Environmental Engineering Reference
In-Depth Information
(e.g., cheeses and cider) made with unpasteurized raw materials may also lead
to illness.
BURDEN AND COST OF FOODBORNE ILLNESS
In 1999, Mead et al.
3
reported new estimates of foodborne illnesses in the United
States. They found that there are several factors that complicate surveillance for
foodborne infections. First is underreporting, especially of mild or asymptomatic
cases, but also of severe cases. Second, they found that because many pathogens
can be spread by means other than food, their role in foodborne illness is often
obscured or unknown. For example, pathogens such as
E. coli
,whichmaybe
spread by food, can also be transmitted through contact with infected animals
or other infected persons, and through contact with contaminated water. Third,
some illnesses are caused by pathogens that have not yet been identified and so
cannot be diagnosed. Many of the pathogens that are reported today, including
Campylobacter jejuni, Escherichia coli
O157:H7,
Listeria monocytogenes
,and
Cyclospora cayetanensis
, were not recognized as causes of foodborne illness
only 25 years ago. In total, Mead et al. estimated that foodborne diseases cause
approximately 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths
in the United States each year. Of these, infections caused by known pathogens
account for an estimated 14 million illnesses, 60,000 hospitalizations, and 1,800
deaths each year. Clearly, further work is needed to identify the causes of these
other foodborne illnesses.
Salmonella, Listeria
,and
Toxoplasma
cause more than
75 percent of deaths by known pathogens.
The total cost of a disease outbreak is often overlooked. For example, a typhoid
fever outbreak in 80 restaurant patrons consuming food contaminated by a car-
rier was estimated to cost $351,920. This cost includes patient-related medical
expenses and costs of loss of income or productivity.
31
One estimate of the annual
economic impact of foodborne disease in the United States is $1 billion to $10
billion. If there are five million cases each year, the average cost per case would
range from $200 to $2000.
32
The FDA estimated in 1985 that 21 to 81 million
cases of diarrhea yearly are caused by foodborne pathogens. The out-of-pocket
costs were estimated to be $560 million for the quarter million hospitalized and
$690 million for those who saw a doctor.
33
More recently, the 2001 FDA Food
Code estimates that the annual cost of foodborne illness is $10 billion to $83
billion annually.
34
This figure is calculated considering the increased estimation
of foodborne illness by Mead et al.
3
The reporting of water- and foodborne illnesses has, with rare exceptions, been
very incomplete. Various estimates have been made in the past indicating that the
number reported represented only 10 to 20 percent of the actual number. Reasons
for underreporting include that many infected persons do not seek medical care,
and that persons who seek medical care may not have a stool sample or other
confirmatory test. Mead et al. estimated, for example, that
Salmonella
infections
are underreported 38-fold, while
E. coli
infections are underestimated 20-fold.
