1stInternational Conference of Egyptian Society of Food Safety “Food Safety Science, Health and Behavior” SharmEl-Sheikh, Egypt February 15-18, 2018

1. COST OF FOOD-BORNE ILLNESSES: A LITRATURE
REVIEW
Institute of National
Planning
1st International Conference of Egyptian Society of Food Safety
“Food Safety Science, Health and Behavior”
Sharm El-Sheikh, Egypt
February 15-18, 2018
Dr. Aly Zein Elabdeen Kassem
Lecturer
Agricultural Planning and development Centre
Institute of National Planning, Egypt

2. Institute of National
Planning
• Foodborne illness is defined by WHO as:
• ‘diseases, usually either infectious or toxic in nature, caused by
agents that enter the body through the ingestion of food (WHO,
2015).
• Causes of foodborne illness include
• bacteria, parasites, viruses, toxins, metals, and prions. (Thomas
et al., 2013),
Foodborne illness Definition and burden

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Planning
• This study aims
• to search the literature concerned with cost of foodborne
illnesses worldwide and at some available national levels
• to conclude and answer the following four research questions;
•
• What are the most common and leading foodborne pathogens?
• What are the methods used in estimating the cost of foodborne
illnesses?
• What are the cost items of foodborne illnesses?
• What are the historical and recent estimations of the burden of food-
related illnesses worldwide and at certain national levels?
•
The Study Objectives

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Planning
• Worldwide,
• there are known 31 global hazards caused together 600
million foodborne illnesses and 420,000 deaths in 2010
(WHO, 2015; Table:1).
• In Europe
• (EFSA) and (ECDC) concern with 14 leading foodborne
pathogens (EFSA and ECDC, 2017),
• In USA
• (CDC) takes into consideration fifteen food-related
pathogens in USA (Scallan et al., 2011a; Table: 2).
The most common foodborne pathogens

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Planning
Country- Author Years of study Leading Foodborne Pathogens
World, WHO
(2015)
2015 Campylobacter spp., non-typhoidal Salmonella enterica,
Salmonella Typhi, Taenia solium, hepatitis A virus and
Fungi producing aflatoxins.
Kirk et al., (2010) Circa 2010 Norovirus, pathogenic Escherichia coli, Campylobacter spp.
and non-typhoidal Salmonella spp.
Canada, Thomas
et al. (2013)
Circa 2006
(2000-2010)
Norovirus, Clostridium perfringens, Campylobacter spp.,
and nontyphoidal Salmonella spp.
UK, Food Standard
Agency (2011)
Circa 2010 Campylobacter, Listeria
Monocytogenes, E. coli O157, Salmonella, Norovirus,
Clostridium perfringens
Bouwknegt et al.,
(2017)
2016 Norovirus, Campylobacter spp. And Staphylococcus aureus
Leading Foodborne-illnesses Pathogens

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Planning
• The unspecified agents represent a critical issue where according to
Mead et al. (1999) they represent more than 75% of foodborne
illnesses in United States.
Leading Foodborne Pathogens

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Planning
• Two USA cost-of-illness models
• Disability-Adjusted Life Years (DALYs), WHO
Methods used in estimating the cost of
foodborne illnesses

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Planning
• Mead et al. In 1999, provided comprehensive estimates of foodborne
illnesses, hospitalizations, and deaths in the United States caused by
known and unknown agents (CDC website, 2018).
• After that Scallan et al. (2011a&b) developed two new reporting
estimates of foodborne diseases acquired in the United States,
• The first model provides estimates of major known pathogens;
• The second model provides estimates for agents of acute gastroenteritis not
specified in the former.
• Scharff, 2010, 2012 estimated the cost of the food-borne illnesses
depending on Scallan et al. (2011a&b).
The Two USA cost-of-illness models

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Planning
• One DALY can be thought of as one lost year of "healthy" life (WHO,
2015).
• DALYs are calculated as the sum of:
• the Years of Life Lost (YLL)
• Due to premature mortality in the population
• and the Years Lost due to Disability (YLD)
• For people living with the health condition or its consequences (WHO, 2015).
Disability-Adjusted Life Years (DALYs), WHO

