Global magnitude and trends

Because food-borne disease is commonly manifest as diarrhea, and death from diarrheal disease is uncommon in the industrialized countries, there is the mis-perception that food-borne disease is not a significant public health problem. However, the data suggest otherwise. Within the past decade, estimates of the incidence of acute gastroenteritis have been published from several industrialized countries, including the United States, Canada, England, Northern Ireland and the Republic of Ireland, the Netherlands, and Australia (Wheeler et al., 1999; de Wit et al., 2001; Herikstad et al., 2002; Imhoff et al., 2004; Majowicz et al., 2004; Scallan et al., 2004; Hall et al., 2005). Differences in study design do not allow direct comparison of the estimates, but an overall approximation is that in these industrialized nations approximately 20 percent of the population suffers from at least one episode of acute gastroenteritis each year, and that about one-third of the cases are due to food-borne transmission.

In the United States, food-borne disease is estimated to cause 76 million illnesses yearly (approximately one case per four persons per year), leading to 325,000 hospitalizations and 5000 deaths annually (Mead et al., 1999). Economic costs have been estimated at $6.9 billion for the four most common bacterial causes (Buzby et al., 1996).

The purpose of all these studies is to derive reliable data on the incidence of food-borne disease (Flint et al., 2005), a goal endorsed by the World Health Organization. The determination of both pathogen-specific and food-specific risks serves several useful purposes by providing data on which to base clinical recommendations, by sharpening the focus of control strategies, and by documenting the effectiveness (or lack thereof) for specific prevention and control efforts (Batz et al., 2005). The primary aim of these public health studies is not the removal of trade barriers, but to direct efforts to decrease the disease burden of food-borne illness.

Globally, diarrheal disease is the second leading cause of death from infectious diseases worldwide, and is approximately 1000-fold more common in the developing, compared with the developed, nations. Most of the deaths in developing nations are in children aged less than five years, whereas in the industrialized nations most diarrhea-related deaths are in the elderly. There are multiple contributors to diarrheal disease in the developing world, including unclean water, lack of sanitation, person-to-person transmission, crowding, close exposure to animals, and contaminated environments as well as contaminated food.

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