The costs of foodborne illness are substantial and significant.  The November 18, 2009, Chicago Tribune article, “Food Poisoning: Source of E. coli illness often can’t be found“, effectively described the difficulty associated with finding the cause of most foodborne illnesses, and the seeming futility of public health agencies’ efforts in tracing suspected pathogens to their source when a victim is not part of an outbreak.  Reading the article, I was reminded of the substantial cost of foodborne illness, and that the majority of foodborne illness victims have no way to recover any related compensation.

At Marler Clark, we take pride in working hard to identify the likely sources of the foodborne pathogens inflicting illness on victims who contact us in the hopes of recovering compensation for lost time at work, medical bills, and other losses associated with their illnesses.  We use the experience and knowledge of our staff epidemiologist, and the resources provided by our many epidemiology and microbiology experts.  Inevitably, however, we face the same challenges as those faced by public health agencies and in many cases it is simply not possible to trace back a likely source.  In those unfortunate cases, the illness victims have no way to identify a potentially responsible party, and to recover at least some of their related losses.

A comprehensive national study in 1999 summed up those illnesses attributable to foodborne gastroenteritis caused by both known and unknown pathogens, and yielded an estimate of 76 million illnesses, 318,574 hospitalizations, and 4,316 deaths per year.  Adding to these figures the nongastrointestinal foodborne illness caused by Listeria, Toxoplasma, and hepatitis A virus, the study arrived at a final national estimate of 76 million illnesses, 323,914 hospitalizations, and 5,194 deaths each year.  The analysis further suggested that unknown agents account for approximately 81 percent of those foodborne illnesses and hospitalizations, and for approximately 64 percent of deaths. [1]        

The available existing data on foodborne illnesses does not fully depict the extent of the problem. Public health experts believe that the majority of cases of foodborne illness are not reported, because the initial symptoms of most foodborne illnesses are not severe enough to warrant medical attention, because the medical facility a person is treated at or the state health department does not report such cases, or the illness is not recognized as foodborne. [2]

It is often assumed that the sources of foodborne illness outbreaks are typically identified, given the extensive coverage of national outbreaks such as the recent contaminated spinach and peanut butter outbreaks.   In fact, however, according to the Centers for Disease Control and Prevention (CDC), in nearly 60 percent of outbreaks, a source of the pathogen involved is never found.  [1]

Tracking the source of the far more numerous cases of sporadic and single illness is even more difficult, and is far less successful. Investigated outbreaks account for only a small and nonrepresentative share of all foodborne illnesses.  Although sporadic illnesses involving a single person are far more common, public health agencies are more likely to learn of, and to investigate, outbreaks affecting many people. [3]

While the overall annual economic cost of foodborne illnesses is unknown, it is estimated to be in the billions of dollars. The range of estimates is wide, primarily because of the uncertainty about the number of cases of foodborne illness and related deaths.  The range of estimates may also depend on the differences in the analytical approach used to prepare the estimate. Some economists attempt to estimate the costs related to medical treatment and lost wages (the cost-of-illness method); others attempt to estimate the value of reducing the incidence of illness or loss of life (the willingness-to-pay method).  

Two estimates demonstrate these differences in analytical approach. In the first, USDA’s Economic Research Service (ERS) used the cost-of-illness approach to estimate that the 1993 medical costs and losses in productivity resulting from seven major foodborne pathogens ranged between $5.6 billion and $9.4 billion.  In the second analysis, ERS used the willingness-to-pay method to estimate the value of preventing deaths for five of the seven major pathogens (included in the first analysis) at $6.6 billion to $22 billion in 1992. [2]

More recently, CDC has studied and estimated the cost of a specific pathogen, the Shiga toxin-producing Escherichia coli O157 (O157 STEC) bacteria.   Escherichia coli O157 infections cause 73,000 illnesses annually in the United States, resulting in more than 2,000 hospitalizations and 60 deaths. In the CDC study, the economic cost of illness due to O157 STEC infections transmitted by food or other means was estimated based on the CDC estimate of annual cases and newly available data from the Foodborne Diseases Active Surveillance Network (FoodNet) of the CDC Emerging Infections Program. The annual cost of illness due to O157 STEC was $405 million (in 2003 dollars), including $370 million for premature deaths, $30 million for medical care, and $5 million in lost productivity. The average cost per case varied greatly by severity of illness, ranging from $26 for an individual who did not obtain medical care to $6.2 million for a patient who died from hemolytic uremic syndrome.  [4]

