PT over 11 years. We initially participated in PT-D which provides stabilized cell samples. In 2019, we switched to PT-InL which supplies fixed, nonviable cell samples. Linear regression showed a good correlation (R > .95) between our results and mean PT results for %CD34 and CD34/mcL regardless of vendor. The %CV for PT-D and PT-InL was similar for %CD34 (19% vs. 16%) whereas %CV for CD34/mcL was 3× higher for PT-D (37% vs. 13%, p = .002). Our %CD34 average Z-score, a measure of our result variance from the mean, showed most %CD34 results falling within 1SD (>75%) and 2SD (>90%) for both vendors (Table 1). In contrast, CD34/mcL varied significantly: The PT-D mean Z-score was 2.5× higher, with only 17% results falling within 1SD (vs. 77% PT-InL, p = .0001) and 46% >2SD (p = .0013, Z = 3.7). In the same PT-D challenges, %CD3 and CD3/mL showed a similar pattern, with %CD3 within 1SD and CD3/mL >2–3 SD suggesting sample degradation and cell loss. For PT-D, the mean CD34/mcL was 22% lower (p = .16, paired-t; range 2-53%) and our result 48% lower (range 32%-92%; p = .003) than the CD34/mcL listed on CoA. PT-InL analysis reached the minimum ISHAGE CD34 count (>200 events) in 92% challenges vs only 71% in PT-D (p = .02). The majority (97%) of PT-InL challenges were graded with >350 participants. PT-D participation was significantly lower (<75 centers) and were ungraded until 2016. TABLE 1. Domestic and international CD34-PT results.

Foodborne illness is common in the United States with most, but not all, foodborne pathogens causing symptoms of acute gastroenteritis (AGI). Outpatient care is the most frequent type of medical care sought; however, more accurate estimates of outpatient costs are needed to inform food safety policy decision. Using the U.S. MarketScan Commercial Claims and Encounters database, we quantified the per-visit cost of outpatient visits with any AGI-related diagnosis (including pathogen-specific and nonspecific or symptom-based diagnoses) and for those with a pathogen-specific diagnosis for 1 of 29 pathogens commonly transmitted through food (including pathogens that cause AGI and some that do not). Our estimates included the per-case cost of office visits and associated laboratory tests and procedures as well as the conservative estimates of prescription cost. Most AGI outpatient visits were coded using nonspecific codes (e.g., infectious gastroenteritis), rather than pathogen-specific codes (e.g., Salmonella). From 2012 to 2015, we identified more than 3.4 million initial outpatient visits with any AGI diagnosis and 45,077 with a foodborne pathogen-specific diagnosis. As is typical of treatment cost data, severe cases of illness drove mean costs above median. The mean cost of an outpatient visit with any AGI was $696 compared with the median of $162. The mean costs of visits with pathogen-specific diagnoses ranged from $254 (median $131; interquartile range [IQR]: $98-184) for Streptococcus spp. Group A (n = 22,059) to $1761 (median $161; IQR: $104-$1101) for Clostridium perfringens (n = 30). Visits with two of the most common causes of foodborne illness, nontyphoidal Salmonella and norovirus, listed as a diagnosis, had mean costs of $841 and $509, respectively. Overall, the median per-case costs of outpatient visits increased with age, with some variation by pathogen. More empirically based estimates of outpatient costs for AGI and specific pathogens can enhance estimates of the economic cost of foodborne illness used to guide food policy and focus prevention efforts.

Listeriosis is a rare bacterial infection associated with foodborne illness that can result in septicemia, a serious acute outcome. Sepsis is responsible for one in three deaths during hospitalization. The objective of this study was to conduct a systematic review and meta-analysis to estimate the proportion of Listeria monocytogenes infections resulting in septicemia. PubMed, Embase, Scopus, and Web of Science were searched from January 1, 2000, to April 1, 2018, for epidemiological studies that assessed studies focusing on L. monocytogenes infections with the outcome of septicemia. Articles in English, Spanish, and Portuguese using case-control, cohort, or outbreak studies reporting measures of association between L. monocytogenes and septicemia were included. Bias and heterogeneity were assessed using univariate meta-regression for region, sample size, study design, and report method. Nineteen articles were eligible for inclusion post-screening, the majority of which were conducted in Europe (n = 15); utilized a retrospective cohort design (n = 16); and collected data via routine or laboratory surveillance methods (n = 10). Prevalence of sepsis ranged from 4.2% to 100% among study populations of 6 to 1374 individuals. Overall, the proportion of listeriosis cases that developed sepsis was 46% (95% confidence interval [CI] 31.0-61.0%); for neonatal cases, 21.3% (95% CI 11.0-31.6%); and for maternal and neonatal cases, 18.8% (95% CI 10.7-26.8%). The heterogeneity was high for overall and group meta-analyses, but it could not be explained by the subanalyses for the overall proportion, whereas for neonatal, and neonatal and maternal cases combined, China had a significantly lower proportion than Europe and the United States. Septicemia following L. monocytogenes infection is a severe acute complication with 31-61% rate found overall; however, greater delineation of demographic data is needed to determine important risk factors. Future research should aim to address the gaps in knowledge in the long-term outcomes of sepsis from L. monocytogenes infection, and whether these outcomes differ from those due to other infections.

