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Address for correspondence: Paul S. Mead, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Mail Stop A38, 1600 Clifton Road, Atlanta, GA 30333, USA; fax: 404-639-2205; e-mail: pfm0@cdc.gov. More than 200 known diseases are transmitted through food (1). The causes of foodborne illness include viruses, bacteria, parasites, toxins, metals, and prions, and the symptoms of foodborne illness range from mild gastroenteritis to life-threatening neurologic, hepatic, and renal syndromes. In the United States, foodborne diseases have been estimated to cause 6 million to 81 million illnesses and up to 9,000 deaths each year (2-5). However, ongoing changes in the food supply, the identification of new foodborne diseases, and the availability of new surveillance data have made these figures obsolete. New, more accurate estimates are needed to guide prevention efforts and assess the effectiveness of food safety regulations. Surveillance of foodborne illness is complicated by several factors. The first is underreporting. Although foodborne illnesses can be severe or even fatal, milder cases are often not detected through routine surveillance. Second, many pathogens transmitted through food are also spread through water or from person to person, thus obscuring the role of foodborne transmission. Finally, some proportion of foodborne illness is caused by pathogens or agents that have not yet been identified and thus cannot be diagnosed. The importance of this final factor cannot be overstated. Many of the pathogens of greatest concern today (e.g., Campylobacter jejuni, Escherichia coli O157:H7, Listeria monocytogenes, Cyclospora cayetanensis) were not recognized as causes of foodborne illness just 20 years ago. In this article, we report new estimates of illnesses, hospitalizations, and deaths due to foodborne diseases in the United States. To ensure their validity, these estimates have been derived by using data from multiple sources, including the newly established Foodborne Diseases Active Surveillance Network (FoodNet). The figures presented include estimates for specific known pathogens, as well as overall estimates for all causes of foodborne illness, known, unknown, infectious, and noninfectious.

Food-Related Illness and Death in the United States Reply to Dr. Hedberg