Global burden of foodborne diseases

Foodbome diseases result from the ingestion of contaminated foods and food products and include a broad group of illnesses caused by parasites, chemicals and pathogens which contaminate food at different points in the food production and preparation process.

Globally, increases in the incidence of foodbome illnesses continue to be reported, often associated with outbreaks and food contamination that raise international concern.

These reports, however, are largely ad hoc and. data from developing countries where populations are particularly exposed to contaminated environments, are scarce. In the absence of a systematic and comprehensive global assessment, the true burden of  foodborne diseases remains unclear.

Foodbome diseases threaten global public health security

Growing international' trade, migration and travel increase the. spread of dangerous pathogens and contaminants in food. In today’s interconnected and

interdependent world, local fondborne disease outbreaks have become a potential threat 1o the entire globe. In 1991, cholera which was thought to have originated from contaminated seafood harvested off the coast of Peru, rapidly spread across Latin in approximately 400000 reported cases and, more than 4000 deaths in several countries.

Through the globalisation of food marketing and distribution, both accidentally and, deliberately contaminated food products can affect the health of people-in numerous countries at the same time.

The identification of one single contaminated food ingredient can lead to the recall of tonnes of food products, to considerable economic losses in production and from trade embargoes, as well as damage to the tourist industry. In early 2008, an outbreak of avian influenza in Bangalore, India, led to an import ban of Indian poultry products in the Middle East, resulting in losses totalling hundreds of thousands of US Dollars to the Indian economy.

Foodbome diseases cannot only spread faster, they appear to be emerging more rapidly than ever before, and are able to circumvent conventional controlmeasures. The growing industrialization of food production catalyses the appearance- and spread of new or antibiotic-resistant pathogens, as was the case for prions associated with'bovine spongiform encephalopathy (BSEJ and leading to new variant Creutefeldtz Jakob disease (vCJD) in humans in the United Kingdom during the 1990s.

Rapid detection and detailed knowledge of foodborne disease burden will reduce the risk of spread of disease and demonstrate the real impact of unsafe food on economic growth and development.

Foodborne diseases are linked to poverty and development

The achievement of the internationally agreed Millennium Development Goals (MDG), including the overarching goal of poverty reduction, will in part depend on a successful reduction of the burden of foodbome diseases, particularly among vulnerable groups  as illustrated in the Figure1.

Without reliable information on disease burden, policy-makers cannot assess the effectiveness of their investment in foodbome disease prevention and control, nor reduce the burden of foodbome diseases. Without the latter, however, international efforts to achieve the MDG will be jeopardized, especially those goals relating to children and the poor.

WHO strategy to estimate the global burden of foodborne diseases

In September 2006, WHO convened a group of international scientists at the “WHO Consultation to Develop a Strategy to Estimate the Global Burden of Foodbome Disease”.

The consultation provided the strategic framework for the assessment of burden of foodb ome diseases, including a roadmap for assembling existing information on the disease burden and a time frame outlining the individual strategic activities. The consultation marked the formed launch of the Initiative to Estimate the Global Burden of Foodbome Diseases from all major causes using summary health metrics that combine morbidity, mortalily and disability in the form of the Disability Adjusted Life Year (DALY). The WHO officially adopted the Burden of Disease and DALY approach for reporting on health information in the late.  

Soon individual technical units and programmes within WHO used and further developed the method and built collaborations with external experts to publish disease burden estimates. The Initiative described in this report is one of the most recent examples in this area.

The Foodbome disease burden epidemiology reference group (FEBG)

One of the major recommendations of the 2006 consultation was the establishment of the Foodborne Disease Burden Epidemiology Reference Group (FERG) which is charged with implementing the recommendations of the consultation and estimating the global burden of foodborne diseases. Following a public call for advisers in the scientific press and a transparent selection process, the WHO Director-General (DG) appointed the FERG members from a large pool of applicants.

The members of the FERG engage in:

Assembling, appraising and reporting on currently existing burden of foodborne disease estimates;

Conducting epidemiological reviews for mortality, morbidity and disability in each of the major FBD;

Providing models for the estimation of FBD burden where data are lacking;Developing cause and source attribution models to estimate the proportion of diseases that are foodborne; and Developing user-friendly tools for burden of FBD studies at country level.