Quantifying the effect of public health actions on population health is essential when justifying sustained public health investment. Using modeling, we conservatively estimated that rapid response to a multistate foodborne outbreak of Salmonella Typhimurium in the United States in 2018 potentially averted 94 reported cases and $633,181 in medical costs and productivity losses.

Background: This paper represents, to our knowledge, the first national-level (United States) estimate of the economic impacts of vibriosis cases as exacerbated by climate change. Vibriosis is an illness contracted through food- and waterborne exposures to various Vibrio species (e.g., nonV. cholerae O1 and O139 serotypes) found in estuarine and marine environments, including within aquatic life, such as shellfish and finfish. Objectives: The objective of this study was to project climate-induced changes in vibriosis and associated economic impacts in the United States related to changes in sea surface temperatures (SSTs). Methods: For our analysis to identify climate links to vibriosis incidence, we constructed three logistic regression models by Vibrio species, using vibriosis data sourced from the Cholera and Other Vibrio Illness Surveillance system and historical SSTs. We relied on previous estimates of the cost-per-case of vibriosis to estimate future total annual medical costs, lost income from productivity loss, and mortality-related indirect costs throughout the United States. We separately reported results for V. parahaemolyticus, V. vulnificus, V. alginolyticus, and “V. spp.,” given the different associated health burden of each. Results: By 2090, increases in SST are estimated to result in a 51% increase in cases annually relative to the baseline era (centered on 1995) under Representative Concentration Pathway (RCP) 4.5, and a 108% increase under RCP8.5. The cost of these illnesses is projected to reach $5.2 billion annually under RCP4.5, and $7.3 billion annually under RCP8.5, relative to $2.2 billion in the baseline (2018 U.S. dollars), equivalent to 140% and 234% increases respectively. Discussion: Vibriosis incidence is likely to increase in the United States under moderate and unmitigated climate change scenarios through increases in SST, resulting in a substantial burden of morbidity and mortality, and costing billions of dollars. These costs are mostly attributable to deaths, primarily from exposure to V. vulnificus. Evidence suggests that other factors, including sea surface salinity, may contribute to further increases in vibriosis cases in some regions of the United States and should also be investigated. https://doi.org/10.1289/EHP9999a

Listeria monocytogenes is a relatively rare but highly pathogenic bacterium that can cause foodborne infections. In the United States there are ∼1600 cases per year, 94% of which result in hospitalizations and 20% in deaths. Per-case burden is high because the disease also causes serious complications, including sepsis, encephalitis, meningitis, miscarriage, and stillbirth. The disease burden of L. monocytogenes is underestimated because some of these acute complications can also result in long-term outcomes. In this article, we conducted a scoping review of L. monocytogenes complications and longer term outcomes from articles published between 2000 and 2018. Search terms were developed for four major databases (PubMed, Scopus, Web of Science, and Embase) as well as gray literature and hand searches of review articles. We follow standard scoping review methodology and assessment. Out of 10,618 unique articles originally identified, 115 articles were included, representing 49 unique outcomes. The majority of studies were cohort designs (n = 67) and conducted in the United States or Europe (n = 98). Four major outcome groupings were death, neurological disorders, sepsis, and congenital infection. This study identifies substantial research on the common acute complications of L. monocytogenes and few long-term consequences of L. monocytogenes. We identify the need for additional studies to determine the longer term impacts of these acute complications.

