Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-8 (of 8 Records) |
Query Trace: Havelaar AH[original query] |
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Attribution of illnesses transmitted by food and water to comprehensive transmission pathways using structured expert judgment, United States
Beshearse E , Bruce BB , Nane GF , Cooke RM , Aspinall W , Hald T , Crim SM , Griffin PM , Fullerton KE , Collier SA , Benedict KM , Beach MJ , Hall AJ , Havelaar AH . Emerg Infect Dis 2021 27 (1) 182-195 Illnesses transmitted by food and water cause a major disease burden in the United States despite advancements in food safety, water treatment, and sanitation. We report estimates from a structured expert judgment study using 48 experts who applied Cooke's classical model of the proportion of disease attributable to 5 major transmission pathways (foodborne, waterborne, person-to-person, animal contact, and environmental) and 6 subpathways (food handler-related, under foodborne; recreational, drinking, and nonrecreational/nondrinking, under waterborne; and presumed person-to-person-associated and presumed animal contact-associated, under environmental). Estimates for 33 pathogens were elicited, including bacteria such as Salmonella enterica, Campylobacter spp., Legionella spp., and Pseudomonas spp.; protozoa such as Acanthamoeba spp., Cyclospora cayetanensis, and Naegleria fowleri; and viruses such as norovirus, rotavirus, and hepatitis A virus. The results highlight the importance of multiple pathways in the transmission of the included pathogens and can be used to guide prioritization of public health interventions. |
Estimate of burden and direct healthcare cost of infectious waterborne disease in the United States
Collier SA , Deng L , Adam EA , Benedict KM , Beshearse EM , Blackstock AJ , Bruce BB , Derado G , Edens C , Fullerton KE , Gargano JW , Geissler AL , Hall AJ , Havelaar AH , Hill VR , Hoekstra RM , Reddy SC , Scallan E , Stokes EK , Yoder JS , Beach MJ . Emerg Infect Dis 2021 27 (1) 140-149 Provision of safe drinking water in the United States is a great public health achievement. However, new waterborne disease challenges have emerged (e.g., aging infrastructure, chlorine-tolerant and biofilm-related pathogens, increased recreational water use). Comprehensive estimates of the health burden for all water exposure routes (ingestion, contact, inhalation) and sources (drinking, recreational, environmental) are needed. We estimated total illnesses, emergency department (ED) visits, hospitalizations, deaths, and direct healthcare costs for 17 waterborne infectious diseases. About 7.15 million waterborne illnesses occur annually (95% credible interval [CrI] 3.88 million-12.0 million), results in 601,000 ED visits (95% CrI 364,000-866,000), 118,000 hospitalizations (95% CrI 86,800-150,000), and 6,630 deaths (95% CrI 4,520-8,870) and incurring US $3.33 billion (95% CrI 1.37 billion-8.77 billion) in direct healthcare costs. Otitis externa and norovirus infection were the most common illnesses. Most hospitalizations and deaths were caused by biofilm-associated pathogens (nontuberculous mycobacteria, Pseudomonas, Legionella), costing US $2.39 billion annually. |
Diarrhoeal disease in children due to contaminated food
Kirk MD , Angulo FJ , Havelaar AH , Black RE . Bull World Health Organ 2017 95 (3) 233-234 In December 2015, the World Health Organization (WHO) released estimates of the burden of human disease attributable to consumption of food contaminated with 31 infectious agents or chemicals.1 The report concluded that exposure to contaminated food worldwide in 2010 resulted in 600 million episodes of illness (95% uncertainty interval, UI: 420–960 million), 420 000 deaths (95% UI: 310 000–600 000) and 33 million disability-adjusted life years (DALYs) (95% UI: 25–46 million).1 The numbers were based on 4.6 billion cases of diarrhoea (95% UI: 3.5–6.5 billion) and 1.6 million deaths due to diarrhoea (95% UI: 1.3–1.9 million) that occurred worldwide in 2010, similar to numbers occurring in later years.2 | A key element of the estimation was attributing a proportion of the diarrhoea deaths to foodborne transmission of infections. A structured expert judgement was used to apportion transmission modes for individual pathogens, by estimating that 29% (95% UI: 22–36%) of 11 key bacterial, viral and protozoal causes of diarrhoea were foodborne.3 Food contaminated with these 11 agents resulted in 548 million episodes of diarrhoea (95% UI: 370–888 million) and 200 000 deaths (95% UI: 137 000–287 000) in 2010. Of these, 217 million infections (39%; 95% UI: 29–38%) were in children younger than 5 years of age.4 This disproportionate burden of foodborne diarrhoeal disease in young children is evident in the high rate ratio of DALYs in children younger than 5 years compared with older children and adults (ratio: 11.6; 95% UI: 8.4–15.6). Among children younger than 5 years, foodborne transmission of the 11 agents could have constituted as much as 16% of the estimated 578 000 deaths due to diarrhoea (95% UI: 448 000–750 000), updated to 2013.5 |
