1 Introduction
Foodborne diseases (FBDs) can be described as pathological alterations that arise as a result of the ingestion of contaminated food. This contamination may be associated with a variety of causes including harmful microorganisms, toxins, and substances that can cause harm to the human body. The most common signs and symptoms of these diseases are associated with the gastrointestinal tract; including nausea, diarrhea, and vomiting as manifestations most frequently reported. Besides the gastrointestinal symptoms that are commonly seen, foodborne pathogens can also affect other parts of the body such as cardiovascular, respiratory, and musculoskeletal systems (Kuchenmüller, 2013). Although global food safety awareness has increased over the decades, FBDs constitute an economic and public health issue in many countries around the world. Their impact is particularly concerning in low- and middle-income countries where strategies for disease surveillance are not well established. International organizations such as the World Health Organization (WHO) and the Food and Agriculture Organization of the United Nations (FAO) have determined methods to analyze and keep track of specific FBDs.
The WHO (2015) estimated that about 600 million cases of illnesses caused by foodborne hazards occurred globally in 2010. Over 90% of these cases were caused by infectious agents that provoke diarrhea, and zoonotic pathogens represented the main microorganisms involved in this public health issue (WHO, 2015). The Joint WHO/FAO Expert Committee in Zoonoses (1959) described zoonoses as infections and diseases that are naturally transmitted between animals and people. The transmission of these infectious diseases is intimately related to the domestication of animals, which brings together humans and several other species of vertebrates. This close contact may have changed the dynamics of animal-human interactions in a way that facilitated the transmission of diseases from domestic animals to people. Although the domestication process had different purposes, animals farmed for food include important reservoirs for multiple foodborne microorganisms.
2 Zoonotic Foodborne Diseases
Zoonotic foodborne pathogens include a variety of infectious agents such as bacteria (e.g. Campylobacter jejuni), viruses (e.g. norovirus), and parasites (e.g. Taenia solium). However, the most common zoonotic FBDs have their etiology attributed to bacterial pathogens (European Food Safety Authority, n.d.). Moreover, these microorganisms are the leading cause when it comes to diseases transmitted through food, being responsible for more than 65% of the reported outbreaks of FBDs (Le Loir et al., 2003). Of every 10 diseases in humans, six are considered zoonotic (Phillips, 2021) with many of them being transmitted through food and water. The importance of zoonotic FBDs has been recognized at local, national, and global levels. In the United States (US), for example, salmonellosis occupies the second position in the list of top zoonotic diseases of national concern (Animal and Plant Health Inspection Service, 2020; Centers for Disease Control and Prevention [CDC], 2020).
2.1 Zoonotic Foodborne Parasites
Protozoan and helminth species of internal parasites are the organisms involved in parasitic foodborne infection in people (Murrel, 2013). Although there are divergences in terms of classifications, the Protozoa are considered to be a subkingdom of the Protista kingdom and include a variety of unicellular eukaryotic organisms (Yaeger, 1996). They are mainly microscopic organisms, and most parasitic protozoa in people have a size less than 50 micrometers (Singleton, 2018). On the other hand, helminths are multicellular organisms that are classified into two phyla: Nemathelminthes (roundworms) and Platyhelminthes (flatworms) (Mahamud et al., 2018). Nemathelminthes include approximately 500,000 species, and they can cause disease to plants, animals, and humans (John & Petri, 2020). Platyhelminths are one of the largest animal phyla and include over 20,000 species (Adell et al., 2015). The diseases caused by some parasites are classified as neglected tropical diseases, which are a group of diseases that primarily affect poor populations living in tropical and subtropical climates (WHO, 2012). This group of diseases include important zoonotic foodborne parasites such as species from the Echinococcus and Taenia genera.
