Fourteen foodborne pathogens cost $14.1 billion and present a significant public health burden, according to a report released today by the University of Florida’s Emerging Pathogens Institute. The study is the first comprehensive ranking of pathogen-food combinations, identifying the top 10 riskiest pairs.

Campylobacter and poultry, Toxoplasma and pork (and unknown sources), Listeria and deli meats, Salmonella and poultry, and Listeria in dairy products top the list.

Next in the ranking: both Salmonella and Norovirus from “complex foods,” Salmonella from produce, Toxoplasma from Beef, and Salmonella from eggs.

Ninety percent of the health burden is caused by five pathogens: Salmonella, Campylobacter, Listeria monocytogenes, Toxoplasma gondii and norovirus. These bugs are responsible for an estimated $12.7 billion in annual economic loss.

The authors of the 70-page report, which was supported by a Robert Wood Johnson Foundation grant, hope the analysis will help federal regulators target finite food safety resources based on risk.

The Food Safety Modernization Act, signed into law in January, directs FDA to adopt a more preventative, risk-based approach, but, as the report authors note, “doesn’t spell out exactly how this should be done.”

“The number of hazards and scale of the food system make for a critical challenge for consumers and government alike,” said Michael Batz, lead author of the report and head of Food Safety Programs at the Emerging Pathogens Institute. “Government agencies must work together to effectively target their efforts. If we don’t identify which pairs of foods and microbes present the greatest burden, we’ll waste time and resources and put even more people at risk.”

To estimate such risks, researchers calculated the public health burden using the cost of medical care and lost productivity from employee sick days, in addition to the expenses associated with serious complications or chronic disabilities that result from the acute illness, and then paired illness with food attribution.

Poultry contaminated with Camplylobacter topped the risk ranking, sickening more than 600,000 Americans and costing $1.3 billion annually. Salmonella in poultry ranked fourth with more than 200,000 illnesses and $700 million in costs. The UF researchers question whether new safety standards announced by the USDA for young chickens and turkeys are sufficient, and recommend evaluating and tightening these standards over time.

The report also recommends that the FDA and USDA develop a joint Salmonella initiative that coordinates efforts, that agencies strengthen Listeria prevention programs in part by improving education efforts aimed at pregnant women (who are more at risk, especially for miscarriages). Other recommendations include: Battling the number of Norovirus illnesses by strengthening state and local food safety programs through increased funding, training and adoption by states of the most recent FDA Food Code and continuing to target E. coli O157:H7.

The full report can be found at the Emerging Pathogens Institute website at