World Health Organization estimates of the relative contributions of food to the burden of disease due to selected foodborne hazards: a structured expert elicitation
Hald T , Aspinall W , Devleesschauwer B , Cooke R , Corrigan T , Havelaar AH , Gibb HJ , Torgerson PR , Kirk MD , Angulo FJ , Lake RJ , Speybroeck N , Hoffmann S . PLoS One 2016 11 (1) e0145839 BACKGROUND: The Foodborne Disease Burden Epidemiology Reference Group (FERG) was established in 2007 by the World Health Organization (WHO) to estimate the global burden of foodborne diseases (FBDs). This estimation is complicated because most of the hazards causing FBD are not transmitted solely by food; most have several potential exposure routes consisting of transmission from animals, by humans, and via environmental routes including water. This paper describes an expert elicitation study conducted by the FERG Source Attribution Task Force to estimate the relative contribution of food to the global burden of diseases commonly transmitted through the consumption of food. METHODS AND FINDINGS: We applied structured expert judgment using Cooke's Classical Model to obtain estimates for 14 subregions for the relative contributions of different transmission pathways for eleven diarrheal diseases, seven other infectious diseases and one chemical (lead). Experts were identified through international networks followed by social network sampling. Final selection of experts was based on their experience including international working experience. Enrolled experts were scored on their ability to judge uncertainty accurately and informatively using a series of subject-matter specific 'seed' questions whose answers are unknown to the experts at the time they are interviewed. Trained facilitators elicited the 5th, and 50th and 95th percentile responses to seed questions through telephone interviews. Cooke's Classical Model uses responses to the seed questions to weigh and aggregate expert responses. After this interview, the experts were asked to provide 5th, 50th, and 95th percentile estimates for the 'target' questions regarding disease transmission routes. A total of 72 experts were enrolled in the study. Ten panels were global, meaning that the experts should provide estimates for all 14 subregions, whereas the nine panels were subregional, with experts providing estimates for one or more subregions, depending on their experience in the region. The size of the 19 hazard-specific panels ranged from 6 to 15 persons with several experts serving on more than one panel. Pathogens with animal reservoirs (e.g. non-typhoidal Salmonella spp. and Toxoplasma gondii) were in general assessed by the experts to have a higher proportion of illnesses attributable to food than pathogens with mainly a human reservoir, where human-to-human transmission (e.g. Shigella spp. and Norovirus) or waterborne transmission (e.g. Salmonella Typhi and Vibrio cholerae) were judged to dominate. For many pathogens, the foodborne route was assessed relatively more important in developed subregions than in developing subregions. The main exposure routes for lead varied across subregions, with the foodborne route being assessed most important only in two subregions of the European region. CONCLUSIONS: For the first time, we present worldwide estimates of the proportion of specific diseases attributable to food and other major transmission routes. These findings are essential for global burden of FBD estimates. While gaps exist, we believe the estimates presented here are the best current source of guidance to support decision makers when allocating resources for control and intervention, and for future research initiatives. |
World Health Organization estimates of the global and regional disease burden of 22 foodborne bacterial, protozoal, and viral diseases, 2010: a data synthesis