2.2 Bacterial Zoonotic Foodborne Pathogens
Bacteria are prokaryotic microorganisms that have different morphologic characteristics, which are analyzed as part of their identification process. Bacteria cells have different shapes with the most common being rods, spheres, and spirals. Although their cell structure may appear simple when compared to eukaryotic cells, bacteria have a complex set of components that can determine how dangerous they are to humans. The cell wall of these microorganisms is organized in two basic forms that are defined based on the results of the Gram staining technique. Gram-positive bacteria have a cell wall with a thick layer of peptidoglycan whereas those that are Gram-negative have a thin layer of peptidoglycan and an outer membrane that is not found in Gram- positive cells.
Additionally, bacteria may carry extracellular components such as fimbriae, flagella, and capsules, which offer structural support and facilitate the agent-host interaction through bacterial colonization, mobility, and exchange of genetic materials (Bhunia, 2018a). Some surface structures are important virulence factors that give bacteria the ability to infect the host, cause disease, and bypass the immune system defenses. The pathogenicity of bacteria that cause FBDs rely on their capacity to penetrate, survive, and multiply in hosts cells along with their ability to produce toxins (Le Loir et al., 2003). Besides pathogens’ virulence factors, the host characteristics including age and immune status are also factors that need to be considered in the dynamics of FBDs.
The most common species of bacteria involved in FBDs include Salmonella enterica, Escherichia coli, and Campylobacter jejuni (Bintsis, 2017; WHO, 2020a; Zhao et al., 2014). Other pathogens with relevance to public health are species from the Vibrio genus and Listeria monocytogenes. All these microorganisms are considered important causative agents of zoonotic FBDs, and they are also responsible for economic and production losses in animal farming. Additionally, even though these pathogens can infect humans through the ingestion of contaminated food, people may become infected through different routes including direct interaction with infected animals. Moreover, food may become contaminated due to cross-contamination where bacteria on surfaces, for example, may be transferred to food during the preparation process. S. enterica serovar Enteritidis and Campylobacter jejuni have been noted to continue to be viable on dry stainless-steel surfaces at room temperature and represent a possible cross-contamination risk (Stein & Chirilã, 2017).
Summary of important zoonotic foodborne bacteria
Source: Authors’ elaboration
2.2.1 Salmonella spp.
Salmonellae are Gram-negative, rod-shaped bacilli that are taxonomically divided into two species: S. enterica and S. bongori (CDC, 2019a). The former is classified into six subspecies that can be distinguished from each other with the use of biochemical tests: S. enterica subsp. enterica, S. enterica subsp. salamae, S. enterica subsp. arizonae, S. enterica subsp. diarizonae, S. enterica subsp. houtenae and S. enterica subsp. Indica (Grimont & Weill, 2007). Additionally, Salmonella is a facultative intracellular microorganism that can colonize the intestinal tract of a variety of homoeothermic and poikilothermic animals (Liu, 2018). More than 2,500 serovars of Salmonella have been reported worldwide and categorized based on somatic (O) and flagellar (H) antigens (Agbaje et al., 2011). The majority of the isolates that cause disease in mammals including humans belong to S. enterica subsp. enterica, and the nontyphoidal Salmonella serovars represent the group that are zoonotic or potentially zoonotic (The Center for Food Security & Public Health, 2013).
Common sources of contaminated food include eggs, poultry, and beef, and infection occurs in the summer months with higher frequency (CDC, 2019a). Usually, an infectious dose greater than 50,000 bacterial cells is necessary to set off a disease in humans, and the onset of symptoms occur between 6 to 72 hours after the consumption of contaminated food (Coburn et al., 2007). The clinical manifestations of FBDs are generally associated with alterations in the gastrointestinal system. However, individuals in high-risk groups such as those that are immunocompromised and the elderly may develop bacteremia as a complication of an infection caused by nontyphoidal Salmonella (Acheson & Hohmann, 2001).
