Headlines - Estimates of Morbidity and Mortality Associated with Foodborne Infections in Metropolitan France, 2008–2013

Santé publique France presents estimates of the annual number of symptomatic cases, hospitalizations, and deaths for 21 pathogens (10 bacteria, 3 viruses, 8 parasites) transmitted to humans through food (excluding waterborne transmission) in mainland France between 2008 and 2013.Epidemiological surveillance of these infections relies primarily on mandatory reporting (MR) and National Reference Centers (NRCs). However, the reported cases do not represent all cases that actually occurred and do not, on their own, allow for an estimation of morbidity and mortality (Figure) due to underreporting, underdiagnosis, and the fact that the proportion of foodborne transmission varies by pathogen. Methods adapted to the different data sources available for each pathogen were used to perform the estimates.The 21 agents studied are responsible each year for 4.9 million cases, 42,800 hospitalizations, and 376 deaths (1.5 million cases, 7,600 hospitalizations, and 256 foodborne deaths).Three agents account for the majority of foodborne cases and hospitalizations: noroviruses (34% and 20% of the total number of cases and hospitalizations, respectively), Campylobacter (26% and 31%), and Salmonella (12% and 24%). Infections with Salmonella spp. and Listeria monocytogenes—a relatively rare agent (<0.1% of cases)—account for half of foodborne deaths (26% and 25%, respectively). The importance of hepatitis E virus as a foodborne pathogen is increasingly recognized, causing 59,300 cases annually, including approximately 500 hospitalizations and 18 deaths. Understanding the absolute and relative prevalence of foodborne infections is useful for public health authorities and operators involved in food safety. These estimates indicate in particular that:- Salmonella spp., Campylobacter, and L. monocytogenes must remain priorities in surveillance and the implementation of prevention and control measures; - efforts to raise awareness among kitchen staff regarding the fecal-oral risk and adherence to good hygiene practices when handling food must continue, especially since anyone can be a carrier before symptoms appear (viruses);- Hygiene rules must be strictly followed at the household level, particularly when there is a sick person in the home.