Kirk MD , Pires SM , Black RE , Caipo M , Crump JA , Devleesschauwer B , Dopfer D , Fazil A , Fischer-Walker CL , Hald T , Hall AJ , Keddy KH , Lake RJ , Lanata CF , Torgerson PR , Havelaar AH , Angulo FJ . PLoS Med 2015 12 (12) e1001921 BACKGROUND: Foodborne diseases are important worldwide, resulting in considerable morbidity and mortality. To our knowledge, we present the first global and regional estimates of the disease burden of the most important foodborne bacterial, protozoal, and viral diseases. METHODS AND FINDINGS: We synthesized data on the number of foodborne illnesses, sequelae, deaths, and Disability Adjusted Life Years (DALYs), for all diseases with sufficient data to support global and regional estimates, by age and region. The data sources included varied by pathogen and included systematic reviews, cohort studies, surveillance studies and other burden of disease assessments. We sought relevant data circa 2010, and included sources from 1990-2012. The number of studies per pathogen ranged from as few as 5 studies for bacterial intoxications through to 494 studies for diarrheal pathogens. To estimate mortality for Mycobacterium bovis infections and morbidity and mortality for invasive non-typhoidal Salmonella enterica infections, we excluded cases attributed to HIV infection. We excluded stillbirths in our estimates. We estimate that the 22 diseases included in our study resulted in two billion (95% uncertainty interval [UI] 1.5-2.9 billion) cases, over one million (95% UI 0.89-1.4 million) deaths, and 78.7 million (95% UI 65.0-97.7 million) DALYs in 2010. To estimate the burden due to contaminated food, we then applied proportions of infections that were estimated to be foodborne from a global expert elicitation. Waterborne transmission of disease was not included. We estimate that 29% (95% UI 23-36%) of cases caused by diseases in our study, or 582 million (95% UI 401-922 million), were transmitted by contaminated food, resulting in 25.2 million (95% UI 17.5-37.0 million) DALYs. Norovirus was the leading cause of foodborne illness causing 125 million (95% UI 70-251 million) cases, while Campylobacter spp. caused 96 million (95% UI 52-177 million) foodborne illnesses. Of all foodborne diseases, diarrheal and invasive infections due to non-typhoidal S. enterica infections resulted in the highest burden, causing 4.07 million (95% UI 2.49-6.27 million) DALYs. Regionally, DALYs per 100,000 population were highest in the African region followed by the South East Asian region. Considerable burden of foodborne disease is borne by children less than five years of age. Major limitations of our study include data gaps, particularly in middle- and high-mortality countries, and uncertainty around the proportion of diseases that were foodborne. CONCLUSIONS: Foodborne diseases result in a large disease burden, particularly in children. Although it is known that diarrheal diseases are a major burden in children, we have demonstrated for the first time the importance of contaminated food as a cause. There is a need to focus food safety interventions on preventing foodborne diseases, particularly in low- and middle-income settings. |
World Health Organization global estimates and regional comparisons of the burden of foodborne disease in 2010
Havelaar AH , Kirk MD , Torgerson PR , Gibb HJ , Hald T , Lake RJ , Praet N , Bellinger DC , de Silva NR , Gargouri N , Speybroeck N , Cawthorne A , Mathers C , Stein C , Angulo FJ , Devleesschauwer B . PLoS Med 2015 12 (12) e1001923 Illness and death from diseases caused by contaminated food are a constant threat to public health and a significant impediment to socio-economic development worldwide. To measure the global and regional burden of foodborne disease (FBD), the World Health Organization (WHO) established the Foodborne Disease Burden Epidemiology Reference Group (FERG), which here reports their first estimates of the incidence, mortality, and disease burden due to 31 foodborne hazards. We find that the global burden of FBD is comparable to those of the major infectious diseases, HIV/AIDS, malaria and tuberculosis. The most frequent causes of foodborne illness were diarrheal disease agents, particularly norovirus and Campylobacter spp. Diarrheal disease agents, especially non-typhoidal Salmonella enterica, were also responsible for the majority of deaths due to FBD. Other major causes of FBD deaths were Salmonella Typhi, Taenia solium and hepatitis A virus. The global burden of FBD caused by the 31 hazards in 2010 was 33 million Disability Adjusted Life Years (DALYs); children under five years old bore 40% of this burden. The 14 subregions, defined on the basis of child and adult mortality, had considerably different burdens of FBD, with the greatest falling on the subregions in Africa, followed by the subregions in South-East Asia and the Eastern Mediterranean D subregion. Some