Due to the multi-factorial nature of foodborne diseases, the FERG is highly multidisciplinary and includes a large number of members. It operates through a Core (or Steering) Group as well as a number of different Task Forces (Figure 2).

The Core Group functions as a steering committee and consists of scientists from each of the areas outlined in theTask Forces. It is charged with monitoring and appraising the technical and epidemiological work of all Task Forces.

The Core Group is chaired by a scientist with extensive international experience in both foodborne diseases and burden of disease methodology. Additional external experts can be called upon to join the FERG on an ad hoc basis to supplement the skills required.

The Task Force on ‘Source Attribution’ is charged with identifying the proportion of disease

burden that is directly due to food contamination and will aim to isolate the specific food sources responsible.

A specific Task Force on Country Burden of Disease protocols will develop user-friendly tools for countries to conduct their own burden of foodbome disease studies thus enabling them to monitor progress of their food safety interventions.

The Secretariat carries out a logistic, administrative and technical support function and is composed of staff from eight areas of work within WHO.

The FERG has following the strategic framework developed in 2006 and is expected to provide a Global Report and Atlas on the Burden of Foodborne Diseases as well as a series of journal papers. These products will be peer-reviewed by scientists Outside FERG to ensure highest quality and policy impact.

A detailed communication strategy has been developed that covers internal and external information sharing, mechanisms for accountability as well as all aspects of advocacy for FERG.

Accordingly key stakeholders (including consumer groups, NGOs, donors and industry) were invited to provide input at the first formal meeting of FERG summarized in this report. A more comprehensive dedicated stakeholder meeting is planned for November 2008. Internally, timely feedback is provided via face to face meetings, regular teleconferences, mailings and the FERG SharePoint. External bi-directional communication continues between FERG/WHO Secretariat and the stakeholder community.  

This communication increases the global visibility and profile of the Initiative, creates a positive perception, solicits international commitment and technical/financial support and raises awareness of FBD as a major public health and development issue.

Alliances and partnerships of the Initiative to Estimate the Global Burden of FBD

The Initiative relies on an alliance of collaborators and partners who provide financial support, technical expertise, information sharing platforms and/or networking possibilities.

Collaborating partners include agencies of the United Nations (UN) and other international organizations, governmental and non-governmental agencies, academia, consumer groups and industry.

 

