Abstract

BACKGROUND:

Recently the World Health Organization, Foodborne Disease Burden Epidemiology Reference Group (FERG) estimated that 31 foodborne diseases (FBDs) resulted in over 600 million illnesses and 420,000 deaths worldwide in 2010. Knowing the relative role importance of different foods as exposure routes for key hazards is critical to preventing illness. This study reports the findings of a structured expert elicitation providing globally comparable food source attribution estimates for 11 major FBDs in each of 14 world subregions.

METHODS AND FINDINGS:

We used Cooke's Classical Model to elicit and aggregate judgments of 73 international experts. Judgments were elicited from each expert individually and aggregated using both equal and performance weights. Performance weighted results are reported as they increased the informativeness of estimates, while retaining accuracy. We report measures of central tendency and uncertainty bounds on food source attribution estimate. For some pathogens we see relatively consistent food source attribution estimates across subregions of the world; for others there is substantial regional variation. For example, for non-typhoidal salmonellosis, pork was of minor importance compared to eggs and poultry meat in the American and African subregions, whereas in the European and Western Pacific subregions the importance of these three food sources were quite similar. Our regional results broadly agree with estimates from earlier European and North American food source attribution research. As in prior food source attribution research, we find relatively wide uncertainty bounds around our median estimates.

CONCLUSIONS:

We present the first worldwide estimates of the proportion of specific foodborne diseases attributable to specific food exposure routes. While we find substantial uncertainty around central tendency estimates, we believe these estimates provide the best currently available basis on which to link FBDs and specific foods in many parts of the world, providing guidance for policy actions to control FBDs.

Global subregions and number of expert panelists with more than 3 years of work experience in the subregion.

Subregions are defined on the basis of child and adult mortality as described by Ezzati et al. (2002) []. Stratum A: very low child and adult mortality; Stratum B: low child mortality and very low adult mortality; Stratum C: low child mortality and high adult mortality; Stratum D: high child and adult mortality; and Stratum E: high child mortality and very high adult mortality. AFR = Africa Region; AMR = Region of the Americas; EMR = Eastern Mediterranean Region; EUR = European Region; SEAR = South-East Asia Region; WPR = Western Pacific Region. Havelaar et al. 2015 provides a list of countries in each subregion []. The use of the term ‘subregion’ here and throughout the text does not identify an official grouping of WHO Member States, and the ‘subregions’ are not related to the six official WHO regions []. Values in circles indicate the number of experts in panels in each region.

Proportion of foodborne disease attributable to specific foods: Median estimate, and 90% and 95% uncertainty intervals by parasite and subregion. “Small ruminants’ meat” was listed as “Goat, lamb and other small ruminants’ meat” in the expert elicitation instrument. The X-axis labels are percentages. The dot represents the median estimate; the dark black line, the 90% uncertainty interval; and the gray line the 95% uncertainty interval.

Proportion of foodborne disease attributable to specific foods: Median estimate, and 90% and 95% uncertainty intervals by parasite and subregion. “Small ruminants’ meat” was listed as “Goat, lamb and other small ruminants’ meat” in the expert elicitation instrument. The X-axis labels are percentages. The dot represents the median estimate; the dark black line, the 90% uncertainty interval; and the gray line the 95% uncertainty interval.

Proportion of foodborne disease attributable to specific foods: Median estimate, and 90% and 95% uncertainty intervals by parasite and subregion. “Small ruminants’ meat” was listed as “Goat, lamb and other small ruminants’ meat” in the expert elicitation instrument. The X-axis labels are percentages. The dot represents the median estimate; the dark black line, the 90% uncertainty interval; and the gray line the 95% uncertainty interval.

Proportion of foodborne disease attributable to specific foods: Median estimate, and 90% and 95% uncertainty intervals by parasite and subregion. “Small ruminants’ meat” was listed as “Goat, lamb and other small ruminants’ meat” in the expert elicitation instrument. The X-axis labels are percentages. The dot represents the median estimate; the dark black line, the 90% uncertainty interval; and the gray line the 95% uncertainty interval.

Proportion of foodborne disease attributable to specific foods: Median estimate, and 90% and 95% uncertainty intervals by parasite and subregion. “Small ruminants’ meat” was listed as “Goat, lamb and other small ruminants’ meat” in the expert elicitation instrument. The X-axis labels are percentages. The dot represents the median estimate; the dark black line, the 90% uncertainty interval; and the gray line the 95% uncertainty interval.

Proportion of foodborne disease attributable to specific foods: Median estimate, and 90% and 95% uncertainty intervals by parasite and subregion. “Small ruminants’ meat” was listed as “Goat, lamb and other small ruminants’ meat” in the expert elicitation instrument. The X-axis labels are percentages. The dot represents the median estimate; the dark black line, the 90% uncertainty interval; and the gray line the 95% uncertainty interval.

Proportion of foodborne disease attributable to specific foods: Median estimate, and 90% and 95% uncertainty intervals by parasite and subregion. “Small ruminants’ meat” was listed as “Goat, lamb and other small ruminants’ meat” in the expert elicitation instrument. The X-axis labels are percentages. The dot represents the median estimate; the dark black line, the 90% uncertainty interval; and the gray line the 95% uncertainty interval.

Proportion of foodborne disease attributable to specific foods: Median estimate, and 90% and 95% uncertainty intervals by bacteria and subregion. “Small ruminants’ meat” was listed as “Goat, lamb and other small ruminants’ meat” in the expert elicitation instrument. The X-axis labels are percentages. The dot represents the median estimate; the dark black line, the 90% uncertainty interval; and the gray line the 95% uncertainty interval.

Proportion of foodborne disease attributable to specific foods: Median estimate, and 90% and 95% uncertainty intervals by bacteria and subregion. “Small ruminants’ meat” was listed as “Goat, lamb and other small ruminants’ meat” in the expert elicitation instrument. The X-axis labels are percentages. The dot represents the median estimate; the dark black line, the 90% uncertainty interval; and the gray line the 95% uncertainty interval.

Proportion of foodborne disease attributable to specific foods: Median estimate, and 90% and 95% uncertainty intervals by bacteria and subregion. “Small ruminants’ meat” was listed as “Goat, lamb and other small ruminants’ meat” in the expert elicitation instrument. The X-axis labels are percentages. The dot represents the median estimate; the dark black line, the 90% uncertainty interval; and the gray line the 95% uncertainty interval.

Proportion of foodborne disease attributable to specific foods: Median estimate, and 90% and 95% uncertainty intervals by bacteria and subregion. “Small ruminants’ meat” was listed as “Goat, lamb and other small ruminants’ meat” in the expert elicitation instrument. The X-axis labels are percentages. The dot represents the median estimate; the dark black line, the 90% uncertainty interval; and the gray line the 95% uncertainty interval.