Foodborne Disease Outbreak Investigation Team Training: Burden of Foodborne Diseases The module is optional. The course coordinator should decide whether training participants need to be convinced that foodborne illnesses are a significant public health problem.

In the last year, how many of you have suffered from nausea, vomiting, abdominal pain, and/or diarrhea? Why undertake this training? Let’s start to answer this question by considering the incidence and cost of foodborne illnesses in the United States. Do you have any idea of the burden of foodborne diseases in the United States? Let me put it a different way “… in the last year, how many of you have suffered from nausea, vomiting, abdominal pain, and/or diarrhea?”

Estimated Cases and Medical Costs An estimated 1 in 6 people suffers from foodborne illness each year leading to an estimated 48 million illnesses 128,000 hospitalizations 3,000 deaths More than 1,000 outbreaks detected $35 billion in medical costs, lost productivity, illness related mortality are incurred Foodborne illness is an important cause of morbidity and mortality in the United States. It has been estimated that one in six Americans suffer from foodborne diseases every year. So they are happening all around us. (And sometimes to us!) In 2011, CDC estimated that foodborne diseases were responsible for 48 million illnesses each year, resulting in 128,000 hospitalizations, and 3,000 deaths. Based on data from 2002-2006, an average of 1,193 foodborne disease outbreaks were reported to CDC each year, resulting in an average of 25,079 outbreak-related illnesses. In 1997, it was estimated that major pathogens from foodborne illness in the United States cost upwards of US $35 billion in medical costs and lost productivity. BACKGROUND TO INSTRUCTOR: Two new studies on the cost of foodborne illnesses have been released since the 1997 CDC estimates. CDC staff do not agree with these estimates, however, so this information is for your interest only. Please do not share with training participants. In 2010, Pew Charitable Trust at Georgetown University estimated that illnesses resulting from the major foodborne pathogens in the United States cost upwards of US $152 billion in medical costs and lost productivity every year. In 2012, Robert Scharff from Ohio State University revised cost estimates using the 2011 CDC incidence estimates. He estimated the annual economic burden from health losses due to foodborne illness in the United States to be $51.0 billion when including medical costs, productivity losses, and illness-related mortality. Source: Centers for Disease Control and Prevention http://www.cdc.gov/foodborneburden/index.html

Unmeasured Costs Cost of investigating food safety problems and outbreaks North Dakota salmonellosis outbreak (180 cases at a cost of $37,426) Michigan campylobacteriosis outbreak (20 cases at a cost of $22,000) Disruption of agency activities Loss of public confidence in food supply and public health system The cost of just investigating an outbreak (not included in the cost estimates on the previous slide) also is substantial (and depend largely on the nature of the outbreak). In a North Dakota salmonellosis outbreak linked to an unlicensed caterer, involving about 180 cases, the cost of the investigation was estimated at $37,426 with $27,372 for staff time and $10,054 for staff travel and laboratory testing. The investigation of an outbreak of campylobacteriosis in Michigan linked to raw milk consumption, involving less than 20 cases, cost over $22,000. In addition to the financial burden, the disruption that results from a foodborne outbreak, even a small one, in terms of agency activities can be substantial. Large outbreaks can derail an agency for weeks and rapidly strain public health and environmental health resources. Perhaps, even more importantly, foodborne outbreaks also undermine the public’s confidence in the food supply and in the public health system established to ensure food safety.

Human Costs The numbers of foodborne disease cases, outbreaks, and costs, alone, are staggering. But they do not convey the tragedies that can result from these illnesses such as the children who are hospitalized and die from hemolytic uremic syndrome due to E. coli O157:H7 (as pictured in this slide). All tragedies are local. The “costs” of foodborne illness can be dramatic for individuals, their families, and our community. Child with hemolytic uremic syndrome (HUS) due to E. coli O157:H7