Incidence and Trends of Infection With Pathogens Transmitted Commonly Through Food

Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2006-2013

Stacy M. Crim, MPH; Martha Iwamoto, MD; Jennifer Y. Huang, MPH; Patricia M. Griffin, MD; Debra Gilliss, MD; Alicia B. Cronquist, MPH; Matthew Cartter, MD; Melissa Tobin-D'Angelo, MD; David Blythe, MD; Kirk Smith, DVM; Sarah Lathrop, PhD; Shelley Zansky, PhD; Paul R. Cieslak, MD; John Dunn, DVM; Kristin G. Holt, DVM; Susan Lance, DVM; Robert Tauxe, MD; Olga L. Henao, PhD


Morbidity and Mortality Weekly Report. 2014;63(15):328-332. 

In This Article


Foodborne disease continues to be an important problem in the United States. Most illnesses are preventable. To evaluate progress toward prevention, the Foodborne Diseases Active Surveillance Network* (FoodNet) monitors the incidence of laboratory-confirmed infections caused by nine pathogens transmitted commonly through food in 10 U.S. sites, covering approximately 15% of the U.S. population. This report summarizes preliminary 2013 data and describes trends since 2006. In 2013, a total of 19,056 infections, 4,200 hospitalizations, and 80 deaths were reported. For most infections, incidence was well above national Healthy People 2020 incidence targets and highest among children aged <5 years. Compared with 2010–2012, the estimated incidence of infection in 2013 was lower for Salmonella, higher for Vibrio, and unchanged overall. Since 2006–2008, the overall incidence has not changed significantly. More needs to be done. Reducing these infections requires actions targeted to sources and pathogens, such as continued use of Salmonella poultry performance standards and actions mandated by the Food Safety Modernization Act (FSMA).[1] FoodNet provides federal and state public health and regulatory agencies as well as the food industry with important information needed to determine if regulations, guidelines, and safety practices applied across the farm-to-table continuum are working.

FoodNet conducts active, population-based surveillance for laboratory-confirmed infections caused by Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin–producing Escherichia coli (STEC) O157 and non-O157, Shigella, Vibrio, and Yersinia in 10 sites covering approximately 15% of the U.S. population (an estimated 48 million persons in 2012).§ FoodNet is a collaboration among CDC, 10 state health departments, the U.S. Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS), and the Food and Drug Administration (FDA). Hospitalizations occurring within 7 days of specimen collection are recorded, as is the patient's vital status at hospital discharge, or at 7 days after specimen collection if the patient was not hospitalized. Hospitalizations and deaths that occur within 7 days are attributed to the infection. Surveillance for physician-diagnosed postdiarrheal hemolytic uremic syndrome (HUS), a complication of STEC infection characterized by renal failure, is conducted through a network of nephrologists and infection preventionists and by hospital discharge data review. This report includes 2012 HUS data for persons aged <18 years.

Incidence was calculated by dividing the number of laboratory-confirmed infections in 2013 by U.S. Census estimates of the surveillance area population for 2012. Incidence of culture-confirmed bacterial infections and laboratory-confirmed parasitic infections (e.g., identified by enzyme immunoassay) are reported. A negative binomial model with 95% confidence intervals (CIs) was used to estimate changes in incidence from 2010–2012 to 2013 and from 2006–2008 to 2013.[2] Change in the overall incidence of infection with six key foodborne pathogens was estimated.[3] For STEC non-O157, only change since 2010–2012 was assessed because diagnostic practices changed before then; for Cyclospora, change was not assessed because data were sparse. For HUS, incidence was compared with 2006–2008. The number of reports of positive culture-independent diagnostic tests (CIDTs) without corresponding culture confirmation is included for Campylobacter, Listeria, Salmonella, Shigella, STEC, Vibrio, and Yersinia.

*Additional information available at
The overall incidence of infection combines data for Campylobacter, Listeria, Salmonella, STEC O157, Vibrio, and Yersinia, six key bacterial pathogens for which >50% of illnesses are estimated to be transmitted by food.
§FoodNet personnel regularly contact clinical laboratories to ascertain all laboratory-confirmed infections in residents of the surveillance areas.
Final incidence rates will be reported when population estimates for 2013 are available.