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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 A1

Data sources used to estimate illnesses, hospitalizations, and deaths caused by 31 pathogens transmitted through food, United States*

Data source Data Pathogen(s) or acute gastroenteritis Geographic coverage Time frame Adjustments
COVIS System†
Number of case-patient reports, proportion hospitalized, proportion who died
Vibrio cholerae, toxigenic; V. vulnificus; V. parahaemolyticus; other Vibrio spp.
United States
2000–2007
Underreporting; underdiagnosis
FoodNet
Number of laboratory-confirmed illnesses, proportion hospitalized, proportion who died
Campylobacter spp.; Cryptosporidium spp.; Cyclospora cayetanensis; Shiga toxin–producing Escherichia coli O157; Shiga toxin-producing E. coli non-O157; Listeria monocytogenes; non-typhoidal Salmonella spp.; S. enterica serotype Typhi; Shigella spp.; Yersinia enterocolitica
FoodNet sites‡
2005–2008
Geographic coverage;§ underdiagnosis
FDOSS
Number of foodborne outbreak-associated illnesses
Bacillus cereus; Clostridium perfringens; enterotoxigenic E. coli; Staphylococcus aureus; Streptococcus spp., Group A
United States
2000–2007; (Streptococcus spp., Group A 1996–2007)¶
Underreporting; underdiagnosis
Proportion hospitalized and proportion who died in foodborne outbreaks
Bacillus cereus; C. perfringens; enterotoxigenic E. coli; S. aureus; Streptococcus spp., Group A; Clostridium botulinum; Trichinella spp.
United States
2000–2007; (Streptococcus spp., Group A 1981–2007)¶
Underdiagnosis
FoodNet Population Survey
Rate of acute gastroenteritis
Average annual rate of acute gastroenteritis was derived by multiplying the average monthly prevalence by 12, where an episode of acute gastroenteritis was defined as diarrhea (>3 loose stools in 24 hours) or vomiting in the past month with both lasting >1 day or resulting in restricted daily activities. Persons with a chronic condition in which diarrhea or vomiting was a major symptom and persons with concurrent symptoms of cough or sore throat were excluded.
FoodNet sites‡
2000–2001, 2002–2003, 2006–2007
Percentage of acute gastroenteritis attributable to norovirus
Multiple-cause-of-death data from the National Vital Statistics System
Death rate
Acute gastroenteritis deaths were identified from the underlying or contributing cause of death classified by ICD-10 diagnostic codes A00.9–A08.5 (infectious gastroenteritis of known cause), A09 (diarrhea and gastroenteritis of presumed infectious origin), or K52.9 (noninfectious gastroenteritis and colitis, unspecified), excluding A04.7 (enterocolitis due to Clostridium difficile) and A05.1 (botulism)#
United States
2000–2006
Percentage of acute gastroenteritis deaths attributable to norovirus
NAMCS, NHAMCS
Hospitalization rate
Acute gastroenteritis hospitalizations were identified from patient visits to clinical settings, including physician offices, hospital emergency and outpatient departments with a diagnosis of infectious enteritis [ICD-9-CM diagnostic codes 001–008 (infectious gastroenteritis of known cause), 009 (infectious gastroenteritis), 558.9 (other and unspecified noninfectious gastroenteritis and colitis), or 787.9 (other symptoms involving digestive system: diarrhea), excluding 008.45 (C, difficile colitis) and 005.1 (botulism)#]
Nationally representative sample of US clinical settings
2000–2006
Weighted to give national estimates according to NCHS criteria; percentage of acute gastroenteritis hospitalizations (combined with NIS and NHDS) attributable to norovirus
Nationwide Inpatient Sample (NIS)
Hospitalization rate
Acute gastroenteritis hospitalizations were identified from discharges with one of the first three listed diagnoses classified by ICD-9-CM diagnostic codes 001–008 (infectious gastroenteritis of known cause), 009 (infectious gastroenteritis), 558.9 (other and unspecified noninfectious gastroenteritis and colitis), or 787.9 (other symptoms involving digestive system: diarrhea), excluding 008.45 (C. difficile colitis) and 005.1 (botulism)#;
Giardia intestinalis (ICD-9-CM code 007.1); Toxoplasma gondii (ICD-9-CM codes 130.0–9)
Sample of discharge records from US hospitals
2000–2006
Weighted to give national estimates according to Healthcare Cost and Utilization Project criteria; Percentage of acute gastroenteritis (combined with NAMCS/NHAMCS and NHDS) hospitalizations attributable to norovirus;
underdiagnosis (G, intestinalis and T, gondii )
Death rate
G. intestinalis (ICD-9-CM code 007.1), T. gondii (ICD-9-CM codes 130.0–9)
Sample of discharge records from US hospitals
2000–2006
Underdiagnosis
National Health and Nutrition Examination Survey
Seroprevalence
T. gondii
United States
1999–2004
Rate of infection over time and percent symptomatic
NHDS
Hospitalization rate
Acute gastroenteritis hospitalizations were identified from discharges with one of the first three listed diagnoses classified by ICD-9-CM diagnostic codes 001–008 (infectious gastroenteritis of known cause), 009 (infectious gastroenteritis), 558.9 (other and unspecified noninfectious gastroenteritis and colitis), or 787.9 (other symptoms involving digestive system: diarrhea), excluding 008.45 (C. difficile colitis) and 005.1 (botulism)#
Nationally representative sample of discharge records from US hospitals
2000–2006
Weighted to give national estimates according to NCHS criteria; percentage of acute gastroenteritis hospitalizations (combined with NAMCS/NHAMCS and NIS) attributable to norovirus
National Notifiable Disease Surveillance System
Number of case-patient reports
Brucella spp.; C. botulinum (foodborne); Trichinella spp.; hepatitis A; G. intestinalis
United States
2000–2007 (2002–2007 for G. intestinalis)**
Underreporting; underdiagnosis
Hospitalization rate
Hepatitis A
United States
2000–2007
Underdiagnosis
National Tuberculosis Surveillance System
Number of tuberculosis case-patient reports, proportion who died
Mycobacterium bovis
United States
2004–2007
Percentage of tuberculosis cases attributable to M. bovis; underdiagnosis
US Census Resident population estimates Astrovirus, rotavirus, sapovirus United States 2006 75% of children experience an episode of clinical illness by 5 years of age.