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Planning
• In USA, basic cost-of-illness model includes economic
estimates for: Used by the U.S. Department of Agriculture (USDA website,
2018)
• Medical costs
• productivity losses,
• and illness-related mortality.
• An enhanced cost-of illness model that: Used by the Center for Food
Safety and Applied Nutrition at the US Food and Drug Administration (Scharff, 2012)
• replaces the productivity loss estimates with monetize Quality-
Adjusted Life Year estimates (QALYs)
• Monetized QALY losses are the product of:
• loss of well-being from a condition, the number of days with the condition,
and the economic value of 1 day derived from the value of statistical life.
(Schaff, 2012)
•
Items of Foodborne illnesses cost, USA

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Planning
• subdivided into three categories: (Mangen et al., 2013).
• Direct healthcare costs;
• costs for doctor’s fees,
• hospitalizations and medicines,
• They account for less than 25% of all costs.
• Direct non-healthcare costs;
• such as travel costs to and from the doctor,
• these cost are relatively low.
• Indirect non-healthcare costs;
• Productivity losses due to work absence
• Special education as a consequence of neurological disease
• up to 75% of the total costs (Mangen et al., 2013).
Items of Foodborne illnesses cost, Traditional

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Planning
Uncertainty!
• due to: MacDougall et al. (2008)
• Underreporting: i.e.
• Positive laboratory test results are not reported to surveillance systems
• Underdiagnoses: i,e.
• Cases that do not seek medical care, are not tested or the laboratory
test does not identify a causative agent).
• Many studies (Scallan et al., 2011; Scharraf et al., 2012;
Thomas et al., 2013) were performed Monte Carlo simulations
• to generate a mean estimate and 90% credible interval to estimate the
proportion of illness domestically acquired and through foodborne
transmission.

13. Institute of National
Planning
Country- Author All Foodborne illnesses/year Hospitalizations deaths (DALYs)* Unknown
Pathogen
included
Cost
World, WHO (2015) 600 Million of 6.9 Billion (2010)
((8.7%)
NA 420000 18 Millions
DLAYs
No NA
Kirk et al., (2010) 4.1 Million
Of 22.03 Million (2010), 8.65%)
31,920 86 NA** Yes NA
Canada, Thomas et al.
(2013)
4.0 Million
Of 32.5 Million (2006), (12.3%)
NA NA NA Yes NA
UK, Food Standard
Agency (2011)
1 Million
Of 62.77 Million (2010), 1.59%)
20.000 500 NA NA £1.5
billion
(2008)
Bouwknegt et al.,
(2017)
672.785 Thousands of 17.02 Million
(2016)
(4%)
NA 90 4,708 DALYs No €171
Million
Euro
Estimates of the annual foodborne illnesses burden
worldwide and at some national levels (2006-2016)

14. Institute of National
Planning
Author All Foodborne illnesses/year Hospitalization
s
deaths (DALYs)** Unknown
Pathogen
included
Cost
Mead et al. (1999) 76 Million of 279 Million (1999),
(27.72%)
(Known pathogens; 14 million)
(Unknown agents; 62 Million)
325,000
(Known
pathogens;
265,000 )
(Unknown
agents; 60,000)
(Known
pathogens;
3,200)
(Unknown
agents;
1,500)
NA*** yes NA
Scallan et al. (2011a) 9.4 Million episodes 55,961 1,351 NA No NA
Scallan et al. (2011b) 38,4 Million episodes 71,878 1,686 NA yes NA
Scharff et al. (2010) 81,91 Million
(Known pathogen;14.9)
(Unknown agents; 67,01 Million)
NA NA NA yes $152 billion
Scharff et al. (2012) Data from Scallan et al.,2011a&b NA yes $77.7 & $51.0
billion****
USDA website (2018) Data from Scallan et al.,2011a&b NA No $12.77*****
billion
Historical estimates of the annual foodborne
illnesses burden in USA (1999-2018).

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Planning
• Although Foodborne illnesses are varied and differentiated
geographically,
• but there are leading pathogens are responsible for most of the vital
foodborne illnesses cases worldwide.
• The reason of the differences in the estimates of foodborne illnesses
are mainly due to
• The difference in the estimation techniques which were used
• and to the effects of uncertainty.

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Planning
Egypt and Arab countries and the Arab Organization for Agricultural
Development are invited and urged to develop a cost of food-borne
illnesses annual report.

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Planning
Dr. Aly Zein Elabdeen Kassem
Lecturer
Institute of National Planning
Fax: +(202) 2634747/ +(202) 2621151
Mobile: +(202) 01285803485/ +(202) 01208468230
http://inplanning.gov.eg
Aly_kasem@yahoo.com
Aly.kasem@hotmail.com