The diagnostic of salmonellosis can be done through laboratory tests that detect bacterial cells or genetic material in stools, body tissue, or fluids of people who have been infected (CDC, 2019b). The traditional Salmonella culture method include pre-enrichment, selective enrichment, isolation of pure culture, biochemical tests, and serological confirmation (Bhunia, 2018b). Other methods used to identify and categorize salmonellae are polymerase chain reaction (PCR) and real-time PCR assays that work by targeting a variety of Salmonella genes including 16S rRNA, agfA, and viaB (Gwida & Al-Ashmawy, 2014). Preventive and control measures include rigorous strategies throughout the food chain in order to avoid food contamination. Furthermore, basic hygiene practices and avoiding the consumption of raw animal products are examples of preventive measures that can be adopted by the general population.
2.2.2 Escherichia coli
The Escherichia genus is currently divided into five species: E. albetii, E. coli, E. fergusonii, E. hermanii, and E. vulneris (Schmidt, 2019). The species E. coli is one of the most studied in this genus, particularly in research that investigates its role in cases of FBDs. E. coli is a Gram-negative, facultative anaerobic bacillus that can be either motile or nonmotile (Desmarchelier & Fegan, 2011). This bacillus can be found in the gastrointestinal tract of a variety of species including humans, cattle, goats, and pigs. Even though most strains of E. coli are harmless, some strains are involved in cases of severe illnesses in people (WHO, 2018a). The strains of this species are serologically differentiated by O, H, and capsular (K) antigens (Nataro & Kaper, 1998). Over 700 serotypes have been identified so far, and as to serotyping strains of E. coli associated with diarrheal disease, it is necessary to determine only the O and H antigens (Doyle et al., 2020).
The term diarrheagenic E. coli is commonly used to classify the strains of this species responsible for causing gastrointestinal infections. The groups of strains of diarrheagenic E. coli can be differentiated based on their virulence factors and pathogenesis, and they include enteropathogenic E. coli (EPEC), Shiga toxin-producing E. coli (STEC), enteroinvasive E. coli (EIEC), enteroaggregative E. coli (EAEC), enterotoxigenic E. coli (ETEC), diffusely-adherent E. coli (DAEC), and adherent-invasive E. coli (AIEC) (Croxen et al., 2013; Nataro & Kaper, 1998). The STEC pathotype is also known as Verocytotoxin-producing E. coli (VTEC) or enterohemorrhagic E. coli (EHEC), and it is the group most commonly linked to foodborne outbreaks (CDC, 2014). As suggested by its name, the nomenclature of this group refers to an E. coli strain that acquired the capacity to produce Shiga toxin (Stx) through the transfer of one or both genes (i.e. stx1a and stx2a) by a Stx phage (Byrne et al., 2015; Petro et al., 2019; Travert et al., 2021). STEC is naturally found in the microbiota of ruminants, which are the most important reservoirs of this zoonotic pathogen (Ballem et al., 2020). Additionally, E. coli O157:H7 is the most important and frequently isolated serotype of STEC (Siddiqui & Yuan, 2021; Tian et al., 2018). Moreover, the low infectious dose of E. coli O157:H7 may be one of the factors why this serotype is involved in many outbreaks. As few as 10 viable bacterial cells have the potential to cause disease in humans (Ameer et al., 2021; Etcheverria & Padola, 2013).
The clinical manifestations of STEC infection comprise of severe stomach cramps, diarrhea, vomiting, and, in some cases, fever (CDC, 2014). Between 5 and 15% of the patients that have symptomatic STEC infection develop a severe condition known as hemolytic uremic syndrome (HUS), which may lead to kidney failure (Bruyand et al., 2018). In terms of diagnosis, O157 STEC can be differentiated from most natural E. coli that inhabit the intestines by their inability to ferment sorbitol within 24 hours on a selective medium such as sorbitol-MacConkey agar (Gould & STEC Clinical Laboratory Diagnostics Working Group, 2012). Additionally, PCR can be used as a molecular method for STEC identification, and it has good sensitivity and specificity for the detection in different sources of infection (Castro et al., 2017).
