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

  • Doc Mudd

    Now there’s one we don’t hear much about. Deadly and prevalent. Maybe we’re not hearing enough about toxoplasma since there are no associated product recalls? Here’s some detail:
    “Toxoplasma gondii is one of the world’s most common parasites. It is the second leading cause of deaths attributed to foodborne illness in the United States, and the third leading cause of foodborne illness hospitalizations. It is estimated that 22.5% of the population over the age of 12 has been infected with the Toxoplasma parasite. For some populations, this figure is as high as 95%.
    Toxoplasma from animal feces can contaminate soil or water.
    To reduce the risk of contracting toxoplasmosis from sources in the environment, take the following precautions:
    Wear gloves when gardening
    Avoid drinking untreated water
    Wash hands thoroughly before and after preparing food
    Wash or peel all fruits and vegetables before consumption
    Do not drink unpasteurized milk”
    Hmmm. With an emerging fad for gardening and ‘organic food’ produced with quaint manure-based technology, toxoplasmosis may have a clear shot at becoming the number one cause of death attributed to foodborne illness during this decade.
    Feeding more raw/improperly cooked organically grown vegetables to larger populations of pregnant women might significantly increase the human carnage wrought by Toxoplasma gondii.

  • Gustaaf van der Feltz

    Government should require the use of bacteriophages against Listeria. Phages are taken from the human imune system and are absolutely harmless but for Listeria monocytogenes. Every listeria is eaten leaving no trace.
    Where do you get these phages? There is a company in Holland called EBI Foodsafety ( ). There you can get a product called Listex. Bur perhaps there are other companies making specific phages.
    This could avoid many deaths and sick! Why not just contact them!

  • Gabrielle Meunier

    The Food Safety Modernization Act was the first step in better prevention of pathogens from entering our food supply. Now the hard part is implementing the law. It is nice to see various organizations willing to help the FDA get their arms around creating a safer food supply. Because as some Senators would say that we have the safest food supply in the world — that just isn’t good enough when millions of Americans are sickened each year ABSOLUTLY NEEDLESSLY from an illness that is preventable.

  • Minkpuppy

    Toxoplasma eh? I didn’t even get training to look for that when I started in slaughter inspection. Probably because it doesn’t form a nice little cyst or nodule like other parasites do. Most people that are diagnosed with it probably don’t even realize where it came from. Odd.

  • ICBM

    Toxoplasmosis, huh…. prevalent , yes…. but injurious? Not really — unless you have a severely compromised immune system, say from HIV… Musta dug deep into the muddd for that one… SOMEBODY’s got a lot of spare time on their hands…

  • Doc Mudd

    Toxoplasma injurious? YES!
    Second most deadly form of food poisoning! (And not just among HIV patients as solaciously asserted in the thread above by at least one cocky apologist for dangerous, grubby local garden truck)
    Looks like Florida’s EPI may have bumped up against the tip of an important food safety iceberg with Toxoplasmosis!
    Kinda brings the inherent dangers of faddish manure-fertilized ‘organic’ garden produce and dubious ‘back to nature’ agriculture into sharp, coherent disease-prone perspective.
    Women of child-bearing age take note of this very real, very serious threat to yourself and your unborn child next time you’re strolling around your local farmers market. ‘Organic’ food = manure-laden food = significant risk from toxoplasmosis.

  • Toxo was a bit of a surprise to us, definitely, but it comes from CDC incidence estimates. It ranks highly because costs of illness and QALY measures are very sensitive to deaths. Scallan et al estimates 327 foodborne deaths annually, compared to 20 for E. coli O157:H7. Congenital impacts are included in our analysis, which bumps it up as well. (It’s worth noting that Toxo was very high in Mead as well, but still pretty much ignored as a foodborne risk over the past decade. Not to be glib, but no outbreaks means no news means no outrage means no pressure means no action.)
    It’s unclear what percent of those deaths are immunocompromised, though historically we’d expect them to be primarily AIDS patients. Obviously the fact that toxo can present acutely or lay dormant in latent form for years presents serious challenges to determining its incidence in general, not to mention whether rates are changing over time. Still, the high number of foodborne deaths surprised us, particularly given improvements in treatment for HIV/AIDS.
    After doing this study, I think there is a real need to get a better handle on the incidence of both adult and congenital toxo in this country. We also need to figure out what portion is foodborne, and which of these pathways are most responsible. Our expert elicitation pointed to pork (45+ returns, peer-reviewed), but a recent FoodNet case-control study points to handling raw beef, and I’ve heard rumors that retail surveys of lamb have found very high rates of contamination.

  • Minkpuppy

    Here I spent my whole meat inspection career thinking that I could only get toxo from my cat’s poop when I should have been worrying about the animals I was inspecting. Thanks guys.
    My tendency towards hypochondria has now become full blown. Do you know how hard it is to convince a doctor to check you for parasites even when they know you work around livestock and meat? Sheesh. Where’s my anti-anxiety meds? 😉