The Study On Epidemiological Characteristics And Disease Burden Of Bacterial Foodborne Disease In China, During 2003-2008

Objective1. To understand epidemiological characteristics of of bacterial foodborne disease outbreak events in China by analysing Chinese foodborne monitoring network data;2. To calculate the disease burden of bacterial foodborne diseases, and three major pathogens (nontyphoidal Salmonella, Vibrio parahaemolyticus and Shigella) in China by available national data of diarrhea morbidity and mortality;3. To calculate the food-specific risk of bacterial foodborne diseases, and three major pathogens (non-typhoid Salmonella, Vibrio parahaemolyticus and Shigella) in China with national dietary survey data in 2002.Methods1. Based on the report data of bacterial foodborne disease outbreaks from foodborne disease monitoring network in 2003-2008, describe and analyze the epidemiological characteristics of bacterial foodborne outbreaks, including the incidence time trend of events, age distribution, geographical distribution, pathogens, food characteristics and causes.2. Through collecting the available literatures on the diarrhea investigation including the incidence, hospitality, in-patient and mortality rate, and the cost of illness, calculate the epidemiological and direct economic burden of bacterial foodborne disease; Calculate the indirect economic burden with human captical approach; Calculate disability-adjusted life year (Disability-adjusted Life Years, DALYs) caused by bacterial foodborne illness using of international common formula. 3. Calculate the proportions of three main foodborne pathgens with reviewing literatures, obtain the incidence and mortality of the three pathgens with the death causes report and other data.4. Calculate the food-specific risks of foodborne diseases caused by bactera and three specific pathogens including nontyphoidal Salmonella, Vibrio parahaemolyticus, and Shigella with the foodborne disease monitoring network data.Results1. Analysis of epidemiological characteristics of bacterial foodborne diseases during 2003-20081157 foodborne outbreaks were reported from national foodborne monitoring network during 2003-2008, causing 35208 cases,17894 hospitalizations and 16 deaths. May to September is the high season; The reported incidence, hospitality and mortality rate leads in 6-15 Year old; Vibrio parahaemolyticus is the most important foodborne pathogen from outbreak report, the cases caused by it composes 25.6 percent of total; poultry meat products is the primary pathogenic food; 16 cases of deaths in 15 cases caused by Pseudomonas cocovenans subsp.; cross-contamination and improper storage and processing are the main causes.2. Disease burden estimation of bacterial foodborne diseasesEpidemical disease burdenIn China, it is estimated that 0.3812 episodes of acute diarrhoea happen per person per year, 0.4795 episodes of gastroenteritis and 0.0875 episodes of bacterial foodborne disease happen per person per year. Bacterial foodborne diseases cause 27.67% cases see the doctors,3.83% hospitalization and 0.0074% deaths.Based on the population of 1314.48 millions, Annually there were 115017 thousands cases, 31825 thousands obtained medical care,4408 thousands hospitalized and 8530 deaths.It is deduced that the underreporting of bacterial foodborne disease from national foodborne disease montoring network is 12490 times, i.e.99.992% is underreported. Economic burdenThe average outpatient cost of bacterial foodborne disease is 88.48 Yuan, and inpatient cost is 1114.56Yuan. The total medical care cost is 7729 million Yuan and indirect medical cost is 1625 million Yuan each year, in total, direct economic burden is 9354 million Yuan; The indirect economic burden of lost productivity is 3861 million Yuan. Therefore, the COI is estimated to be 13215 million Yuan annually in China, consisting 1.34% of total health expenditure, and 0.06% of GDP in 2006.Disability-adusted Life Year (DALY) estimationThe health burden of bacterical foodborne disease in China is estimated 278827.63 DALYs, the death causes 178,244.17 DALYs, and illness causes 100583.46 DALYs. The total health burden is 2.6 times of that of AIDS in 2006,13.3% of diabetes.3. the epidemical burden of foodborne disease caused by specific pathogenAnnually, foodborne nontyphoidal Salmonella causes 11050 thousands incidences and 792 deaths; foodborne Vibrio parahaemolyticus causes 8574 thousands incidences and no death; foodborne Shigella causes 9806 thousands incidences and 500 deaths.It is deduced underreportings of nontyphoidal Salmonella, Vibrio parahaemolyticus and Shigella are separately 8346,2799 and 33017 times, i.e.99.988%of foodborne nontyphoidal Salmonella,99.964% of foodborne Vibrio parahaemolyticus and 99.997% of foodborne Shigella are underreported.4. Food attributionThe most important cause of bacterial foodborne diseases is poultry and meat products, leading to 51401 thousands episodes of fooeborne disease per year, accounting for 44.69% of cases overall; poultry and meat products are the highest risk food, every one million servings can lead to 160 cases, each intake a meal of meat products, the probability of illness is 7.36×10-5. Baked products ranked second; and aquatic products ranked third, intake of vegetables and edible fungi contribute the lowest risk.The most important cause of foodborne nontyphoidal Salmonella diseases is poultry and meat products, accounting for 54% of cases overall; The risk from intake of baked products is highest, every one million servings can lead to 92 cases, the illness probability of each intake a meal of baking products is 2.256×10-5. Livestock and poultry meat and egg products ranks second, and vegetables and edible fungi ranks lowest.The most important cause of foodborne Vibrio parahaemolyticus diseases is seafood, accounting for 37% of cases overall; every one million servings can lead to 21 cases, the illness probability of each intake a meal of seafood is 9.197×10-6. Livestock and poultry meat and soybean products ranks second, and vegetables and cereal products rank lowest, the main causes of foodborne Shigella disease are fruit juice, poultry and meat products, and milk products. Every one million servings of fruit juice can lead to 306 cases, the illness probability of each intake a meal of fruit juice is 1.299×10-4. poultry and meat products rank second, and milk products rank third. Conclusions1. Vibrio parahaemolyticus is the leading pathogen of foodborne diseases outbreaks in China. Pseudomonas cocovenans subsp. is the leading cause of death; 6-15 year-old group is the focus population to prevent and control of foodborne disease outbreaks; Poultry and meat product is the main reason food; Cross-contamination and improper processing, storage are the most important causes of foodborne outbreaks.2. Baterial foodborne diseases caused heavy burden on the cases and society in China. The prevention and control of bacterial foodborne disease should be strengthed, focusing on the construct of foodborne monitoring network, improving monitoring ability, and strengthing the health education to consumers and handlers.3. Nontyphoidal Salmonella, Vibrio parahaemolyticus and Shigella are the three main foodborne pathogens. Nontyphoidal Salmonella leads first and the other two pathogens rank second. The underreporting of Shigella of foodborne monitoring network is the most serious and should be improved.4. Poultry and meat products are the main cause of bacterial foodborne diseases; Intake of baked foods leads the risk of non-typhoid Salmonella infection, seafood leads the risk of Vibrio parahaemolyticus, and fruit juice shares the highest probability of infecting Shigella. It should be strengthed on the inspection and administering on risk foods and strengthing the health education to consumers and food handlers.