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.
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.
