Researchers have estimated the burden of disease from certain foodborne pathogens in the Netherlands in 2019.

about 41 percent of the foodborne burden was associated with meat such as poultry, pork, beef and lamb. These products caused a third of all food-related fatal cases.

Each year, the National Institute for Public Health and the Environment (RIVM) investigates how many people become sick or die from 14 pathogens. This is the burden of disease and is expressed in Disability Adjusted Life Years (DALYs). Foodborne disease accounted for 4,200 of the 11,000 DALYs  per year, and €174 million of the €423 million.

The total number of DALYs the pathogens caused in 2019 was 11,000 – the same as in 2018 and 2017. Sources include food, the environment, direct animal contact, human-to-human transmission, and travel. Cases in the food pathway increased but went down in the other four areas.

Total cost of illness (COI) in 2019 of €423 million ($518 million) was slightly lower than €426 million ($522 million) in 2018. This includes direct medical fees and costs for patients and/or their families like travel expenses, and costs for other things such as being absent from work.

The foodborne disease burden slightly decreased from 4,300 DALYs in 2018 to 4,200 in 2019 and the COI increased from €171 million ($209 million) in 2018 to €174 million ($213 million) in 2019.

Dutch pathogen burden
The 14 pathogens tracked are Campylobacter, E. coli O157, Salmonella, Listeria monocytogenes, Bacillus Cereus, Clostridium perfringens, Staphylococcus aureus, norovirus, rotavirus, hepatitis A, hepatitis E, cryptosporidium, Giardia and Toxoplasma.

In the future, the burden of disease and costs for Bacillus cereus, Clostridium perfringens and Staphylococcus aureus will not be estimated because of the absence of surveillance on these infections. However, for the overall 2019 estimates, the three pathogens were included.

There was a small decrease in the estimated total of cases because of the 14 food related pathogens from 1.63 million in 2018 to 1.57 million in 2019. This was mostly because of the lower number of norovirus, rotavirus, and Cryptosporidium cases, according to the report.

The total number of estimated deaths because of foodborne disease in 2019 was slightly higher than in 2018, with 245 deaths compared to 238. Sixty-six were due to norovirus, Campylobacter caused 53, Salmonella 24 and Listeria 16.

An increase in the burden of disease between 2018 and 2019 was found for Campylobacter. For norovirus and rotavirus, there was a decrease. The largest burden at population level was caused by Campylobacter, followed by Toxoplasma gondii and norovirus. Although the disease burden for Campylobacter has decreased since 2010, it slightly increased in 2018 and this rise continued in 2019.

Cost estimates
The four pathogens causing the largest costs were norovirus €106 million ($130 million), rotavirus €64 million ($78 million), Staphylococcus aureus toxin €63 million ($77 million), and Campylobacter €62 million ($76 million). The lowest contribution was hepatitis A virus at €1.3 million ($1.6 million).

Estimated costs went down for Cryptosporidium and norovirus. The average per case cost was highest for perinatal Listeria monocytogenes infections at €291,000 ($356,000).

Healthcare costs accounted for 21 percent of total costs for the 14 pathogens, patient or family costs for 2 percent and costs in other sectors made up 77 percent.

The study was commissioned by the Ministry of Health, Welfare and Sport (VWS) to provide a better understanding of the burden of disease and exposure routes of foodborne infections among the Dutch population and to monitor trends over multiple years.