Burden of salmonellosis, campylobacteriosis and listeriosis: a time series analysis, Belgium, 2012 to 2020.

Salmonellosis, campylobacteriosis and listeriosis are food-borne diseases. We estimated and forecasted the number of cases of these three diseases in Belgium from 2012 to 2020, and calculated the corresponding number of disability-adjusted life years (DALYs). The salmonellosis time series was fitted with a Bai and Perron two-breakpoint model, while a dynamic linear model was used for campylobacteriosis and a Poisson autoregressive model for listeriosis. The average monthly number of cases of salmonellosis was 264 (standard deviation (SD): 86) in 2012 and predicted to be 212 (SD: 87) in 2020; campylobacteriosis case numbers were 633 (SD: 81) and 1,081 (SD: 311); listeriosis case numbers were 5 (SD: 2) in 2012 and 6 (SD: 3) in 2014. After applying correction factors, the estimated DALYs for salmonellosis were 102 (95% uncertainty interval (UI): 8-376) in 2012 and predicted to be 82 (95% UI: 6-310) in 2020; campylobacteriosis DALYs were 1,019 (95% UI: 137-3,181) and 1,736 (95% UI: 178-5,874); listeriosis DALYs were 208 (95% UI: 192-226) in 2012 and 252 (95% UI: 200-307) in 2014. New actions are needed to reduce the risk of food-borne infection with Campylobacter spp. because campylobacteriosis incidence may almost double through 2020.

Economic Cost of a Listeria monocytogenes Outbreak in Canada, 2008.

Estimates of the economic costs associated with foodborne disease are important to inform public health decision-making. In 2008, 57 cases of listeriosis and 24 deaths in Canada were linked to contaminated delicatessen meat from one meat processing plant. Costs associated with the cases (including medical costs, nonmedical costs, and productivity losses) and those incurred by the implicated plant and federal agencies responding to the outbreak were estimated to be nearly $242 million Canadian dollars (CAD, 2008). Case costs alone were estimated at approximately $2.8 million (CAD, 2008) including loss of life. This demonstrates the considerable economic burden at both the individual and population levels associated with foodborne disease and foodborne outbreaks in particular. Foodborne outbreaks due to severe pathogens, such as Listeria monocytogenes and those that result in product recalls, are typically the most costly from the individual and/or societal perspective. Additional economic estimates of foodborne disease would contribute to our understanding of the burden of foodborne disease in Canada and would support the need for ongoing prevention and control activities.

Cost-of-illness and disease burden of food-related pathogens in the Netherlands, 2011.

To inform risk management decisions on control and prevention of food-related disease, both the disease burden expressed in Disability Adjusted Life Years (DALY) and the cost-of-illness of food-related pathogens are estimated and presented. Disease burden of fourteen pathogens that can be transmitted by food, the environment, animals and humans was previously estimated by Havelaar et al. (2012). In this paper we complement these by cost-of-illness estimates. Together, these present a complete picture of the societal burden of food-related diseases. Using incidence estimates for 2011, community-acquired non-consulting cases, patients consulting their general practitioner, hospitalized patients and the incidence of sequelae and fatal cases, estimates were obtained for DALYs, direct healthcare costs (e.g. costs for doctor's fees, hospitalizations and medicines), direct non-healthcare costs (e.g. travel costs to and from the doctor), indirect non-healthcare costs (e.g. productivity loss, special education) and total costs. The updated disease burden for 2011 was equal to 13,940 DALY/year (undiscounted) or 12,650 DALY/year (discounted at 1.5%), and was of the same magnitude as previous estimates. At the population-level thermophilic Campylobacter spp., Toxoplasma gondii and rotavirus were associated with the highest disease burden. Perinatal listeriosis infection was associated with the highest DALY per symptomatic case. The total cost-of-illness in 2011 of fourteen food-related pathogens and associated sequelae was estimated at € 468 million/year, if undiscounted, and at € 416 million/year if discounted by 4%. Direct healthcare costs accounted for 24% of total costs, direct non-healthcare costs for 2% and indirect non-healthcare costs for 74% of total costs. At the population-level, norovirus had the highest total cost-of-illness in 2011 with € 106 million/year, followed by thermophilic Campylobacter spp. (€ 76 million/year) and rotavirus (€ 73 million/year). Cost-of-illness per infected case varied from € 150 for Clostridium perfringens intoxications to € 275,000 for perinatal listeriosis. Both incident cases and fatal cases are more strongly correlated with COI/year than with DALY/year. More than 40% of all cost-of-illness and DALYs can be attributed to food, in total € 168 million/year and 5,150 DALY/year for 2011. Beef, lamb, pork and poultry meat alone accounted for 39% of these costs. Products of animal origin accounted for € 86 million/year (or 51% of the costs attributed to food) and 3,320 DALY/year (or 64% of the disease burden attributed to food). Among the pathogens studied Staphylococcus aureus intoxications accounted for the highest share of costs attributed to food (€ 47.1 million/year), followed by Campylobacter spp. (€ 32.0 million/year) and norovirus (€ 17.7 million/year).

