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2011 Methods and Tables

Table 6a. Data sources used to estimate illnesses, hospitalizations, and deaths due to known foodborne pathogens in the United States, 2011 (from Scallan et al.)
Data Source Data Pathogen(s) Geographic Coverage Time Frame Adjustments
Cholera  and  Other  Vibrio  Illness  Surveillance  System  (COVIS)*  Number  of  case-patient  reports,  proportion  hospitalized,  proportion  who  died Vibrio  cholerae,  toxigenic;  Vibrio  vulnificus;  Vibrio  parahaemolyticus;  other  Vibrio  spp. United  States 2000–2007 Underreporting;  Under-diagnosis 
Foodborne  Diseases  Active  Surveillance  Network  (FoodNet)  Number  of  laboratory-confirmed  illnesses,  proportion  hospitalized,  proportion  who  died Campylobacter  spp.;  Cryptosporidium  spp.;  Cyclospora  cayetanensis;  Shiga  toxin–producing  Escherichia  coli  O157;  Shiga  toxin-producing  E.coli  non-O157;  Listeria  monocytogenes;  non-typhoidal  Salmonella;  Salmonella  serotype  Typhi;  Shigella  spp.;  Yersinia  enterocolitica FoodNet  sites 2005–2008 Geographical  coverages§;  Under-  diagnosis
Foodborne  Disease  Outbreak  Surveillance  System  (FDOSS) Number  of  foodborne  outbreak-associated  illnesses Bacillus  cereus;  Clostridium  perfringens;  Enterotoxigenic  Escherichia  coli;  Staphylococcus  aureus;  Streptococcus  spp.Group  A United  States 2000–2007;  (Streptococcus  spp.,Group  A  1996–2007) Underreporting;  Under-diagnosis
Proportion  hospitalized  and  proportion  who  died  in  foodborne  outbreaks Bacillus  cereus;  Clostridium  perfringens;  Enterotoxigenic  Escherichia  coli;  Staphylococcus  aureus;  Streptococcus  spp.,  Group  A;  Clostridium  botulinum;  Trichinella  spp. United  States 2000–2007;  (Streptococcus  spp.,Group  A1981–2007) Under-diagnosis
Nationwide Inpatient  Sample  (NIS) Hospitalization  rate Giardia  intestinalis  (ICD-9-CM  code  007.1),  Toxoplasma  gondii  (ICD-9-CM  codes  130.0-9) Sample  of  discharge  records  from  US  hospitals 2000–2006 Weighted  to  give  national  estimates  according  to  Healthcare  Cost  and  Utilization  Project  (HCUP)  criteria;  Under-diagnosis(Giardia  intestinalis  and  Toxoplasma  gondii
Death  rate Giardia  intestinalis  (ICD-9-CM  code  007.1),  Toxoplasma  gondii  (ICD-9-CM  codes  130.0-9) Sample  of  discharge records  from  US  hospitals

2000–2006

Under-diagnosis

National  Health  and  Nutrition  Examination  Survey  (NHANES)

Seroprevalence

Toxoplasma  gondii 

United  States 1999–2004 Rate  of  infection  over  time  and  percentage  symptomatic 
National  Notifiable  Diseases  Surveillance  System  (NNDSS) Number  of  case-patient  reports Brucella  spp.;  Clostridium  botulinum  (foodborne);  Trichinella  spp.;  Hepatitis  A;  Giardia  intestinalis United  States 2000–2007 (2002–2007  for Giardia  intestinalis)# Underreporting;  Under-diagnosis
Hospitalization  rate Hepatitis  A United  States 2000–2007  Under-diagnosis
National  Tuberculosis  Surveillance  System  (NTSS) Number  of  tuberculosis  case-patient  reports,  proportion  who  died Mycobacterium  bovis United  States 2004–2007 Percentage  of  tuberculosis  cases  attributable  to  M.bovis;  under-diagnosis 
US  Census Population  estimates Astrovirus,  rotavirus,  sapovirus United  States 2006 75%  of  children  experience  an  episode  of  clinical  illness  by  5  years  of  age
Various  acute  gastroenteritis  data  sources  (see  Table  6b) Acute  gastroenteritis  illnesses,  hospitalizations,  and  deaths Norovirus See Table 6b See Table 6b Fraction  of  acute  gastroenteritis  attributable  to  norovirus

* Passive surveillance from COVIS was used in preference to active surveillance from FoodNet for Vibrio spp. because most illnesses are reported by Gulf States (Florida, Alabama, Louisiana, Texas) that are not included in the FoodNet surveillance area.

Beginning in 2000, there were 10 FoodNet sites. In 2008, the population of these sites was 46 million persons, 15% of the US population.

