About one in every 10 people around the world is sickened by foodborne disease each year. Of those 600 million people, 420,000 die as a result. These numbers are the first global estimates — conservative ones  — of foodborne illnesses and were calculated by the World Health Organization (WHO). The comprehensive report, published Thursday, Dec. 3, incorporated 31 foodborne hazards, including bacteria, viruses, parasites, toxins and chemicals. Diarrheal diseases were responsible for most of the global burden, causing 550 million illnesses and 230,000 deaths, WHO reported. And children younger than 5 years old carried 40 percent of the foodborne disease burden, despite representing only 9 percent of the global population.

31 Foodborne Hazards in WHO Global Estimates
Diarrheal Disease Agents	Campylobacter spp., Cryptosporidium spp., Entamoeba histolytica, Enteropathogenic E. coli (EPEC), Enterotoxigenic E. coli (ETEC), Giardia spp., Norovirus, Salmonella enterica (non-invasive infections) non-typhoidal, Shigella spp., Shiga toxin-producing E. coli (STEC), Vibrio cholerae
Invasive Infectious Disease Agents	Brucella spp., Hepatitis A virus, Listeria spp., Mycobacterium bovis, Salmonella enterica (invasive infections) non-typhoidal, Salmonella enterica Paratyphi A, Salmonella enterica Typhi
Helminths	Ascaris spp., Echinococcus multilocularis, Echinococcus granulosus, Clonorchis sinensis, Fasciola spp., Intestinal flukes, Opisthorchis spp., Paragonimus spp., Taenia solium, Toxoplasma gondii, Trichinella spp.
Chemicals	Aflatoxin, Cassava cyanide, Dioxin

  Certain diseases, such as those caused by non-typhoidal Salmonella, are a public health concern across all regions of the world. Other diseases, such as typhoid fever, foodborne cholera, and those caused by pathogenic E. coli, are much more common in low-income countries. Campylobacter is an important pathogen in high-income countries. “Until now, estimates of foodborne diseases were vague and imprecise. This concealed the true human costs of contaminated food,” said Dr. Margaret Chan, WHO director-general. “This report sets the record straight.” The risk of foodborne diseases is most severe in low- and middle-income countries and is linked to preparing food with unsafe water, poor hygiene and inadequate conditions in food production and storage, lower levels of literacy and education, and insufficient food safety legislation or implementation of such legislation.

The WHO African and South-East Asia regions have the highest incidence and highest death rates, including among children younger than 5 years. The WHO African Region was estimated to have the highest burden of foodborne diseases per population. More than 91 million people are estimated to fall ill, and 137,000 die each year. Non-typhoidal Salmonella causes the most deaths, and 10 percent of the overall foodborne disease burden in this region is caused by Taenia solium (the pork tapeworm), according to the report. Chemical hazards, specifically cyanide and aflatoxin, cause one-quarter of deaths from foodborne diseases in the region. Konzo, a particular form of paralysis caused by cyanide in cassava, is unique to the African Region, resulting in death in 1 of every 5 people affected. The WHO South-East Asia region has the second-highest burden of foodborne diseases per population. In terms of absolute numbers, though, more people living in the region fall ill and die from foodborne diseases every year than in any other WHO Region, with more than 150 million cases and 175 000 deaths a year. Diarrheal disease-causing agents, Norovirus, non-typhoidal Salmonella and pathogenic E. coli cause the majority of foodborne disease deaths in the region. Globally, half of the people who are infected and die from either typhoid fever or Hepatitis A reside in the South-East Asia Region. “Knowing which foodborne pathogens are causing the biggest problems in which parts of the world can generate targeted action by the public, governments, and the food industry,” Chan said. In addition to disease incidence and mortality, WHO estimated disease burden in terms of Disability Adjusted Life Years (DALYs). They calculated that the global burden of foodborne disease is 33 million DALYs. Worldwide, 18 million DALYs were attributed to foodborne diarrheal disease agents, particularly non-typhoidal Salmonella enterica and enteropathogenic E. coli (EPEC). Other foodborne hazards with a substantial contribution to the global burden included Salmonella Typhi and Taenia solium.

The estimates are “conservative” ones, said Dr. Kazuaki Miyagishima, director of WHO’s Department of Food Safety and Zoonoses. “More needs to be done to improve the availability of data on the burden of foodborne diseases.” But “[d]espite the data gaps and limitations of these initial estimates, it is apparent that the global burden of foodborne disease is considerable,” WHO concluded. “All stakeholders can contribute to improvements in food safety throughout the food chain by incorporating these estimates into policy development at national, regional and international levels.” (To sign up for a free subscription to Food Safety News, click here.)