A comprehensive review of foodborne disease burden associated with protein foods: a 13-year evaluation of incidence and outbreaks in high-income countries

This investigation focused on the compilation and analysis of the incidence of foodborne diseases and foodborne outbreaks related to protein-based foods, published in official surveillance reports from the European Union (EU), United States of America (USA), Canada, and New Zealand (NZ), in the period of 2010-2023, for foodborne pathogens norovirus, Campylobacter spp., Cryptosporidium spp., Listeria monocytogenes, Salmonella enterica (non-typhoidal, typhoid, and paratyphoid) and Shiga-toxin-producing Escherichia coli (STEC). Most outbreaks reported during this period were caused by non-typhoidal Salmonella, norovirus, and Campylobacter spp., predominantly in European Member States (MS), followed by the USA. This compilation analysis evidenced the heterogeneity between regions/countries in the contribution of protein foods to total strong evidence outbreaks that occurred in the studied period. For instance, whereas in the USA, "cheese" was the most frequent source of listeriosis (52.6%), in EU-MS, "meat" was the topmost contributor (43.1%). In EU-MS, norovirus outbreaks were mainly associated with "crustaceans and mollusks" (80.9%); "eggs" accounted for most salmonellosis (52.1%) outbreaks, followed by "meat" (27.1%), the latter of which was also the largest contributor to campylobacteriosis (66.9%) and STEC outbreaks (52.7%). Strong-evidence cryptosporidiosis outbreaks in EU-MS were attributed to "cheese," while in NZ and the USA, they were all linked to "milk." In the USA and NZ, salmonellosis was frequently associated with "meat" (44.3-46.9%); campylobacteriosis, with "milk" (44.9-45.2%); and norovirus outbreaks were attributed to "crustaceans and mollusks" (21.2-29%), "dough-based derivatives" (9.7-26.7%), and composite meals, i.e., "meat-based meals" (16.3-32.3%) and "seafood-based meals" (12.9-14.1%). STEC was often linked to "milk" in NZ (62.5%) and to "meat" in the USA (54.1%).