Global burden of foodborne diseases

Foodbome diseases result from the ingestion of contaminated foods and food products and include a broad group of illnesses caused by parasites, chemicals and pathogens which contaminate food at different points in the food production and preparation process. Globally, increases in the incidence of foodbome illnesses continue to be reported, often associated with outbreaks and food contamination that raise international concern. These reports, however, are largely ad hoc and. data from developing countries where populations are particularly exposed to contaminated environments, are scarce. In the absence of a systematic and comprehensive global assessment, the true burden of foodborne diseases remains unclear. Foodbome diseases threaten global public health security Growing international trade, migration and travel increase the. spread of dangerous pathogens and contaminants in food. In todays interconnected and interdependent world, local fondborne disease outbreaks have become a potential threat 1o the entire globe. In 1991, cholera which was thought to have originated from contaminated seafood harvested off the coast of Peru, rapidly spread across Latin in approximately 400000 reported cases and, more than 4000 deaths in several countries. Through the globalisation of food marketing and distribution, both accidentally and, deliberately contaminated food products can affect the health of people-in numerous countries at the same time. The identification of one single contaminated food ingredient can lead to the recall of tonnes of food products, to considerable economic losses in production and from trade embargoes, as well as damage to the tourist industry. In early 2008, an outbreak of avian influenza in Bangalore, India, led to an import ban of Indian poultry products in the Middle East, resulting in losses totalling hundreds of thousands of US Dollars to the Indian economy. Foodbome diseases cannot only spread faster, they appear to be emerging more rapidly than ever before, and are able to circumvent conventional controlmeasures. The growing industrialization of food production catalyses the appearance- and spread of new or antibiotic-resistant pathogens, as was the case for prions associated withbovine spongiform encephalopathy (BSEJ and leading to new variant Creutefeldtz Jakob disease (vCJD) in humans in the United Kingdom during the 1990s. Rapid detection and detailed knowledge of foodborne disease burden will reduce the risk of spread of disease and demonstrate the real impact of unsafe food on economic growth and development. Foodborne diseases are linked to poverty and development The achievement of the internationally agreed Millennium Development Goals (MDG), including the overarching goal of poverty reduction, will in part depend on a successful reduction of the burden of foodbome diseases, particularly among vulnerable groups as illustrated in the Figure1. Without reliable information on disease burden, policy-makers cannot assess the effectiveness of their investment in foodbome disease prevention and control, nor reduce the burden of foodbome diseases. Without the latter, however, international efforts to achieve the MDG will be jeopardized, especially those goals relating to children and the poor. WHO strategy to estimate the global burden of foodborne diseases In September 2006, WHO convened a group of international scientists at the WHO Consultation to Develop a Strategy to Estimate the Global Burden of Foodbome Disease. The consultation provided the strategic framework for the assessment of burden of foodb ome diseases, including a roadmap for assembling existing information on the disease burden and a time frame outlining the individual strategic activities. The consultation marked the formed launch of the Initiative to Estimate the Global Burden of Foodbome Diseases from all major causes using summary health metrics that combine morbidity, mortalily and disability in the form of the Disability Adjusted Life Year (DALY). The WHO officially adopted the Burden of Disease and DALY approach for reporting on health information in the late. Soon individual technical units and programmes within WHO used and further developed the method and built collaborations with external experts to publish disease burden estimates. The Initiative described in this report is one of the most recent examples in this area. The Foodbome disease burden epidemiology reference group (FEBG) One of the major recommendations of the 2006 consultation was the establishment of the Foodborne Disease Burden Epidemiology Reference Group (FERG) which is charged with implementing the recommendations of the consultation and estimating the global burden of foodborne diseases. Following a public call for advisers in the scientific press and a transparent selection process, the WHO Director-General (DG) appointed the FERG members from a large pool of applicants. The members of the FERG engage in: Assembling, appraising and reporting on currently existing burden of foodborne disease estimates; Conducting epidemiological reviews for mortality, morbidity and disability in each of the major FBD; Providing models for the estimation of FBD burden where data are lacking;Developing cause and source attribution models to estimate the proportion of diseases that are foodborne; and Developing user-friendly tools for burden of FBD studies at country level. Due to the multi-factorial nature of foodborne diseases, the FERG is highly multidisciplinary and includes a large number of members. It operates through a Core (or Steering) Group as well as a number of different Task Forces (Figure 2). The Core Group functions as a steering committee and consists of scientists from each of the areas outlined in theTask Forces. It is charged with monitoring and appraising the technical and epidemiological work of all Task Forces. The Core Group is chaired by a scientist with extensive international experience in both foodborne diseases and burden of disease methodology. Additional external experts can be called upon to join the FERG on an ad hoc basis to supplement the skills required. The Task Force on Source Attribution is charged with identifying the proportion of disease burden that is directly due to food contamination and will aim to isolate the specific food sources responsible. A specific Task Force on Country Burden of Disease protocols will develop user-friendly tools for countries to conduct their own burden of foodbome disease studies thus enabling them to monitor progress of their food safety interventions. The Secretariat carries out a logistic, administrative and technical support function and is composed of staff from eight areas of work within WHO. The FERG has following the strategic framework developed in 2006 and is expected to provide a Global Report and Atlas on the Burden of Foodborne Diseases as well as a series of journal papers. These products will be peer-reviewed by scientists Outside FERG to ensure highest quality and policy impact. A detailed communication strategy has been developed that covers internal and external information sharing, mechanisms for accountability as well as all aspects of advocacy for FERG. Accordingly key stakeholders (including consumer groups, NGOs, donors and industry) were invited to provide input at the first formal meeting of FERG summarized in this report. A more comprehensive dedicated stakeholder meeting is planned for November 2008. Internally, timely feedback is provided via face to face meetings, regular teleconferences, mailings and the FERG SharePoint. External bi-directional communication continues between FERG/WHO Secretariat and the stakeholder community. This communication increases the global visibility and profile of the Initiative, creates a positive perception, solicits international commitment and technical/financial support and raises awareness of FBD as a major public health and development issue. Alliances and partnerships of the Initiative to Estimate the Global Burden of FBD The Initiative relies on an alliance of collaborators and partners who provide financial support, technical expertise, information sharing platforms and/or networking possibilities. Collaborating partners include agencies of the United Nations (UN) and other international organizations, governmental and non-governmental agencies, academia, consumer groups and industry.