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Volume 17, Number 1—January 2011

Research

Foodborne Illness Acquired in the United States—Major Pathogens

Elaine Scallan1Comments to Author , Robert M. Hoekstra, Frederick J. Angulo, Robert V. Tauxe, Marc-Alain Widdowson, Sharon L. Roy, Jeffery L. Jones, and Patricia M. Griffin
Author affiliations: Author affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Main Article

Table 2

Estimated annual number of episodes of domestically acquired foodborne illnesses caused by 31 pathogens, United States*

Pathogen Laboratory- confirmed Multipliers
Total, mean (90% CrI) Travel- related, % Domestically acquired, mean (90% CrI) Foodborne, %§ Domestically acquired foodborne, 
mean (90% CrI)
Under-reporting† Under-diagnosis‡
Bacteria
Bacillus cereus, foodborne¶ 85# 25.5 29.3 63,623 (15,770–147,827) <1 63,411 (15,721–147,380) 100 63,400 (15,719–147,354)
Brucella spp. 120** 1.1 15.2 2,003 (1,302–2,964) 16 1,679 (1,089–2,484) 50 839 (533–1,262)
Campylobacter spp. 43,696†† 1.0 30.3 1,322,137 (530,126–2,521,026) 20 1,058,387 (423,255–2,019,498) 80 845,024 (337,031–1,611,083)
Clostridium botulinum, foodborne¶ 25** 1.1 2.0 56 (34–92) <1 55 (34–91) 100 55 (34–91)
Clostridium perfringens, foodborne¶ 1,295# 25.5 29.3 969,342 (192,977–2,492,003) <1 966,120 (192,331–2,483,682) 100 965,958 (192,316–2,483,309)
STEC O157 3,704†† 1.0 26.1 96,534 (26,982–227,891) 4 93,094 (26,046–219,676) 68 63,153 (17,587–149,631)
STEC non–O157 1,579†† 1.0 106.8 168,698 (17,163–428,522) 18 138,063 (14,080–350,891) 82 112,752 (11,467–287,321)
ETEC, foodborne¶ 53# 25.5 29.3 39,781 (53–102,250) 55 17,897 (24–46,215) 100 17,894 (24–46,212)
Diarrheagenic E. coli 
 other than STEC and ETEC 53 25.5 29.3 39,871 (53–102,378) <1 39,739 (52–102,028) 30 11,982 (16–30,913)
Listeria monocytogenes 808†† 1.0 2.1 1,662 (582–3,302) 3 1,607 (563–3,193) 99 1,591 (557–3,161)
Mycobacterium bovis 195†† 1.0 1.1 208 (177–241) 70 63 (49–78) 95 60 (46–74)
Salmonella spp., nontyphoidal‡‡ 41,930†† 1.0 29.3 1,229,007 (772,129–2,008,076) 11 1,095,079 (687,126–1,790,225) 94 1,027,561 (644,786–1,679,667)
S. enterica serotype Typhi 433†† 1.0 13.3 5,752 (299–17,357) 67 1,897 (91–5,756) 96 1,821 (87–5,522)
Shigella spp. 14,864†† 1.0 33.3 494,908 (93,877–1,420,877) 15 421,048 (79,844–1,208,445) 31 131,254 (24,511–374,789)
Staphylococcus aureus, foodborne¶ 323‡# 25.5 29.3 241,994 (72,584–531,398) <1 241,188 (72,352–529,509) 100 241,148 (72,341–529,417)
Streptococcus spp. group A, 
 foodborne¶ 15# 25.5 29.3 11,257 (15–78,104) <1 11,219 (15–77,875) 100 11,217 (15–77,875)
Vibrio cholerae, toxigenic 8** 1.1 33.1 277 (94–630) 70 84 (19–212) 100 84 (19–213)
V. vulnificus 111** 1.1 1.7 207 (138–287) 2 203 (136–281) 47 96 (60–139)
V. parahaemolyticus 287** 1.1 142.4 44,950 (23,706–74,984) 10 40,309 (21,277–67,282) 86 34,664 (18,260–58,027)
Vibrio spp., other 220** 1.1 142.7 34,585 (21,756–51,535) 11 30,727 (19,278–45,886) 57 17,564 (10,848–26,475)
Yersinia enterocolitica 950†† 1.0 122.8 116,716 (36,363–204,898) 7 108,490 (33,797–190,605) 90 97,656 (30,388–172,734)
Subtotal



4,883,568 (3,160,412–7,148,360)

4,330,358 (2,771,307–6,438,919)