2.2.3 Campylobacter spp.
Over 20 species have been assigned to the Campylobacter genus, but C. jejuni and C. coli are the most commonly isolated from humans (Man, 2011). Campylobacter spp. are Gram-negative, non-spore-forming bacteria that are usually motile by means of a single polar unsheathed flagellum at one or both ends of the cell (Silva et al., 2011). Species from the Campylobacter genus have a helical shape, but they have the ability to change their structure and become rod- or coccoid-shaped (Esson et al., 2016). Campylobacter spp. are commensal microorganisms of the gastrointestinal tract of many farm, wild, and companion animals, which are reservoirs for human infection (Facciolà et al., 2017; Fitzgerald & Nachamkin, 2015). Among the zoonotic species of this genus, C. jejuni is responsible for over 81% of the cases of campylobacteriosis in people (Liu, 2018).
The incubation period (i.e. time between becoming infected and presenting symptoms) of campylobacteriosis is typically two to five days, but it can range from 1 to 10 days (WHO, 2020b). Infectious doses between 8 × 102 to 2 × 109 cells of C. jejuni have been shown to cause diarrheal diseases in humans (Black et al., 1988). As for most bacterial FBDs, the clinical manifestations of campylobacteriosis include diarrhea, intense abdominal pain, nausea, and vomiting. About 0.1% of individuals infected with campylobacteriosis develop Guillain-Barré syndrome, which is a serious autoimmune disorder that can cause muscle weakness and paralysis (Janssen et al., 2008; CDC, 2019c). Since there are no specific symptoms that can help to confirm a case of campylobacteriosis, different diagnostic methods have been used such as PCR, DNA microarray, enzyme-linked immunosorbent assay (ELISA), biochemical characterization, and serotyping (Choudhary et al., 2021).
2.2.4 Listeria monocytogenes
Listeria spp. are Gram-positive, rod-shaped, non-spore-forming, facultative aerobic bacteria that are motile by means of a few peritrichous flagella (Wang & Orsi, 2013). Listeria spp. includes 20 recognized species, and L. monocytogenes represents the most pathogenic member of the genus (Nwaiwu, 2020). Based on O and H antigens, 13 serotypes of L. monocytogenes have been identified, and the serotypes 1/2a, 1/2b, 1/2c, and 4b are the most commonly found in food and the food production environment (Jamshidi & Zeinali, 2019). Cattle and small ruminants including goats and sheep are important reservoirs of L. monocytogenes and their feces can carry this pathogen and, consequently, contaminate the soil and surrounding environment (Vivant et al., 2013). Moreover, the infective dose of L. monocytogenes has been estimated to be 10 to 100 million CFU in healthy individuals, and 0.1 to 10 million CFU in people at high risk (Government of Canada, 2012). Examples of individuals at high risk are those who are immunocompromised, pregnant, or over 65 years.
In humans, listeriosis can occurs in two forms: noninvasive listeriosis and invasive listeriosis. The former is a mild manifestation of the disease and has symptoms that include diarrhea, headache, and fever, whereas the latter is a severe form of the disease that particularly affects people at high risk and has symptoms such as fever, myalgia, septicemia, and meningitis (WHO, 2018b). It is important to mention that this disease has high mortality rates, ranging from 20 to 30% (Hernandez-Milian & Payeras-Cifre, 2014). The diagnosis of this disease is made through cultures of blood, spinal fluid, or other body cavity fluids (Mcneil et al., 2017). Furthermore, the diagnosis of listeriosis during pregnancy is difficult as about 30% of the cases are asymptomatic; however, if disease is suspected, placental cultures are considered the gold standard for diagnosis of maternal fetal listeriosis (Serventi et al., 2020).
