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The article, written by Sandra Hoffman, Michael Batz and J. Glenn Morris, focuses on 14 of the 31 major foodborne pathogens reported on by Scallan et al. in an issue of the Centers for Disease Control and Prevention's publication, Emerging Infectious Diseases, based on the incidence estimates of foodborne illness in the United States.  According to the Scallan paper, these 14 pathogens account for 95% of illnesses and hospitalizations and 98% of deaths due to identifiable pathogens.  Scallan et al., yearly estimates in 2011:  48,000,000 sickened, 125,000 hospitalized and 3,000 deaths.

The pathogens focused on in the Hoffman article were Campylobacter, Clostridium perfringens, Cryptosporidium, Cyclospora, E. coli O157:H7, STEC non-O157, Listeria, norovirus, Salmonella, Shigella, Toxoplasma, Vibrio, and Yersinia.  The authors estimated that these 14 pathogens cause $14.0 billion (ranging from $4.4 billion to $33.0 billion) in cost of illness.  They also estimate that 90% of this loss is caused by five pathogens: nontyphoidal Salmonella enterica ($3.3 billion), Campylobacter spp. ($1.7 billion), Listeria monocytogenes ($2.6 billion), Toxoplasma gondii ($3 billion), and norovirus ($2 billion).

Disease outcome estimates included long-term disabilities, chronic conditions, and latent impacts of acute foodborne illness that are not captured by CDC's incidence estimates.  Those included Guillain-Barre Syndrome (GBS) caused by Campylobacter, diarrhea relapse caused by C. parvum, end-stage renal disease (ESRD) caused by either E. coli O157 or Non-O157 STEC, vision loss caused by Toxoplasma, and numerous impacts of congenital toxoplasmosis and listeriosis such as stillbirths, neonatal deaths, and lifelong physical and mental disabilities.

Hoffman's paper also follows the U.S. Environmental Protection Agency and U.S. Food and Drug Administration practice of valuing all deaths at a an estimate of $7.9 million (in 2009 U.S. dollars).

Cost of medical treatment included physician and emergency room visits, hospitalization, outpatient treatment, and long-term care for permanent or chronic conditions, with costs of hospitalization the most significant.

Productivity loss was estimated for each health state as the product of days of work lost per case and daily wage rate, adjusted for the employment rate.

The authors' estimates also included medical costs and productivity losses due to long-term health outcomes such as mental disabilities resulting from congenital listeriosis, physical and mental disabilities resulting from Campylobacter-associated GBS, and ESRD following infection with STECs.

The paper is worth a full read.

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