Analysis of foodborne outbreak data reported internationally for source attribution.

Analysis of foodborne outbreak data is one approach to estimate the proportion of human cases of specific enteric diseases attributable to a specific food item (food attribution). Although we recognize that for a variety of reasons reported outbreaks represent only a small portion of all actual outbreaks, using outbreak data for food attribution is the only methodological approach where, theoretically, there is an actual direct link between the pathogen, its source and each infected person. The purpose of this study was to explore the usefulness of foodborne outbreak data extracted from publicly available international electronic reports and publications to provide estimates of food attribution, to derive and compare these estimates between regions, while improving the understanding of the pathogen/food vehicle combination. Electronic reports and publications of foodborne outbreaks that occurred globally since the 1980s were systematically scanned and their data were extracted and compiled in a database. A system of food categorization was developed and food vehicles assigned accordingly. The association between the aetiology and the food source was statistically described for outbreaks with both reported aetiology and incriminated food vehicle. Differences in associations between Australia and New Zealand, Canada, the European Union (EU) and the United States (US) were explored using multiple correspondence analysis and were formally tested between the EU and the US for selected pathogens and food sources. As a result, the food and aetiology cross tabulation of 4093 foodborne outbreaks that occurred globally between 1988 and 2007 is presented and discussed. For a few aetiologies and some foods the association is very specific. The lack of a specific association between the other foods and aetiologies highlights the potential roles of cross-contamination, environmental contamination and the role of the infected foodhandler along the food chain from farm to fork. Detailed analysis of the four regions highlighted some specific associations: Salmonella Enteritidis outbreaks occurred relatively often in the EU states with eggs as the most common source; Campylobacter associated outbreaks were mainly related to poultry products in the EU and to dairy products in the US; there was an association between Escherichia coli outbreaks and beef in Canada; and while Salmonella Typhiumurium outbreaks were relatively common in Australia and New Zealand, across all regions, Salmonella was associated with a variety of food groups. The value and limitations of the study are discussed, as well as the extrapolation of the food attribution estimates beyond their outbreak context.