2.2.5 Vibrio spp.
The Vibrio genus has over 70 species that are ubiquitous and abundant in aquatic environments (Kokashvili et al., 2015). The components of this genus are Gram-negative, facultative anaerobic, rod-shaped bacteria with a single polar flagellum, and, with the exception of V. cholerae and V. mimicus, all species are halophilic (Long et al., 2017). Vibrio spp. represent the cause of most human diseases associated with microorganisms of aquatic environments and seafood, and V. cholerae, V. parahaemolyticus, V. alginolyticus, and V. vulnificus the most common pathogenic species (Baker-Austin et al., 2018). In the United States, environmental factors such as temperature and salinity of water have been determined to be predictors of V. parahaemolyticus and V. vulnificus abundance (Raszl et al., 2016).
Individuals infected with Vibrio spp. may be asymptomatic or may present clinical manifestations such as diarrhea, abdominal pain, nausea, vomiting, fever, headache, and myalgia (Baker-Austin et al., 2018; Liu, 2018). In terms of microbiological diagnosis, the thiosulfate citrate bile-salts sucrose (TCBS) agar is the standard medium used for selective isolation of Vibrio species. Furthermore, culture independent methods such as PCR can be used to quantify Vibrio spp. in different sources of infection (Givens et al., 2014).
3 Food Chain and Food Contamination
Analyzing the food supply chain in terms of animal production is an essential part of understanding the dynamics of zoonotic FBDs. Several pathogens have been linked to agricultural and food preparation practices, which is one of the reasons why food safety measures are constantly being developed and put in place. Analyses have shown that agricultural drivers were associated with approximately 50% of zoonotic diseases that emerged in human since 1940 (Rohr et al., 2019). Moreover, population growth and demographic changes are expected for the next decades along with an amplification of the already intensive animal farming system (Godfray & Garnett, 2014). If no plan of effective control measures is adopted, the intensification of the food supply chain will allow the spread of pathogens in a much larger scale than the one currently seen. Because the incidence of infectious diseases typically increases proportionally with the increase of host density, the rise in human and livestock densities could also affect the spread of pathogens (Jones et al., 2013; Rohr et al., 2019). In addition, new zoonotic foodborne pathogens may appear during this process, and the development and implementation of surveillance systems is an essential step to control them.
Food contamination occurs when microorganisms or chemicals get into food products and their presence make the food unsafe. The contamination of food products may occur during different stages of the food chain such as production, processing, distribution, preparation, and the final consumption (Abebe et al., 2020). A variety of animal products are subjected to contamination, the most common being eggs, meat, poultry, and dairy products. One comprehensive approach to address issues related to food contamination is the adoption of strategies based on Hazard Analysis Critical Control Point (HACCP). This is a management system that addresses food safety through the identification, evaluation, and control of hazards (US Food and Drug Administration, 2018).
4 Global Burden of Foodborne Diseases
Foodborne diseases are a public health concern worldwide, but they affect countries at different levels. Low- and middle-income nations are the most impacted by these diseases and also the countries with the lowest performances with regards to disease surveillance. Although food safety and FBD awareness have increased globally, strategies to efficiently monitor and control the spread of foodborne pathogens still lack in those countries. Even though FBDs have been causing economic losses and public health concerns for a long time, only a few countries have assessed the burden of these infectious diseases. Moreover, not every person who becomes ill after ingestion of contaminated food seeks the healthcare system, which contributes to the gap that exists between the reported data and the real scenario. Even though this chapter does not enter into the merit of issues related to healthcare access, it is important to mention that lack of access to quality healthcare is a contributing factor for the underreport of FBDs. The lack of surveillance and data on FBDs also prevents health authorities from analyzing past trends, which could help to develop new approaches for limiting the burden.
