WHO Initiative to
Estimate the Global
Burden of Foodborne
Diseases
Global Health Metrics and
Evaluation Conference, Seattl...
Estimating the Global Burden of Foodborne Diseases …
… has not been done before
… is complex
… requires considerable resou...
18 May 20113
Why Estimate Global Burden?
2006 Expert
Consultation: WHO
to lead efforts &
appoint Foodborne
Disease Burden
...
18 May 20114
FERG Objectives
• To provide epidemiological estimates on the global burden of all
relevant foodborne disease...
FERG Structure
WHO Initiative to Estimate the Global Burden of Foodborne
Diseases | June 17, 2013
5
18 May 20116
How does FERG work?
● Annual meetings
– Planning and evaluation
– Interaction between task forces
– Interacti...
Hazards included in FERG estimates
● Diarrheal diseases by Salmonella enterica (including invasive
salmonellosis), Shigell...
18 May 20118
● 5 billion episodes per year, of
which 3.2 billion in SEARO
● Average incidence rate
0.5/yr, similar for all...
18 May 20119
The global burden of neurocysticercosis
● Neurocysticercosis is caused by
Taenia solium (pigs)
● Wide variati...
Global burden of aflatoxin
● 25,200-155,000 aflatoxin-induced liver cancer cases/yr
● ~5-30% of all hepatocellular carcino...
18 May 201111
Source Attribution
●Determine for each hazard (or specific groups of hazards) the
proportion of the disease ...
18 May 201112
Current approaches taken by FERG for source
attribution
● An assessment of all available methods has been pe...
Piecing it all together: the Computational Task Force
WHO Initiative to Estimate the Global Burden of Foodborne
Diseases |...
18 May 201114
FERG Country Studies Task Force
● Task Force activity
– Development of burden of foodborne disease protocols...
18 May 201115
Conclusions
● FERG has an ambitious agenda
● The Initiative continues to expand
● First results have been pu...
Thanks to …
● Amy Cawthorne, Fred Angulo, David Bellinger, Tim
Corrigan, Alejandro Cravioto, Herman Gibb, Tine Hald, John
...
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WHO Initiative to Estimate the Global Burden of Foodborne Diseases

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GHME 2013 Conference
Session: Global and national Burden of Disease II
Date: June 17 2013
Presenter: Arie Havelaar
Institute:
National Institute for Public Health and the Environment

Published in: Health & Medicine, Technology
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WHO Initiative to Estimate the Global Burden of Foodborne Diseases

