INTESTINAL INFECTION

Trends in indigenous foodborne disease and deaths, England and Wales: 1992 to 2000

G K Adak, S M Long, S J O’Brien

Gastrointestinal Diseases Division, PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK

Correspondence to:
Correspondence to:
Dr G K Adak, Gastrointestinal Diseases Division, PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK;
badak{at}phls.org.uk

Background: Commitment to food safety is evidenced by high profile governmental initiatives around the globe. To measure progress towards targets, policy makers need to know the baseline from which they started.

Aim: To describe the burden (mortality, morbidity, new presentations to general practice, hospital admissions, and hospital occupancy) and trends of indigenous foodborne disease (IFD) in England and Wales between 1992 and 2000.

Methods: Routinely available surveillance data, special survey data, and hospital episode statistics were collated and arithmetic employed to estimate the burden and trends of IFD in England and Wales. Adjustments were made for underascertainment of disease through national surveillance and for foreign travel. The final estimates were compared with those from the USA.

Results: In 1995 there were an estimated 2 365 909 cases, 21 138 hospital admissions, and 718 deaths in England and Wales due to IFD. By 2000 this had fallen to 1 338 772 cases, 20 759 hospital admissions, and 480 deaths. In terms of disease burden the most important pathogens were campylobacters, salmonellas, Clostridium perfringens, verocytotoxin producing Escherichia coli (VTEC) O157, and Listeria monocytogenes. The ratio of food related illness in the USA to IFD in England and Wales in 2000 was 57:1. Taking into account population rates, this ratio fell to 11:1 and converged when aetiology and disease severity were considered.

Conclusion: Reducing IFD in England and Wales means tackling campylobacter. Lowering mortality rates however also requires better control and prevention of salmonellas, Cl perfringens, L monocytogenes, and VTEC O157.

Keywords: food poisoning; gastrointestinal diseases; Campylobacter; salmonella food poisoning; Escherichia coli O157

Abbreviations: AR, ascertainment ratio–ratio of the estimated number of cases of illness in the population due to specific pathogens to the number of laboratory reports in the national database for laboratory confirmed infections; CDC, United States Centers for Disease Control and Prevention; CDSC, PHLS Communicable Disease Surveillance Centre; HES, hospital episode statistics; GSURV, national database for the surveillance scheme for general outbreaks of infectious intestinal disease; FSA, UK Food Standards Agency; IFD, indigenous foodborne disease; IID, infectious intestinal disease; LabBase, national database for laboratory confirmed infections; NLV, Norwalk-like viruses; NS, national statistics; PHLS, Public Health Laboratory Service; py, person years; RCGP, Royal College of General Practitioners; VTEC, verocytotoxin producing Escherichia coli

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