The first estimates on global and regional burden of FBDs was presented only in 2015 and was led by the WHO. The report provides readers with estimates of incidence and mortality rates along with disease burden in terms of Disability Adjusted Life Years (DALYs) caused by 31 foodborne hazards. DALYs for a disease or condition are the total sum of the years of life lost due to premature mortality and the years lived with a disability (WHO, n.d.). Although norovirus was responsible for the most DALYs worldwide in 2010 (i.e. over 15 million DALYs), bacterial pathogens such as S. enterica and E. coli represented important causes of DALYs (WHO, 2015). Furthermore, human-to-human contact was the main route of transmission of norovirus for most regions, whereas food represented the principal route of transmission for Shiga toxin-producing E. coli, Non-typhoidal S. enterica, and Campylobacter spp. in all regions. This fact highlights the importance of research at all levels on the interplay between humans, zoonotic pathogens and their animal reservoirs, and animal food products.
5 The United States Context
Foodborne illnesses have an impact on countries’ health and economic systems worldwide. In the United States, it was estimated that foodborne pathogens caused an economic burden of $17.6 billion, which is 13% higher than the 2013 estimate (Economic Research Service, 2021). Other estimates show that the annual economic burden of FBDs in Australia and New Zealand is respectively $1.289 billion and $86 million (McLinden et al., 2014). National public health estimates on this issue show that 48 million people get sick and 3,000 die of FBDs every year (CDC, 2018). These estimates highlight the impact of FBDs in the country and the value of epidemiological analyses that keep these diseases under surveillance.
One of the tools used to monitor FBDs in the US is the National Notifiable Disease Surveillance System (NNDSS). The NNDSS is an integrated system that allows public health at all levels (i.e. local, national, and global) to share data that is used to monitor, control, and prevent the occurrence and spread of notifiable diseases and conditions (US Department of Health and Human Services, n.d.). The list of nationally notifiable infectious diseases includes zoonotic FBDs such as salmonellosis, campylobacteriosis, STEC infection, listeriosis, and vibriosis. These are diseases for which more data is necessary to develop effective control and preventive measures in order to reduce their occurrence and spread. Additionally, the Healthy People initiative set health-related national objectives on a 10-year basis for improving the health and well-being of all individuals. These objectives can be used as comparison measurements to assess the progress towards the control of infectious diseases.
6 Analysis of Trends in Zoonotic Foodborne Diseases
The trends on the incidence of many zoonotic FBDs have varied throughout the years. The US list of Nationally Notifiable Infectious Diseases and Conditions is comprised of many illnesses caused by different pathogens. Some of the zoonotic FBDs include salmonellosis, STEC infection, listeriosis, campylobacteriosis, and vibriosis. Epidemiologic data on these diseases can be retrieved from the NNDSS for the US and from the European Centre for Disease Prevention and Control for countries of the European Union. Additionally, the Public Health Agency of Canada also provides epidemiological data regarding these diseases. It has to be noted that despite the fact these diseases are commonly transmitted through contaminated food, the proportion of cases linked to food consumption is not available. Also, each disease has a case definition that includes clinical and laboratory criteria as part of its diagnosis in the United States.
Reported cases of zoonotic foodborne diseases in the United States, 2010–2019
Source: Authors’ elaboration
Reported cases of zoonotic foodborne diseases in the United States, 2010–2019
From 2010 to 2019, some changes were seen in the incidence rate (IR) of major zoonotic FBDs. Fluctuations were observed in the incidence of salmonellosis with rates varying from 17.59 cases per 100,000 people in 2010 to 16.63 cases per 100,000 people in 2019. Unless specified otherwise, for the remainder of this chapter, IR represents the number of cases per 100,000 people. During those 10 years, the highest rate was reported in 2018 with an incidence of 18.67. The Healthy People initiative had targeted for 2020 an incidence of salmonellosis of 11.4 (Office of Disease prevention and Health Promotion [ODPHP], 2021). This substantial decrease in new cases of salmonellosis is an ambitious aim that continues in place as an objective of the Healthy People 2030. The persistence of this disease has also been observed in other countries. The Canadian government has reported IRs of salmonellosis varying from 17.63 in 2013 to 19.24 in 2018 with a peak in 2014, when the country registered 21.56 cases of this disease per 100,000 people.
