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Following the successful eradication of Brucella abortus infection in cattle, human brucellosis in England and Wales has become an uncommon imported disease. Culture of the organism presents a major laboratory hazard, and difficulties in identification may occur using a biochemical test-strip method. An overview of recent treatment trials of brucellosis indicates that regimens combining streptomycin and doxycycline are associated with a higher success rate (judged by the frequency of treatment failure and relapse following therapy) than combinations of rifampicin and doxycycline.

SUMMARYThis study presents the findings of a national survey of 1482 cases of salmonellosis reported to Environmental Health Departments in England and Wales between August 1988 and March 1989. A questionnaire survey of ill individuals and the environmental health officers who investigated them sought information about costs which were imposed upon public health authorities, the health sector, individuals and their families and the costs to the wider economy in terms of lost production.Costs of £996339 were identified. Over half (£507555) resulted from lost production due to sickness absence and more than a third (£392822) were costs to the public sector which resulted from health care and local authority investigation of cases. The remaining costs (£95962), although the smallest proportion of the total, indicated that salmonellosis can have a significant impact on affected individuals and their families.

The National Studies on Acute Gastrointestinal Illness (NSAGI) initiative was designed to generate baseline period prevalence rates of self-reported AGI in communities across Canada, assess the burden associated with AGI, and quantify the under-reporting of AGI in Canada's national enteric disease reporting systems.Methods utilized included population surveys administered randomly via telephone services. Three population surveys in three locations within Canada included over 10,000 residents. Questions pertained to recent symptoms as well as socio-demographic factors, use of the health care system and missed work or school due to illness.In summary of published results, there are an estimated 1.3 episodes of AGI per person-year and an estimated 10-47, 13-37 and 23-49 cases in the community for every case of verotoxigenic Escherichia coli, Salmonella and Campylobacter, respectively, captured within the national surveillance system. AGI represents an annual per capita cost of $115 CAD.The work of NSAGI highlights the significant burden and impact of AGI in the Canadian population. These results will also be incorporated into the current work at the World Health Organization (WHO) to estimate the global burden of food related illnesses.

To assess the socio-economic impact of infectious intestinal disease (IID) on the health care sector, cases and their families, cases of IID ascertained from a population cohort component and those presenting to general practices were sent a socio-economic questionnaire 3 weeks after the acute episode. The impact of the illness was measured and the resources used were identified and costed. The duration, severity and costs of illness linked to viruses were less than those linked to bacteria. The average cost per case of IID presenting to the GP was Pound Sterling253 and the costs of those not seeing a GP were Pound Sterling34. The average cost per case was Pound Sterling606 for a case with salmonella, Pound Sterling315 for campylobacter, Pound Sterling164 for rotavirus and Pound Sterling176 for SRSV. The estimated cost of IID in England was Pound Sterling743m expressed in 1994/5 prices. The costs of IID are considerable and the duration of the illness was found to be longer than previous reports have suggested.

This review summarises reports of food poisoning, salmonellosis, campylobacteriosis and other acute foodborne illness to the PHLS Communicable Disease Surveillance Centre, and notifications of food poisoning collated by the Office of Population Censuses and Surveys, in the period 1989-1991. During this period there were continuing rises in notifications of food poisoning and reports of salmonellosis and campylobacteriosis. There was considerable success in the control of foodborne listeriosis. Newly emerging pathogens, such as Vero cytotoxin producing Escherichia coli, became more important. There was unprecedented scrutiny of the salmonella data by experts and politicians, reflecting continuing concern over the role of eggs as well as poultry meat in the increase of Salmonella enteritidis phage type 4 infection. This concern, along with advances in information technology, has led to developments in the collection and dissemination of information which continue to be implemented.

In the ten-year period, 1980-89, 294 reported outbreaks of food poisoning were associated with eating pre-cooked sliced meats, meat products and other manufactured foods in England and Wales, including 65 outbreaks in which the product was imported. Salmonellas were the most commonly reported agent, causing 132 (45%) of the outbreaks; other bacteria caused a further 51 (17%) outbreaks. The remainder were due to viruses (five outbreaks), scombrotoxin (60 outbreaks), or were of unknown cause (46 outbreaks). The number of outbreaks associated with manufactured foods accounted for only a small proportion (less than 5%) of food poisoning outbreaks reported to CDSC during this period and needs to be set against the huge amounts of manufactured foods consumed. However, because of the quantities made and the widespread distribution of particular products, such outbreaks may affect many individuals who are geographically widespread.

Summary The paper describes the work of the Public Health Laboratory Service, popularly referred to as “Colindale”, and reviews the types of infection which are commonly food or waterborne and their relative importance. Cholera, typhoid and paratyphoid are rare diseases usually acquired abroad. Bovine tuberculosis, brucellosis and foodborne helmenthiasis have been almost eliminated as indigenous diseases. However, salmonellosis and Campylobacter enteritis are increasing. The increase has not been satisfactorily explained but is probably due to bovine and poultry infections. Although most notified food poisoning incidents are due to salmonella, a number of other organisms have been implicated, the cause being defective food hygiene. Viral foodborne diseases, including hepatitis A, have been associated mainly with shellfish. The incidence of new foodborne infections may be increasing.

SUMMARYA hospital outbreak of multiply-resistant Salmonella heidelberg infection, which affected 17 patients and 2 staff, is described. The tangible cost of the outbreak was estimated at £21 151, £17989 (85·1%) of which was borne by the hospital. The cost to the Microbiology Department was £3596 (17·0% of the total). A detailed analysis of the costs and implications for staffing disruption is given and a comparison is made with the costs of preventive activities. Ways of containing expenses in the event of an outbreak and the economic implications for clinical budgeting and privatization of the laboratory service are considered.

The recognition and investigation of an outbreak of food poisoning in 1982 due to chocolate contaminated with Salmonella napoli enabled the food that carried the salmonella to be identified and four fifths of the implicated consignment of chocolate to be withdrawn. The economic benefits of prompt intervention in the outbreak have been assessed. The cost of the outbreak was over 0.5 pounds m. It is estimated that five deaths were prevented by the intervention and that 185 admissions to hospital and 29,000 cases of S napoli enteritis were avoided. This successful investigation yielded a 3.5-fold rate of return to the public sector and a 23.3-fold return to society on an investment in public health surveillance. A methodology is described that can be used to estimate the benefits of early intervention in outbreaks of foodborne illness and topics for further research are suggested. It is concluded that public health authorities and industry have much to gain by collaborating in the research into the design of cost effective programmes to prevent foodborne infections.