Disease Attribution to Foods for Four UK Pathogens

Using data from the third intestinal infectious disease survey (IID3), the FSA aims to estimate the number of cases, general practice presentations, and hospitalisations caused by foodborne transmission of selected pathogens in the UK. To achieve this, estimates of the percentage of disease attributable to food for each pathogen are required. A systematic literature review was conducted to provide attribution estimates for four pathogens of interest: enteropathogenic Escherichia coli (EPEC), sapovirus, hepatitis A virus (HAV), and Toxoplasma gondii . This project pilots the review methodology and makes recommendations for its extension to other IID3 pathogens. Search results from SCOPUS, PubMed, and ScienceDirect databases were compiled into separate libraries for each pathogen. Articles published after 2012 in English, containing data on percentages of disease attributable to transmission pathways, were screened for inclusion. Thirteen studies were included in total. The studies estimated foodborne disease percentages as follows: EPEC, 64%; HAV, 10%-42%; sapovirus, 13%-16.3%; and T. gondii , 28%-61%. Fresh produce was identified as the primary foodborne transmission pathway for HAV, with estimates ranging from 45%-95.4%, and for sapovirus, 58.3%. Pork was implicated as a significant transmission pathway for T. gondii , with estimates between 20% and 41%. Variability in findings was noted, potentially due to differences in study design, data sources, or geographic and temporal factors. Despite this, the results offer valuable insights for the FSA in calculating the burden of foodborne infectious intestinal disease in the UK.