One in six Taiwanese people suffered from foodborne illness annually during a four year period studied by researchers.

From 2012 to 2015, almost 3.9 million foodborne illnesses and 50 deaths occurred annually in the country.

Scientists said the study, published in the Journal of the Formosan Medical Association, provided the first national estimates on the disease burden from foodborne illnesses in Taiwan.

Among just more than half of foodborne illnesses cases with identifiable causal microorganisms, non-typhoid Salmonella, norovirus, and Vibrio parahaemolyticus were leading pathogens.

Foodborne illnesses caused a substantial financial disease burden, with a medical cost up to NT $1.3 billion (U.S. $43,400) annually.

Need for active surveillance
In the United States, the Centers for Disease Control and Prevention estimates that 48 million foodborne illnesses, hitting one in every six Americans, occur annually, which causes 12,800 hospitalizations and 3,000 deaths.

Estimates for the study in Taiwan were based on the National Health Insurance Research Database (NHIRD), TFDA figures, and Taiwan Centers for Disease Control (TCDC) statistics of notifiable diseases. Scientists also adopted the World Health Organization (WHO) Foodborne Disease Burden Epidemiology Reference Group (FERG) methodology.

In 2014, Taiwan Food and Drug Administration (TFDA) statistics listed only 4,504 cases. Reporting of foodborne outbreak cases to the agency is not mandatory.

Results show these statistics underestimate the number of people experiencing foodborne illness. Researchers found that foodborne illnesses estimated from NHIRD were 865 times higher than the amount of cases reported to TFDA.

Non-typhoid Salmonella causes an estimated 185,977 cases with six deaths annually. Norovirus causes 157,565 cases and no deaths and Vibrio parahaemolyticus 99,351 cases and no deaths. Cases caused by non-typhoid Salmonella peaked in summer, those caused by norovirus peaked in winter.

Results also showed Salmonella incidence is highest in children younger than 5 years old, a highly vulnerable population.

Researchers said foodborne illnesses cause a substantial disease burden in Taiwan.

“Our study highlights the important role of biological agents in food safety, which should be taken into account in food safety policy-making,” they reported. “To minimize the public health risk, establishment of active surveillance and investigation mechanisms for the leading foodborne pathogens is warranted.”

Assessing risk of E. coli in beef
Meanwhile, another study has estimated if imported beef products are a potential hazard to Taiwanese consumers.

Taiwan produces 7,000 metric tons of beef annually; however, 95 percent of beef consumed in the country is imported, of which about 30 percent is from the United States.

The study, published in the journal Microorganisms, assumed that raw beef imported from the U.S. may be contaminated with E. coli O157:H7. By combining the amount of colony forming units (CFU) of E. coli O157 in beef products with the daily consumption by Taiwanese individuals in grams per day, researchers conducted a simulation analysis of exposure to E. coli O157 among the population.

The probability distribution showed that, in males aged 19 to 65 years in Taiwan, when rare beef was consumed, on one occasion for every 100 instances, there was a 90 percent probability of ingesting seven colony forming units of E. coli O157:H7. When medium beef was eaten, in one of every 10,000 servings, there was a 90 percent probability of ingesting two colony forming units of E. coli O157.

When the risk was 5 percent, the rate of foodborne illnesses caused by consuming rare beef contaminated with E. coli O157 was 10 to 28 cases per 1 million individuals. For medium beef, this rate was 6 to 13 per 100 million individuals.

Sensitivity analyses indicated that the amount of E. coli O157 remaining in beef products after cooking was the most important risk factor, followed by the amount of beef products consumed. Proper cooking of beef reduces the incidence of foodborne disease to almost zero, they reported.

Researchers also recommended that importers should strictly control and manage testing for pathogenic bacteria to reduce contamination and the public should reduce consumption of high-risk beef products, such as rare beef.

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