Academic journal article Bulletin of the World Health Organization

Estimating the Burden of Foodborne Diseases in Japan/Estimation De la Charge Des Maladies D'origine Alimentaire Au Japon/Estimacion De la Carga De Enfermedades De Transmision Alimentaria En Japon

Academic journal article Bulletin of the World Health Organization

Estimating the Burden of Foodborne Diseases in Japan/Estimation De la Charge Des Maladies D'origine Alimentaire Au Japon/Estimacion De la Carga De Enfermedades De Transmision Alimentaria En Japon

Article excerpt

Introduction

There have been few attempts to provide comprehensive, consistent and comparable estimates of the burden of acute foodborne diseases. (1) In 2006, however, the World Health Organization (WHO) set up the Foodborne Disease Burden Epidemiology Reference Group (FERG) specifically to produce such estimates. (2) FERG aims to provide the data and tools needed to set appropriate, evidence-informed priorities for food safety at country level. Since its launch, FERG has established several task forces that focus on parasitic and enteric diseases, Chemicals and natural toxins, source attribution, computational modelling and country studies. The members of the country studies task force were asked to develop methods for estimating the burden posed by foodborne disease at national level. These methods were intended to facilitate the collection of national data on foodborne disease burdens and support the use of such data for policy-making and practice in food safety. (3) FERG selected Albania, Japan, Thailand and Uganda as the locations for initial pilot studies estimating disability-adjusted life-years (DALYs) lost as a result of foodborne disease. (4,5)

In Japan, priorities for foodborne disease prevention are primarily based on the apparent public health significance of each disease, although impact on the food market, consumers' risk perceptions and public opinion are also taken into consideration. (6) The Japanese Food Sanitation Act and Infectious Disease Control Act require collection of data on the incidence of food poisoning and infectious diseases, respectively. However, as there has never been a comprehensive, internally consistent and robust assessment of the burden posed by foodborne disease in Japan, robust and objective standards for ranking priorities are lacking. Surveillance data are not as useful as formal estimates when identifying and ranking diseases in terms of their contributions to the countrys overall burden. Our objective is to assess the burden posed by common foodborne diseases in Japan, using the methods recommended by FERG and expressing the main findings in terms of DALYs.

Methods

Disease selection

After analysis of food poisoning statistics and consultation with experts, we identified Campylobacter species, Salmonella species and enterohaemorrhagic Escherichia coli (EHEC) as the first, second and third most common causes of foodborne disease in Japan in 2011.7 This ranking was entirely based on clinical cases in health facilities. To estimate the relative burden posed by each of these three causes of foodborne disease, we used a pyramid reconstruction method and supplemented routine surveillance and reporting data with information from telephone and patient surveys.

Data sources

We used data from four sources to estimate the annual incidence of acute gastroenteritis caused by Campylobacter, Salmonella and EHEC and to estimate associated mortality rates. The four data sources were: (i) food poisoning statistics that had been compiled using information collected by local governments on outbreaks of food poisoning; (ii) surveillance data on EHEC (routine collection of data on EHEC cases in Japan was not made a legal requirement until 1999; disease caused by Salmonella or Campylobacter species was not recorded); (8,9) (iii) national patient surveys for 1996, 1999, 2002, 2005, 2008 and 2011. (These surveys record patients in hospitals and clinics on a single day in October, coded according to the International Classification of Diseases [ICD-10]); (10) and (iv) vital registration records assimilated by the Japan Ministry of Health, Labour and Welfare. (11)

Incidence estimation

Because of the limitations of the reported statistics, the annual numbers of cases of acute gastroenteritis attributable to foodborne disease caused by Campylobacter ([Y.sub.1]), Salmonella ([Y.sub.2]) and EHEC ([Y.sub.3]) were estimated using the formulae:

[Y. …

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