World Health Organization Global Estimates and Regional Comparisons of the Burden of Foodborne Disease in 2010

Abstract

Illness and death from diseases caused by contaminated food are a constant threat to public health and a significant impediment to socio-economic development worldwide. To measure the global and regional burden of foodborne disease (FBD), the World Health Organization (WHO) established the Foodborne Disease Burden Epidemiology Reference Group (FERG), which here reports their first estimates of the incidence, mortality, and disease burden due to 31 foodborne hazards. We find that the global burden of FBD is comparable to those of the major infectious diseases, HIV/AIDS, malaria and tuberculosis. The most frequent causes of foodborne illness were diarrheal disease agents, particularly norovirus and Campylobacter spp. Diarrheal disease agents, especially non-typhoidal Salmonella enterica, were also responsible for the majority of deaths due to FBD. Other major causes of FBD deaths were Salmonella Typhi, Taenia solium and hepatitis A virus. The global burden of FBD caused by the 31 hazards in 2010 was 33 million Disability Adjusted Life Years (DALYs); children under five years old bore 40% of this burden. The 14 subregions, defined on the basis of child and adult mortality, had considerably different burdens of FBD, with the greatest falling on the subregions in Africa, followed by the subregions in South-East Asia and the Eastern Mediterranean D subregion. Some hazards, such as non-typhoidal S. enterica, were important causes of FBD in all regions of the world, whereas others, such as certain parasitic helminths, were highly localised. Thus, the burden of FBD is borne particularly by children under five years old-although they represent only 9% of the global population-and people living in low-income regions of the world. These estimates are conservative, i.e., underestimates rather than overestimates; further studies are needed to address the data gaps and limitations of the study. Nevertheless, all stakeholders can contribute to improvements in food safety throughout the food chain by incorporating these estimates into policy development at national and international levels.

Fig 1. Ranking of foodborne hazards globally for 2010, expressed as Disability Adjusted Life Years.

White dots indicate the median burden, black boxes the inter-quartile range (50% UI), black lines the 5 and 95 percentiles (90%UI) and grey lines the 2.5 and 97.5 percentiles (95% UI). Note the y-axis is on a logarithmic scale. Abbreviations: EPEC: Enteropathogenic Escherichia coli; ETEC: Enterotoxigenic E. coli; STEC: Shiga toxin-producing E. coli.

Fig 2. Relative contribution of years of life lost (YLL) due to premature mortality and years lived with disability (YLD) to the global burden of 31 hazards in food for 2010.

For abbreviations, see Fig 1.

Fig 3. Age-distribution of Disability Adjusted Life Years for 31 hazards contributing to the global burden of foodborne disease for 2010.

For abbreviations, see Fig 1.

Fig 4. Scatterplot of the global burden of foodborne disease per 100,000 population and per case.

The grey-shaded areas indicate arbitrary cut-offs between high (H) or low (L) population burden (> or ≤ 10 DALYs per 100,000 population) and high or low individual burden (> or ≤ 1 DALY per case). Abbreviations: NoV: Norovirus; Camp: Campylobacter spp.; EPEC: Enteropathogenic Escherichia coli; ETEC: Enterotoxigenic E. coli; STEC: Shiga toxin-producing E. coli; NTS: non-typhoidal Salmonella enterica; Shig: Shigella spp.; Vchol; Vibrio cholerae Ehist: Entamoeba histolytica; Cryp: Cryptosporidium spp.; Giar: Giardia spp.; HAV: Hepatitis A virus; Bruc: Brucella spp.; Lmono: Listeria monocytogenes; Mbov: Mycobacterium bovis; SPara: Salmonella Paratyphi A; STyph: Salmonella Typhi; Toxo: Toxoplasma gondii; Egran: Echinococcus granulosus; Emult: E. multilocularis; Tsol: Taenia solium; Asc: Ascaris spp.; Trich: Trichinella spp.; Clon: Clonorchis sinensis; Fasc: Fasciola spp.; Flukes: Intestinal flukes; Opis: Opisthorchis spp.; Parag: Paragonimus spp.; Diox: Dioxins; Afla: Aflatoxin.

Fig 5. The global burden of foodborne disease (DALYS per 100,000 population) by hazard groups and by subregion for 2010.

See Table 2 for the countries in each subregion.