WHO estimates of the global, regional, and national burden of eight foodborne non-diarrhoeal enteric disease hazards, 2000–21
an updated data synthesis
Shannon E. Majowicz (University of Waterloo)
Elaine Scallan Walter (University of Colorado Anschutz Medical Campus)
Sara M. Pires (Technical University of Denmark (DTU))
Yuki Minato (United Nations House)
Luria L. Founou (University of St Andrews, College of Health Sciences, Research Institute of the Centre of Expertise and Biological Diagnostic of Cameroon)
Brecht Devleesschauwer (Universiteit Gent)
Carlotta di Bari (Universiteit Gent)
Arie H. Havelaar (University of Florida)
Gabriela F. Nane (TU Delft - Electrical Engineering, Mathematics and Computer Science)
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Abstract
Background: Foodborne diseases cause substantial illness and death globally. We updated WHO estimates of the burden caused by non-diarrhoeal enteric disease hazards: Brucella spp; Clostridium botulinum; hepatitis A virus; Listeria monocytogenes; Mycobacterium bovis, Mycobacterium caprae, and Mycobacterium orygis; invasive non-typhoidal Salmonella enterica (iNTS); S enterica serotypes Paratyphi A, B, and C; and S enterica serotype Typhi (S Typhi). Methods: We estimated illnesses, deaths, and disability-adjusted life-years (DALYs) for 194 countries for 2000–21 using data from systematic reviews, the 2021 Global Burden of Diseases, Injuries, and Risk Factors Study 2021, a structured expert judgement study, and WHO country consultations. We used disease-specific computational models and hierarchical metaregression modelling with geographical clustering, a global linear time trend, and uncertainty propagation. Findings: In 2021, transmission of these eight hazards by food collectively caused 24·0 million illnesses (95% uncertainty interval 16·9–31·7), 106 000 deaths (63 900–169 000), and 7·26 million DALYs (4·15–12·0). S Typhi, iNTS, and hepatitis A virus caused most DALYs. The greatest burden was in the WHO African region, followed by the South-East Asia region. Mortality was 5·2 times higher and DALY rates were 8·3 times higher in children younger than 5 years compared with people aged 5 years and older. The burden for all hazards, except L monocytogenes, decreased from 2000 to 2021, with S Typhi replacing iNTS as the leading cause of foodborne DALYs. Interpretation: Non-diarrhoeal enteric diseases still cause considerable foodborne disease burden, despite decreases over time. Vulnerable populations, particularly children in low-income countries, bear the greatest burden. Integrated efforts including vaccination, food safety, clean water, sanitation, hygiene, and improved health-care access are required. Funding: WHO.
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