The effect can be catastrophic on everyday life for those who lack the resources to cover these costs. 62.1 percent of all bankruptcies in 2007 were medical; 92 percent of these medical debtors had medical debts over $5000, or 10 percent of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6 percent.  The odds that a bankruptcy had a medical cause were 2.38-fold higher in 2007 than in 2001. [5]

Even more importantly, the long term health impacts of foodborne illness can be substantial and severe.  The severity of acute foodborne disease varies greatly, depending on the pathogen and the vulnerability of the person infected.  Diarrhea and vomiting are common symptoms and, in most cases, last for only a few days.  While foodborne illnesses are often temporary, they can also result in more serious illnesses requiring hospitalization, long-term disability, and death.  

Some pathogens have the ability to cause very serious acute illnesses, with parasites, bacteria or bacterial toxins invading the bloodstream. When this occurs, various organs may become compromised or fail, leading to serious health complications or premature death (Mead et al. 1999). For a subset of patients, other serious long-term health outcomes, such as kidney failure, paralysis, seizures, and neurological/cognitive impacts, can develop (Reeseet al. 2004; Lindsay 1997).  Serious complications can result when diarrhetic infections resulting from foodborne pathogens act as a triggering mechanism in susceptible individuals, causing an illness such as reactive arthritis to flare up.  In other cases, no immediate symptoms may appear, but serious consequences may eventually develop. [6]

Children, the elderly, pregnant women, and other individuals with compromised immune systems are at high risk for developing serious cases of foodborne illness. Children are of special concern.  About half of the reported cases of foodborne illnesses occur
in children under 15 years o
f age (CDC, FoodNet data, 2008), and children have more years of life ahead of them in which to be affected by long-term health outcomes. [6]

The likelihood of serious complications is unknown, but some experts estimate that 2 to 3 percent of all cases of foodborne illness lead to serious consequences. For example: E. coli O157:H7 can cause kidney failure in young children and infants; Salmonella can lead to reactive arthritis, serious infections, and deaths; Listeria can cause meningitis and stillbirths and is fatal in 20 to 40 percent of cases; and Campylobacter may be the most common precipitating factor for Guillain-Barre syndrome, which is one of the leading causes of paralysis from disease in the United States. [2]

These numbers are significant, of course, but somewhat dry.  The statistics necessarily fail to account for the subjective and highly personal emotional impacts on those who become ill, and on their families.  These illnesses too often cause permanent anxiety, stress, and fear of the future, in addition to pain, physical limitations, and economic uncertainty.  

It is frustrating when a likely source of a client’s illness cannot be identified, especially when the illness has been severe, and its impacts will be many, life-changing, and permanent.  That person has no available remedy or recourse to help reduce at least the economic burdens imposed by the illness.

[1] Mead, Slutsker, Dietz, McCaig, Bresee, Shapiro, Griffin, and Tauxe, “Food-Related Illness and Death in the United States”, Emerging Infectious Diseases, Vol. 5, No. 5, 1999.
[2] “Food Safety, Reducing the Threat of Foodborne Illnesses”, US General Accounting Office, GAO/T-RCED-96-185 (1996).
[3] Buzby, Frenzen, and Rasco, “Product Liability and Microbial Foodborne Illness”Agricultural Economic Report No. (AER799) 45 pp, April 2001.
[4] Frenzen PD, Drake A, Angulo FJ; “Economic cost of illness due to Escherichia coli O157 infections in the United States”. J Food Prot. 2005 Dec: 68 (12):2623-30.
[5] Himmelstein, Thorne, and Woolhandler, “Medical Bankruptcy in the United States, 2007: Results of a National Study”, The American Journal of Medicine, Vol. 122, No. 8, August 2009.
[6] Roberts, Kowalcyk, and Buck, “The Long-Term Health Outcomes of Selected Foodborne Pathogens”, Center for Foodborne Illness Research & Prevention.