The occurrence of foodborne disease in Brazil is low compared to other countries but this could be due to underreporting and people not seeking health care when ill, according to a study.

The work, published in the journal Nutrients, evaluated foodborne diseases in Brazil after 11 years of the Epidemiological Surveillance System of Foodborne Diseases. The study analyzed secondary data from the National System of Injuries and Notifications (SINAN-NET) from the Health Department.

In Brazil, the National Agency of Sanitary Surveillance (ANVISA) carries out inspection and maintenance of legislation related to sanitation and good manufacturing practices for food-producing sites.

There were 7,630 foodborne disease outbreaks in the National Epidemiological Surveillance System of Foodborne Diseases (VE-DTA). Of the registered reports, 134,046 people were sick; 19,394 were hospitalized, and there were 127 registered deaths.

“In Brazil from 2007 to 2017, 134,046 cases of foodborne disease were registered, this being an extremely low number for an 11-year period. Data are probably underreported since the VE-DTA system lacks completeness, and because foodborne disease symptoms are mostly mild, a large part of the population does not seek care from health services,” said researchers.

“It is important to consider that the national and international reports show that most cases of foodborne disease are not notified to health authorities; because many foodborne pathogens cause mild symptoms, victims do not seek medical help, contributing to underreporting of epidemiological data.”

The Centers for Disease Control and Prevention in the United States estimates that each year roughly 48 million people get sick, 128,000 are hospitalized, and 3,000 die of foodborne diseases. More than 23 million fall ill and 5,000 die in Europe annually due to unsafe food, according to World Health Organization estimates in 2015.

The VE-DTA system was developed in 2017 and aims to provide information to promote health actions and reduce the incidence of and deaths caused by foodborne disease in Brazil.

“Despite the efforts to record and investigate foodborne disease in Brazil, there are still considerable difficulties in using data from the VE-DTA system, as evidenced by the lack of publications. The last foodborne disease epidemiological bulletin is from the year 2005, and it uses data on the foodborne disease from 1994 to 2004, before implementation of the VE-DTA system,” said researchers.

The year with the highest number of foodborne disease outbreaks was 2014 (n = 886, 11.6 percent) and the lowest was 2010 (n = 498). In 2014, the Football World Cup was held in the country which likely contributed to the increase as more people visited Brazil and more food was produced.

Unknown foods were most often registered for foodborne disease cases (n = 4,382, 57.4 percent), followed by mixed foods (695), and water (504). Mixed foods often had various ingredients and were usually homemade.

“Since…people do not know which food caused the foodborne disease, it makes it difficult to investigate the outbreak. Also, the etiological agents have different incubation times, making it even more difficult to associate foodborne disease symptoms with the food consumed and the etiological agent involved,” said researchers.

The most involved microorganisms were Salmonella spp. (22.1 percent of all cases), followed by E. coli (20.5 percent) and Staphylococcus aureus (18.2 percent). Over the study period, there was a decrease in outbreaks caused by Salmonella spp. and a rise in cases of infection by E. coli. In most registered outbreaks the etiological agents were not identified which hinders investigations.

Brazil, because of its warmer climate, has a different profile of etiological agents with higher temperatures having the most noticeable effect on salmonellosis reports.

Pernambuco, Minas Gerais, and the Rio Grande do Sul were Brazilian states with the highest foodborne disease notifications; with 13.93 percent, 13.14 percent, and 10.87 percent, respectively. The most deaths were in Minas Gerais (n = 30; Southeast region), followed by Amazonas (15) in the North, and Maranhão (15) in the Northeast.

The Southeast and South regions have a greater population density than other areas of Brazil, corresponding with the higher number of foodborne disease reports. The VE-DTA system also is more complete in the Southeast region compared to other areas.

The initial site of outbreaks showed the places with the highest occurrence were residences, with 2,922 cases (38.3 percent). Restaurants and bakeries were second with 1,265 cases, followed by sites such as lodges and workplaces, with 881 cases.

“The occurrence of foodborne disease outbreaks in residences shows a serious problem regarding the lack of sanitary education and knowledge about adequate preparation and storage of food by the population in general. Outbreaks of foodborne diseases in households tend to be less well-known because they involve a smaller number of people (usually family),” said researchers.

On average, the time for the investigation of outbreaks in Brazil was 54 days. With the exception of 2007, there was a tendency for the investigation time of cases to decrease over the years.

Researchers said the country still faces problems in controlling foodborne diseases.

“In this sense, we recommend that there is a greater focus on educational activities and preventive actions related to food handling and storage with the entire population since most food-related outbreaks originate in a residential environment.”