The US incidence of STEC infection has been continuously rising since 2014 when the country reported a total of 6,179 cases. An increase greater than two-fold in the number of cases was registered in 2019, accounting for an IR of 5.16. The US national objective for 2020, however, was to reduce the incidence of STEC infections to 0.6 cases per 100,000 people (ODPHP, 2021). A similar trend has been observed in European countries such as Denmark and Norway. Even though these countries have a much lower number of cases when compared to the US, the incidence of STEC infection there is increasing at a high rate. On the other hand, the Netherlands have been progressively reducing the occurrence of this disease, reporting 459 cases in 2019. Although many factors play a role in the dynamics of this infection, it was found that there is a relationship between the number of cases of STEC infection in the US and the per capita consumption of chicken in the country.
Between 2010 and 2019, the US has reported low IRs of listeriosis, ranging from 0.23 to 0.28. The highest number of cases in this period of time was observed in 2017 when the country reported a total of 887 cases, which represented an IR of 0.27. In the same year, Germany and France had the highest number of cases of listeriosis in the European Union, registering a total of 726 and 370 confirmed cases, respectively. Because of the difference in population size between these two European countries and the US, they reported a much higher IR of listeriosis for that year (i.e. Germany: 0.88 cases per 100,000 people and France: 0.55 cases per 100,000 people). An incidence higher than that of the US was also found in Canada where a rate of 0.33 was reported. The Healthy People 2020 target for this disease was a rate of 0.2 cases per 100,000 people (ODPHP, 2021). Although there is some small fluctuation in the incidence of listeriosis throughout the last decade, this disease seems to be under control. However, its high mortality rate makes it a disease that needs to be constantly under surveillance.
Campylobacteriosis became a nationally notifiable disease in the US in 2015. Annual national data on this disease has been released since then. The number of cases of this disease have been annually increasing since its first report in 2015. In 2019, the country reported 71,509 cases of campylobacteriosis, making it the nationally notifiable FBD with the highest number of cases in that year. In 2017, the US had an IR of 20.78, which was lower than that reported by most European countries in the same year. From 2015 to 2019, the IR of campylobacteriosis increased from 17.01 to 21.79. The national goal, however, was to decrease it to 8.5 cases per 100,00 by 2020 (ODPHP, 2021). Additionally, the number of cases of vibriosis has also increased over the years in the US, where the case counts more than tripled from 2010 to 2019. Yet, the highest incidence (0.91 cases per 100,000 people) was reported in 2018.
Incidence of reported cases of zoonotic foodborne diseases in the United States, 2010–2019
Source: Authors’ elaboration
7 Conclusion
It has been shown that zoonotic FBDs are on the rise in the US and other high-income countries. Although the burden of FBDs is greater in low- and middle-income countries, public health authorities of high-income nations have to be aware of epidemiological trends in order to control and prevent the increase in the IR of these diseases. Measures based on the One Health approach, which considers the human-animal-environment interface, are a way to fully understand the rise in the IR of zoonoses and to effectively develop strategies to mitigate their impact on populations. The limitations in the research of epidemiological trends include the lack of analysis of other zoonotic FBDs such as norovirus infection even though this is not considered a nationally notifiable disease. Although the diseases analyzed are commonly transmitted through the consumption of contaminated food, the proportion of cases that were related to food is not available. Additionally, the comparison of IR between countries was limited as many countries do not have a surveillance system that report data on FBDs on a regular basis. Furthermore, supplementary studies are necessary to evaluate what factors are associated with the increase in IR of zoonotic FBDs in the US and to examine the association between these diseases and food products of animal origin.
Acknowledgements
The authors acknowledge the support of Northeastern Illinois University and its Master of Public Health Program.
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