3,645,773 (2,321,468–5,581,290)
Parasites
Cryptosporidium spp. 7,594†† 1.0 98.6 748,123 (162,961–2,135,110) 9 678,828 (147,796–1,940,626) 8 57,616 (12,060–166,771)
Cyclospora cayetanensis 239†† 1.0 83.1 19,808 (239–65,135) 42 11,522 (139–38,031) 99 11,407 (137–37,673)
Giardia intestinalis 20,305** 1.3 46.3 1,221,564 (892,393–1,633,965) 8 1,121,864 (818,627–1,501,290) 7 76,840 (51,148–109,739)
Toxoplasma gondii 1.0 0 173,995 (134,593–218,866) <1 173,415 (134,172–218,169) 50 86,686 (64,861–111,912)
Trichinella spp. 13** 1.3 9.8 162 (44–355) 4 156 (42–341) 100 156 (42–341)
Subtotal



2,163,652 (1,401,591–3,596,566)

1,985,785 (1,292,817–3,290,175)

232,705 (161,923–369,893)
Viruses
Astrovirus NA NA NA 3,090,384 (2,350,589–3,833,232) 0 3,089,868 (2,350,263–3,832,706) <1 15,433 (5,569–26,643)
Hepatitis A virus 3,576** 1.1 9.1 35,769 (21,505–60,715) 41 21,041 (12,455–35,918) 7 1,566 (702–3,024)
Norovirus NA NA NA 20,865,958 (12,842,072–30,743,963) <1 20,796,079 (12,798,628–30,638,633) 26 5,461,731 (3,227,078–8,309,480)
Rotavirus NA NA NA 3,090,384 (2,350,589–3,833,232) 0 3,089,868 (2,350,263–3,832,706) <1 15,433 (5,569–26,643)
Sapovirus NA NA NA 3,090,384 (2,350,589–3,833,232) 0 3,089,868 (2,350,263–3,832,706) <1 15,433 (5,569–26,643)
Subtotal



30,172,879 (21,795,012–40,272,501)

30,086,723 (21,733,225–40,154,878)

5,509,597 (3,273,623–8,355,568)
Total 37,220,098 (28,434,745–47,630,066) 36,402,867 (27,698,948–46,716,681) 9,388,075 (6,641,440–12,745,709)

*All estimates were based on US population in 2006. Modal or mean value shown unless otherwise stated; see Technical Appendix 3 for the parameters of these distributions. The credible interval (CrI) lower bound for total illnesses was replaced with the number of laboratory–confirmed illnesses when that lower bound was zero. The observed lower bound was then carried forward using the travel–related and foodborne percentages. STEC, Shiga toxin–producing Escherichia coli; ETEC, enterotoxigenic E. coli; NA, not applicable.
†Adjustment for underreporting because of surveillance method; underreporting multiplier for passive surveillance systems (Cholera and Other Vibrio Illness Surveillance [COVIS] or the National Notifiable Disease Surveillance System [NNDSS]) derived by comparing the incidence of laboratory–confirmed illnesses for Listeria, non–typhoidal Salmonella spp., Shigella, and STEC O157 (for bacteria) and Cryptosporidium spp. and Cyclospora cayetanensis (for parasites) ascertained in the Foodborne Diseases Active Surveillance Network (FoodNet) to the incidence of laboratory–confirmed illnesses for the same pathogens reportable to NNDSS; underreporting multiplier for outbreak–associated illness reported through the Foodborne Disease Outbreak Surveillance System (FDOSS) derived by comparing the incidence of laboratory–confirmed illnesses caused by Campylobacter spp., Cryptosporidium spp., Cyclospora cayetanensis, STEC,Listeria monocytogenes, Salmonella spp., Shigella spp., Vibrio spp., and Yersinia enterocolitica ascertained in FoodNet to the incidence of laboratory–confirmed illnesses of these bacterial infections reported to FDOSS. The modal value is presented here; Technical Appendix 3 has the low and high values of these PERT distributions. More detail on the data used to estimate underreporting multipliers is given in Technical Appendix 4.
‡Adjustment for underdiagnosis because of variations in medical care seeking, specimen submission, laboratory testing, and test sensitivity. The modal value is presented here; Technical Appendix 3 describes the low and high values of these PERT distributions.
§Percent foodborne among domestically acquired illnesses.
¶Estimates based on the number of foodborne illnesses ascertained in surveillance and therefore assumed to reflect only foodborne transmission.
#Passive surveillance data on outbreak-associated illnesses from FDOSS.
**Passive surveillance data from COVIS or NNDSS.
††Active surveillance data from FoodNet, adjusted for geographical coverage; data from the NTSS for M. bovis.
‡‡For all analyses in this article, S. enterica serotype Paratyphi is grouped with nontyphoidal Salmonella spp.

Main Article

1Current affiliation: Colorado School of Public Health, Aurora, Colorado, USA.

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