*COVIS, Cholera and Other Vibrio Illness Surveillance; FoodNet, Foodborne Diseases Active Surveillance Network; FDOSS, Foodborne Disease Outbreak Surveillance System; ICD-10, International Classification of Diseases, 10th Revision; NAMCS, National Ambulatory Medical Care Survey; NHAMCS, National Hospital Ambulatory Medical Care Survey; ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification; NCHS, National Center for Health Statistics; NIS, Nationwide Inpatient Sample; NHDS, National Hospital Discharge Survey.
†Passive surveillance from COVIS was used in preference to active surveillance from FoodNet for Vibrio spp. because most illnesses are reported by Gulf Coast States (Florida, Alabama, Louisiana, Texas) that are not included in the FoodNet surveillance area.
‡Beginning in 2000, there were 10 FoodNet sites. In 2008, the population of these sites was 45 million persons, 15% of the US population.
§Incidence of laboratory-confirmed illnesses in FoodNet for 2005–2008 was applied to 2006 US Census population estimates.
¶Data from FDOSS on Streptococcus spp., group A, were included for 1996–2007 for illnesses and for 1981–2007 for hospitalizations and deaths because of a paucity of data (Technical Appendix 1, Technical Appendix 3).
#Codes for other and unspecified noninfectious gastroenteritis and colitis were included because infectious illnesses of unknown etiology are sometimes coded as noninfectious.
**G. intestinalis became nationally notifiable in 2002.

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

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