Academic journal article Journal of Environmental Health

Food-Related Illness and Death in the United States

Academic journal article Journal of Environmental Health

Food-Related Illness and Death in the United States

Article excerpt


To better quantify the impact of foodborne diseases on health in the United States, we compiled and analyzed information from multiple surveillance systems and other sources. We estimate that foodborne diseases cause approximately 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year. Known pathogens account for an estimated 14 million illnesses, 60,000 hospitalizations, and 1,800 deaths. Three pathogens, Salmonella, Listeria, and Toxoplasma, are responsible for 1,500 deaths each year, more than 75% of those caused by known pathogens, while unknown agents account for the remaining 62 million illnesses, 265,000 hospitalizations, and 3,200 deaths. Overall, foodborne diseases appear to cause more illnesses but fewer deaths than previously estimated.

Editor's note: This paper was originally published in Emerging Infectious Diseases (EID) by National Center for Infectious Diseases of the Centers for Disease Control and Prevention. The format of the paper therefore varies from normal Journal of Environmental Health style. In EID, over 100 references accompanied the paper, as did a seven-page appendix describing the methods and assumptions behind the authors' pathogen-specific estimates. These sources were not reprinted in this issue of the Journal because of space limitations. Upon request, however, they are available from NEHA service representatives by fax or mail.


More than 200 known diseases are transmitted through food (1). The causes of food-borne illness include viruses, bacteria, parasites, toxins, metals, and prions, and the symptoms of foodborne illness range from mild gastroenteritis to life-threatening neurologic, hepatic, and renalsyndromes. In the United States, foodborne diseases have been estimated to cause 6 million to 81 million illnesses and up to 9,000 deaths each year (2-5). However, ongoing changes in the food supply, the identification of new foodborne diseases, and the availability of new surveillance data have made these figures obsolete. New, more accurate estimates are needed to guide prevention efforts and assess the effectiveness of food safety regulations.

Surveillance of foodborne illness is complicated by several factors. The first is underreporting. Although foodborne illnesses can be severe or even fatal, milder cases are often not detected through routine surveillance. Second, many pathogens transmitted through food are also spread through water or from person to person, thus obscuring the role of foodborne transmission. Finally, some proportion of foodborne illness is caused by pathogens or agents that have not yet been identified and thus cannot be diagnosed. The importance of this final factor cannot be overstated. Many of the pathogens of greatest concern today (e.g., Campylobacter jejuni, Escherichia coli 0157:H7, Listeria monocytogenes, Cylospora cayetanensis) were not recognized as causes of foodborne illness just 20 years ago.

In this article, we report new estimates of illnesses, hospitalizations, and deaths due to foodborne diseases in the United States. To ensure their validity, these estimates have been derived by using data from multiple sources, including the newly established Foodborne Diseases Active Surveillance Network (FoodNet). The figures presented include estimates for specific known pathogens, as well as overall estimates for all causes of foodborne illness, known, unknown, infectious, and noninfectious.

Data Sources

Data sources for this analysis include the Foodborne Diseases Active Surveillance Network (FoodNet) (6), the National Notifiable Disease Surveillance System (7), the Public Health Laboratory Information System (8), the Gulf Coast States Vibrio Surveillance System (9), the Foodborne Disease Outbreak Surveillance System (10), the National Ambulatory Medical Care Survey (11), the National Hospital Ambulatory Medical Care Survey (12-14), the National Hospital Discharge Survey (15), the National Vital Statistics System (16), and selected published studies. …

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