Background Sepsis causes a major health burden in the United States. To better understand the role of sepsis as a driver of the burden and cost of foodborne illness in the United States, we estimated the frequency and treatment cost of sepsis among US patients hospitalized with 31 pathogens commonly transmitted through food or with unspecified acute gastrointestinal illness (AGI). Methods Using data from the National Inpatient Sample from 2012 to 2015, we identified sepsis hospitalizations using 2 approaches-explicit ICD-9-CM codes for sepsis and a coding scheme developed by Angus that identifies sepsis using specific ICD-9-CM diagnosis codes indicating an infection plus organ failure. We examined differences in the frequency and the per-case cost of sepsis across pathogens and AGI and estimated total hospitalization costs using prior estimates of foodborne hospitalizations. Results Using Explicit Sepsis Codes, sepsis hospitalizations accounted for 4.6% of hospitalizations with a pathogen commonly transmitted through food or unspecified AGI listed as a diagnosis; this was 33.2% using Angus Sepsis Codes. The average per-case cost was $35 891 and $20 018, respectively. Applying the proportions of hospitalizations with sepsis from this study to prior estimates of the number foodborne hospitalizations, the total annual cost was $248 million annually using Explicit Sepsis Codes and $889 million using Angus Sepsis Codes. Conclusions Sepsis is a serious complication among patients hospitalized with a foodborne pathogen infection or AGI resulting in a large burden of illness. Hospitalizations that are diagnosed using explicit sepsis codes are more severe and costly, but likely underestimate the burden of foodborne sepsis. We examine differences in the frequency and per-case cost of sepsis across pathogens commonly transmitted through food. We integrate this with CDC foodborne disease incidence estimates to calculate the total cost of sepsis from 31 foodborne pathogens and foodborne AGI.

Earth and Space Science Open Archive Presented WorkOpen AccessYou are viewing the latest version by default [v1]The Influence of Climate Change on Vibriosis in the United States: Projected Health and Economic Impacts for the 21st CenturyAuthorsMichaelKolianiDMeganSheahanCaitlinGouldJamesNeumanniDPatrickKinneySandraHoffmannCharlesFantSelinaWangSee all authors Michael KolianiDCorresponding Author• Submitting AuthorEnvironmental Protection Agency Washington DCiDhttps://orcid.org/0000-0002-7134-8317view email addressThe email was not providedcopy email addressMegan SheahanIndustrial Economics, Inc.view email addressThe email was not providedcopy email addressCaitlin GouldEnvironmental Protection Agency Washington DCview email addressThe email was not providedcopy email addressJames NeumanniDIndustrial Economics, Inc.iDhttps://orcid.org/0000-0001-7553-3037view email addressThe email was not providedcopy email addressPatrick KinneyBoston Universityview email addressThe email was not providedcopy email addressSandra HoffmannUS Department of Agriculture Economic Research Serviceview email addressThe email was not providedcopy email addressCharles FantIndustrial Economics, Inc.view email addressThe email was not providedcopy email addressSelina WangTufts Universityview email addressThe email was not providedcopy email address

Foodborne illness ranks seventh globally among major health hazards, falling between air pollution and tuberculosis. Yet food safety is relatively understudied by economists. This paper provides an introduction to food safety for economists new to the subject. It presents an overview of the problem, the history of major policy reforms, and the structure of food safety governance in the United States and internationally. It identifies potential opportunities for economists in interdisciplinary food safety research and presents one example of this kind of collaboration, namely research focused on identifying the food sources of US Campylobacter infections. I1; Q17; Q18 JEL CLASSIFICATION

Previous economic estimates of infection with Toxoplasma gondii and chronic sequelae following infection lack sufficient data to establish the true burden of disease and its chronic sequelae. This scoping review aims to fill this gap by updating existing literature regarding the development of postinfectious sequelae following T. gondii infection. Literature published between January 1, 2000, and November 6, 2018, in PubMed, EMBASE, and Scopus was searched for a wide range of postinfectious sequelae and economic estimate terms. This scoping review includes summaries from the 108 articles covering 5 main groupings of outcomes (categories are not exclusive) including vision disorders (n = 58), psychological and mental health disorders (n = 27), neurological disorders (n = 17), fetal death and infection (n = 15), and hearing loss (n = 6), as well as a description of other outcomes reported. While the majority of the included studies assessed the incidence of these outcomes postinfection, very few followed participants long-term. These prospective studies are needed to understand the true burden of postinfectious sequelae over the life course, particularly because congenital infection with Toxoplasma can lead to severe outcomes for newborns. This scoping review can be used as an important resource for other researchers wishing to conduct future systematic reviews and meta-analyses, as well as for policy makers interested in developing guidance for public and health care partners.