Emergence of pregnancy-related listeriosis amongst ethnic minorities in England and Wales.

Listeriosis is a rare but severe food-borne disease that predominantly affects pregnant women, the unborn, newborns, the elderly and immunocompromised people. Following a large outbreak in the 1980s, specific food safety advice was provided to pregnant women and the immunocompromised in the United Kingdom. Following two coincident yet unconnected cases of pregnancy-related listeriosis in eastern European women in 2008, a review of the role of ethnicity in pregnancy-related listeriosis in England and Wales was undertaken in 2009. Cases reported to the national listeriosis surveillance scheme were classified as 'ethnic', belonging to an ethnic minority, or 'non-ethnic' based on their name, and trends were examined. Between 2001 and 2008, 1,510 cases of listeriosis were reported in England and Wales and, of these, 12% were pregnancy-related cases. The proportion of pregnancy-related cases classified as ethnic increased significantly from 16.7% to 57.9% (chi-square test for trend p=0.002). The reported incidence among the ethnic population was higher than that among the non-ethnic population in 2006, 2007 and 2008 (Relative Risk: 2.38, 95% confidence interval: 1.07 to 5.29; 3.82, 1.82 to 8.03; 4.33, 1.74 to 10.77, respectively). This effect was also shown when analysing data from January to September 2009, using extrapolated live births as denominator. Increased immigration and/or economic migration in recent years appear to have altered the population at risk of pregnancy-related listeriosis in England and Wales. These changes need to be taken into account in order to target risk communication strategies appropriately.

Human listeriosis in England, 2001-2007: association with neighbourhood deprivation.

Listeriosis is a rare but severe food-borne disease that predominantly affects pregnant women, the unborn, newborns, the elderly and immunocompromised people. Despite the high mortality rate of the disease, its socio-economic determinants have not been studied in detail, meaning that health inequalities that might exist in relation to this disease are not apparent. Laboratory surveillance data on listeriosis cases reported in England between 2001 and 2007 were linked to indices of deprivation and denominator data using patients' postcodes. Incidence relative to increasing quintiles of deprivation was calculated by fitting generalised linear models while controlling for population size. Patient food purchasing and consumption data were scrutinised and compared with commercial food purchasing denominator data to further quantify the observed differences in disease incidence. For all patient groups, listeriosis incidence was highest in the most deprived areas of England when compared with the most affluent, and cases were more likely to purchase foods from convenience stores or from local services (bakers, butchers, fishmongers and greengrocers) than the general population were. Patients' risk profile also changed with increasing neighbourhood deprivation. With increased life expectancy and rising food prices, food poverty could become an increasingly important driver for foodborne disease in the future. While United Kingdom Government policy should continue to focus on small food businesses to ensure sufficient levels of food hygiene expertise, tailored and targeted food safety advice on the avoidance of listeriosis is required for all vulnerable groups. Failure to do so may enhance health inequality across socio-economic groups.

The cost and benefit of Listeria monocytogenes food safety measures.

The objectives of this study were to evaluate economic techniques used to determine the cost and benefit of Listeria monocytogenes control and to estimate the economic optimum of L. monocytogenes food safety measures. The level of food safety measures is optimal if marginal benefit and marginal cost equate. Estimates of benefit and cost of L. monocytogenes food safety measures, from available published literature, are derived from different methods of economic analysis (willingness to pay, cost of illness, cost function, and event study methods). The estimated annual benefit and cost of L. monocytogenes food safety measures range from $2.3 billion to $22 billion and from $.01 billion to $2.4 billion, respectively. The estimated marginal benefit exceeds the estimated marginal cost, which implies that more food safety measures are warranted before the optimal level of L. monocytogenes food safety can be reached. However, due to considerable lack of data, the optimal level of L. monocytogenes food safety measures could not be estimated. When better data become available, this study can serve as a template for estimating the optimal level of food safety. The understanding of the economic optimum of food safety level will contribute to designing a control program that is economical and acceptable for US society.

Economic analysis of vaccination applied to ovine listeriosis.

An economic model for determining whether vaccination against a disease would be beneficial financially on individual farms is proposed; it is based on four pieces of information: the costs of a disease case including its treatment, the cost of vaccinating each animal including veterinary fees, the expected incidence of the disease, and the efficacy of the vaccine. The model was applied to ovine listeriosis, which is a serious disease problem in Norway. Vaccination appeared to be beneficial for the average sheep flock of 100 ewes which might expect two or more cases of listeriosis per year. Furthermore, the model suggests the ratio of the price of a single vaccination to the cost of a disease case can be used to plan more efficient vaccine field trials.