  1. 1. WHO Initiative to Estimate the Global Burden of Foodborne Diseases Global Health Metrics and Evaluation Conference, Seattle June 17-19, 2013 WHO Initiative to Estimate the Global Burden of Foodborne Diseases | June 17, 2013
  2. 2. Estimating the Global Burden of Foodborne Diseases … … has not been done before … is complex … requires considerable resources because … … many different hazards can be transmitted by food … most can also be transmitted by other pathways … contamination occurs at many different points in the chain … they cause very diverse health outcomes … with different duration, severity and mortality WHO Initiative to Estimate the Global Burden of Foodborne Diseases | June 17, 2013 2
  3. 3. 18 May 20113 Why Estimate Global Burden? 2006 Expert Consultation: WHO to lead efforts & appoint Foodborne Disease Burden Epidemiology Reference Group (FERG) World Health Assembly 63, 2010 - Food Safety Resolution Member States urged to: Improve evidence base Reduce burden DG WHO urged to: Support country-based assessments Monitor & report burden
  4. 4. 18 May 20114 FERG Objectives • To provide epidemiological estimates on the global burden of all relevant foodborne diseases (according to age, sex and WHO regions) • To assist WHO to strengthen the capacity of countries to conduct burden of foodborne diseases and policy context studies • To assist WHO in bridging the gap between collection of scientific evidence and food safety policy making
  5. 5. FERG Structure WHO Initiative to Estimate the Global Burden of Foodborne Diseases | June 17, 2013 5
  6. 6. 18 May 20116 How does FERG work? ● Annual meetings – Planning and evaluation – Interaction between task forces – Interaction with stakeholders ● Task Force meetings – Physical meetings when necessary – Teleconferences ● Engagement with the scientific community – Commissioning of work (systematic reviews, data collection, expert elicitation) – Presentation at scientific meetings ● Engagement with countries – Data collection (country burden studies) – Policy interface
  7. 7. Hazards included in FERG estimates ● Diarrheal diseases by Salmonella enterica (including invasive salmonellosis), Shigella spp., Vibrio cholerae, EPEC, ETEC, STEC, Campylobacter spp., norovirus, Cryptosporidium spp., Entamoeba spp., Giardia spp., and unspecified agents ● Salmonella (para)typhi, Mycobacterium bovis, Brucella spp., ● Listeria monocytogenes, Hepatitis A virus ● Intoxications by Clostridium perfringens, Clostridium botulinum, Bacillus cereus, Staphylococcus aureus ● Chronorchis spp., Opisthorchis spp., Fascioloa spp. ● Echinococcus multilocularis, E. granulosis, Trichinella spp. ● Toxoplasma gondii ● Arsenic, Cadmium, Lead, Methylmercury ● Aflatoxin, Cyanogenic glycosides, Peanut allergens ● Dioxins WHO Initiative to Estimate the Global Burden of Foodborne Diseases | June 17, 2013 7
  8. 8. 18 May 20118 ● 5 billion episodes per year, of which 3.2 billion in SEARO ● Average incidence rate 0.5/yr, similar for all regions except EMRO (0.9/yr) ● 1.2 million deaths per year in SEARO and AFRO ● Approx. 6% of all deaths in these regions ● Estimate for SEARO 6-fold higher than previously published ● Compare with 1.1 million deaths in children < 5 years in these two regions (approx. 15% of all deaths) Fischer Walker CL, Black RE. Epidemiol Inf 2010;138:1215-1226 Diarrhea morbidity and mortality in children ≥ 5 years and adults
  9. 9. 18 May 20119 The global burden of neurocysticercosis ● Neurocysticercosis is caused by Taenia solium (pigs) ● Wide variation in the prevalence of NCC globally – 9% in Mexico, no symptoms – Hospitalisation 0.3-1.5 per 100,000 pyr in USA ● 30% of patients with epilepsy have NCC (Latin America, Sub-Saharan Africa, South-East Asia) ● Global burden of epilepsy is 6.2 million DALYs Ndimubanzi PC et al. PLoS Negl Trop Dis 2010;4(11):e870
  10. 10. Global burden of aflatoxin ● 25,200-155,000 aflatoxin-induced liver cancer cases/yr ● ~5-30% of all hepatocellular carcinoma cases 10 Liu Y, Wu F. (2010). Environ Health Perspect 118:818-824.
  11. 11. 18 May 201111 Source Attribution ●Determine for each hazard (or specific groups of hazards) the proportion of the disease burden that is attributable to food ●Identify – and if possible quantify - the responsible reservoirs and/or food commodities leading to illness ●Food attribution at the point-of-exposure; specific food source attribution at the point-of-entry into household/food setting Food Specific food sources
  12. 12. 18 May 201112 Current approaches taken by FERG for source attribution ● An assessment of all available methods has been performed, proposing SA methods for all prioritised hazards that are not (almost) 100% originating from a single food source/reservoir ● For estimating the overall proportion foodborne, structured expert elicitation is assessed to be the only option for the vast majority of hazards, since – Other methods estimate the proportion attributed to specific foods or reservoirs, but not the total – The inevitable “unknowns” makes simple summation impossible ● For estimating the contribution from specific sources (or sub-pathways) within the pathway food, different methods including outbreak data and expert elicitation will be applied
  13. 13. Piecing it all together: the Computational Task Force WHO Initiative to Estimate the Global Burden of Foodborne Diseases | June 17, 2013 13
  14. 14. 18 May 201114 FERG Country Studies Task Force ● Task Force activity – Development of burden of foodborne disease protocols and other tools to support individual country studies – Policy situation analysis and knowledge translation/risk communication tools to support the use of burden of disease data in setting policy – On-going technical support during individual country studies ● Longer term goal – Evaluation of protocols, making necessary revisions, towards a finalised user friendly suite of training and support tools – Support of additional national burden of foodborne disease and situation analysis studies ● Following an application process in 2010, four pilot studies started in late 2011: Japan, Thailand, Uganda, Albania
  15. 15. 18 May 201115 Conclusions ● FERG has an ambitious agenda ● The Initiative continues to expand ● First results have been published, more are well underway ● Attribution is a crucial, yet difficult component ● Final results are expected to be published in 2014 ● Data gaps and uncertainties will remain
  16. 16. Thanks to … ● Amy Cawthorne, Fred Angulo, David Bellinger, Tim Corrigan, Alejandro Cravioto, Herman Gibb, Tine Hald, John Ehiri, Martyn Kirk, Rob Lake, Nicolas Praet, Niko Speybroeck, Nilanthi de Silva, Claudia Stein, Paul Torgerson, Tanja Kuchenmüller ● Other members of the Foodborne Disease Burden Epidemiology Reference Group (FERG) ● Resource advisers ● Commissioned scientists ● Sponsors ● More information: http://www.who.int/foodsafety/foodborne_disease/ferg/en/index7.html WHO Initiative to Estimate the Global Burden of Foodborne Diseases | June 17, 2013 16

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