hazards, such as non-typhoidal S. enterica, were important causes of FBD in all regions of the world, whereas others, such as certain parasitic helminths, were highly localised. Thus, the burden of FBD is borne particularly by children under five years old-although they represent only 9% of the global population-and people living in low-income regions of the world. These estimates are conservative, i.e., underestimates rather than overestimates; further studies are needed to address the data gaps and limitations of the study. Nevertheless, all stakeholders can contribute to improvements in food safety throughout the food chain by incorporating these estimates into policy development at national and international levels. |
Methodological framework for World Health Organization estimates of the global burden of foodborne disease
Devleesschauwer B , Haagsma JA , Angulo FJ , Bellinger DC , Cole D , Dopfer D , Fazil A , Fevre EM , Gibb HJ , Hald T , Kirk MD , Lake RJ , Maertens de Noordhout C , Mathers CD , McDonald SA , Pires SM , Speybroeck N , Thomas MK , Torgerson PR , Wu F , Havelaar AH , Praet N . PLoS One 2015 10 (12) e0142498 BACKGROUND: The Foodborne Disease Burden Epidemiology Reference Group (FERG) was established in 2007 by the World Health Organization to estimate the global burden of foodborne diseases (FBDs). This paper describes the methodological framework developed by FERG's Computational Task Force to transform epidemiological information into FBD burden estimates. METHODS AND FINDINGS: The global and regional burden of 31 FBDs was quantified, along with limited estimates for 5 other FBDs, using Disability-Adjusted Life Years in a hazard- and incidence-based approach. To accomplish this task, the following workflow was defined: outline of disease models and collection of epidemiological data; design and completion of a database template; development of an imputation model; identification of disability weights; probabilistic burden assessment; and estimating the proportion of the disease burden by each hazard that is attributable to exposure by food (i.e., source attribution). All computations were performed in R and the different functions were compiled in the R package 'FERG'. Traceability and transparency were ensured by sharing results and methods in an interactive way with all FERG members throughout the process. CONCLUSIONS: We developed a comprehensive framework for estimating the global burden of FBDs, in which methodological simplicity and transparency were key elements. All the tools developed have been made available and can be translated into a user-friendly national toolkit for studying and monitoring food safety at the local level. |
National studies as a component of the World Health Organization initiative to estimate the global and regional burden of foodborne disease
Lake RJ , Devleesschauwer B , Nasinyama G , Havelaar AH , Kuchenmuller T , Haagsma JA , Jensen HH , Jessani N , Maertens de Noordhout C , Angulo FJ , Ehiri JE , Molla L , Agaba F , Aungkulanon S , Kumagai Y , Speybroeck N . PLoS One 2015 10 (12) e0140319 BACKGROUND: The World Health Organization (WHO) initiative to estimate the global burden of foodborne diseases established the Foodborne Diseases Burden Epidemiology Reference Group (FERG) in 2007. In addition to global and regional estimates, the initiative sought to promote actions at a national level. This involved capacity building through national foodborne disease burden studies, and encouragement of the use of burden information in setting evidence-informed policies. To address these objectives a FERG Country Studies Task Force was established and has developed a suite of tools and resources to facilitate national burden of foodborne disease studies. This paper describes the process and lessons learned during the conduct of pilot country studies under the WHO FERG initiative. FINDINGS: Pilot country studies were initiated in Albania, Japan and Thailand in 2011 and in Uganda in 2012. A brief description of each study is provided. The major scientific issue is a lack of data, particularly in relation to disease etiology, and attribution of disease burden to foodborne transmission. Situation analysis, knowledge translation, and risk communication to achieve evidence-informed policies require specialist expertise and resources. CONCLUSIONS: The FERG global and regional burden estimates will greatly enhance the ability of individual countries to fill data gaps and generate national estimates to support efforts to reduce the burden of foodborne disease. |
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