§ Incidence of laboratory-confirmed illnesses in FoodNet from 2004 to 2007 was applied to the 2006 US Census population estimates.

Data from FDOSS on Streptococcus spp., Group A were included from 1996 to 2007 for illnesses and from 1981 to 2007 for hospitalizations and deaths because of a paucity of data (Appendix 1 and 3).

# Giardia intestinalis became nationally notifiable in 2002.

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Table 6b. Data sources used to estimate illnesses, hospitalizations, and deaths due to acute gatroenteritis in the United States, 2011 (from Scallan et al.)

Data source Data Definition Geographic coverage Time frame
FoodNet  Population  Survey Rate  of  illness  Average  annual  rate  of  acute  gastroenteritis  was  derived  by  multiplying  the  average  monthly  prevalence  by  12,  where  an  episode  of  acute  gastroenteritis  was  defined  as  diarrhea  (≥3  loose  stools  in  24  hours)  or  vomiting  in  the  past  month  with  both  lasting  >1  day  or  resulting  in  restricted  daily  activities.  Persons  with  a  chronic  condition  in  which  diarrhea  or  vomiting  was  a  major  symptom  and  persons  with  concurrent  symptoms  of  cough  or  sore  throat  were  excluded. FoodNet  sites 2000–2001,  2002–2003,  2006–2007
Death  certificates  --  Multiple-cause-of-death  data  from  the  National  Vital  Statistics  System Death  rate Norovirus;  Acute  gastroenteritis  deaths  were  identified  from  the  underlying  or  contributing  cause  of  death  classified  by  ICD-10  diagnostic  codes  A00.9–A08.5  (infectious  gastroenteritis  of  known  cause)  A09  (diarrhea  &  gastroenteritis  of  presumed  infectious  origin);  and  K52.9  (noninfectious  gastroenteritis  &colitis,  unspecified);  excluding  A04.7  (enterocolitis  due  to  Clostridium  difficile)  &  A05.1  (botulism) United  States 2000–2006
National  Ambulatory  Medical  Care  Survey  (NAMCS);  National  Hospital  Ambulatory  Medical  Care  Survey  (NHAMCS) Hospitalization  rate  Norovirus;  Acute  gastroenteritis  hospitalizations  were  identified  from  patient  visits  to  clinical  settings,  including  physician  offices,  hospital  emergency  and  outpatient  departments  with  a  diagnosis  of  infectious  enteritis  ICD-9-CM  diagnostic  codes  001–008  (infectious  gastroenteritis  of  known  cause);  009  (infectious  gastroenteritis);  558.9  (other  and  unspecified  noninfectious  gastroenteritis  and  colitis),  or  787.9  (other  symptoms  involving  digestive  system:  diarrhea);  [excluding  008.45  (Clostridium  difficile  colitis)  and  005.1  (botulism)]  or  reason  for  visit  classification  codes  for  diarrhea  (1595)  or  gastrointestinal  infection  (1540)  resulting  in  hospitalization. Nationally  representative  sample  of  US  clinical  settings 2000–2006
Nationwide  Inpatient  Sample  (NIS) Hospitalization  rate Norovirus;  Acute  gastroenteritis  hospitalizations  were  identified  from  discharges  with  one  of  the  first  three  listed  diagnoses  classified  by  ICD-9-CM  diagnostic  codes  001–008  (infectious  gastroenteritis  of  known  cause);  009  (infectious  gastroenteritis);  558.9  (other  and  unspecified  noninfectious  gastroenteritis  and  colitis),  or  787.9  (other  symptoms  involving  digestive  system:  diarrhea);  excluding  008.45  (Clostridium  difficile  colitis)  and  005.1  (botulism) Sample  of  discharge  records  from  US  hospitals 2000–2006

National  Hospital  Discharge  Survey  (NHDS)

Hospitalization  rate Norovirus.  Acute  gastroenteritis  hospitalizations  were  identified  from  discharges  with  one  of  the  first  three  listed  diagnoses  classified  by  ICD-9-M  diagnostic  codes  001–008  (infectious  gastroenteritis  of  known  cause);  009  (infectious  gastroenteritis);  558.9  (other  and  unspecified  noninfectious  gastroenteritis  and  colitis),  or  787.9  (other  symptoms  involving  digestive  system:  diarrhea);  excluding  008.45  (Clostridium  difficile  colitis)  and  005.1  (botulism) Nationally  representative  sample  of  discharge  records  from  US  hospitals  2000–2006

Beginning in 2000, there were 10 FoodNet sites. In 2008, the population of these sites was 46 million persons, 15% of the US population.

Codes for other and unspecified noninfectious gastroenteritis and colitis were included because infectious illnesses of unknown etiology are sometimes coded as noninfectious.

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