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      The health and economic impact of acute gastroenteritis in Belgium, 2010–2014

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          Acute gastroenteritis (AGE) remains a common condition in both low- and high-income countries. In Belgium, however, there is currently a lack of information on the societal health and economic impact of AGE. We conducted a retrospective study using mortality and cause-of-death data, hospital data, primary care data, health interview survey data and other published data. We estimated the burden of illness during a 5-year period (2010–2014) in Belgium in terms of deaths, patients admitted to hospitals, patients consulting their general practitioner (GP) and cases occurring in the community. We further quantified the health impact in terms of disability-adjusted life years (DALYs) and the economic impact in terms of cost-of-illness estimates. We estimated 343 deaths, 27 707 hospitalised patients, 464 222 GP consultations and 10 058 741 episodes occurring in the community (0.91 cases/person) on average per year. AGE was associated with 11 855 DALYs per year (107 DALY per 100 000 persons). The economic burden was estimated to represent direct costs of €112 million, indirect costs of €927 million (90% of the total costs) and an average total cost of €103 per case and €94 per person. AGE results in a substantial health and economic impact in Belgium, justifying continued mitigation efforts.

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          Most cited references 33

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          Study of infectious intestinal disease in England: rates in the community, presenting to general practice, and reported to national surveillance. The Infectious Intestinal Disease Study Executive.

          To establish the incidence and aetiology of infectious intestinal disease in the community and presenting to general practitioners. Comparison with incidence and aetiology of cases reaching national laboratory based surveillance. Population based community cohort incidence study, general practice based incidence studies, and case linkage to national laboratory surveillance. 70 general practices throughout England. 459 975 patients served by the practices. Community surveillance of 9776 randomly selected patients. Incidence of infectious intestinal disease in community and reported to general practice. 781 cases were identified in the community cohort, giving an incidence of 19.4/100 person years (95% confidence interval 18.1 to 20.8). 8770 cases presented to general practice (3.3/100 person years (2.94 to 3.75)). One case was reported to national surveillance for every 1.4 laboratory identifications, 6.2 stools sent for laboratory investigation, 23 cases presenting to general practice, and 136 community cases. The ratio of cases in the community to cases reaching national surveillance was lower for bacterial pathogens (salmonella 3.2:1, campylobacter 7.6:1) than for viruses (rotavirus 35:1, small round structured viruses 1562:1). There were many cases for which no organism was identified. Infectious intestinal disease occurs in 1 in 5 people each year, of whom 1 in 6 presents to a general practitioner. The proportion of cases not recorded by national laboratory surveillance is large and varies widely by microorganism. Ways of supplementing the national laboratory surveillance system for infectious intestinal diseases should be considered.
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            A population-based estimate of the burden of diarrhoeal illness in the United States: FoodNet, 1996-7.

            This study was performed to better understand and more precisely quantify the amount and burden of illness caused by acute diarrhoea in the United States today. A telephone-based population survey was conducted between 1 July, 1996, and 31 June, 1997, in sites of the Foodborne Diseases Active Surveillance Network (FoodNet). The overall prevalence of acute diarrhoea in the 4 weeks before interview was 11%, giving a rate of 1.4 episodes of diarrhoea per person per year. The rate of diarrhoeal illness defined as a diarrhoeal episode lasting longer than 1 day or which resulted in significant impairment of daily activities was 0.7 per person per year. It can be concluded that acute diarrhoea is common and represents a significant burden of illness in the United States. Our data on self-reported diarrhoea, when generalized to the entire nation, suggests 375 million episodes of acute diarrhoea each year in the United States. Many of these episodes are mild. However, our data also indicate that there are approximately 200 million episodes of diarrhoeal illness each year in the United States.
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              Cost-of-illness and disease burden of food-related pathogens in the Netherlands, 2011.

              To inform risk management decisions on control and prevention of food-related disease, both the disease burden expressed in Disability Adjusted Life Years (DALY) and the cost-of-illness of food-related pathogens are estimated and presented. Disease burden of fourteen pathogens that can be transmitted by food, the environment, animals and humans was previously estimated by Havelaar et al. (2012). In this paper we complement these by cost-of-illness estimates. Together, these present a complete picture of the societal burden of food-related diseases. Using incidence estimates for 2011, community-acquired non-consulting cases, patients consulting their general practitioner, hospitalized patients and the incidence of sequelae and fatal cases, estimates were obtained for DALYs, direct healthcare costs (e.g. costs for doctor's fees, hospitalizations and medicines), direct non-healthcare costs (e.g. travel costs to and from the doctor), indirect non-healthcare costs (e.g. productivity loss, special education) and total costs. The updated disease burden for 2011 was equal to 13,940 DALY/year (undiscounted) or 12,650 DALY/year (discounted at 1.5%), and was of the same magnitude as previous estimates. At the population-level thermophilic Campylobacter spp., Toxoplasma gondii and rotavirus were associated with the highest disease burden. Perinatal listeriosis infection was associated with the highest DALY per symptomatic case. The total cost-of-illness in 2011 of fourteen food-related pathogens and associated sequelae was estimated at € 468 million/year, if undiscounted, and at € 416 million/year if discounted by 4%. Direct healthcare costs accounted for 24% of total costs, direct non-healthcare costs for 2% and indirect non-healthcare costs for 74% of total costs. At the population-level, norovirus had the highest total cost-of-illness in 2011 with € 106 million/year, followed by thermophilic Campylobacter spp. (€ 76 million/year) and rotavirus (€ 73 million/year). Cost-of-illness per infected case varied from € 150 for Clostridium perfringens intoxications to € 275,000 for perinatal listeriosis. Both incident cases and fatal cases are more strongly correlated with COI/year than with DALY/year. More than 40% of all cost-of-illness and DALYs can be attributed to food, in total € 168 million/year and 5,150 DALY/year for 2011. Beef, lamb, pork and poultry meat alone accounted for 39% of these costs. Products of animal origin accounted for € 86 million/year (or 51% of the costs attributed to food) and 3,320 DALY/year (or 64% of the disease burden attributed to food). Among the pathogens studied Staphylococcus aureus intoxications accounted for the highest share of costs attributed to food (€ 47.1 million/year), followed by Campylobacter spp. (€ 32.0 million/year) and norovirus (€ 17.7 million/year).

                Author and article information

                Epidemiol Infect
                Epidemiol. Infect
                Epidemiology and Infection
                Cambridge University Press (Cambridge, UK )
                12 March 2019
                : 147
                [1 ]Department of Epidemiology and Public Health, Sciensano , Brussels, Belgium
                [2 ]European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC) , Stockholm, Sweden
                [3 ]Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels , Belgium
                [4 ]Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KU Leuven) , Leuven, Belgium
                [5 ]Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp , Antwerp, Belgium
                [6 ]Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University , Merelbeke, Belgium
                Author notes
                Author for correspondence: Brecht Devleesschauwer, E-mail: brecht.devleesschauwer@
                S095026881900044X 00044
                © The Author(s) 2019

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 1, Tables: 4, References: 40, Pages: 7
                Original Paper

                Public health

                gastroenteritis, disability-adjusted life years, cost-of-illness, burden of disease


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