Volume 17, Number 1—January 2011
Research
Foodborne Illness Acquired in the United States—Major Pathogens
, Robert M. Hoekstra, Frederick J. Angulo, Robert V. Tauxe, Marc-Alain Widdowson, Sharon L. Roy, Jeffery L. Jones, and Patricia M. Griffin
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.
1Current affiliation: Colorado School of Public Health, Aurora, Colorado, USA.