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