WHO estimates of the global, regional, and national burden of eight foodborne non-diarrhoeal enteric disease hazards, 2000–21: an updated data synthesis

BACKGROUND: Foodborne diseases cause substantial illness and death globally. We updated WHO estimates of the burden caused by non-diarrhoeal enteric disease hazards: Brucella spp; Clostridium botulinum; hepatitis A virus; Listeria monocytogenes; Mycobacterium bovis,Mycobacteriumcaprae, and Mycobacteriumorygis; invasive non-typhoidal Salmonella enterica (iNTS); S enterica serotypes Paratyphi A, B, and C; and S enterica serotype Typhi (S Typhi). METHODS: We estimated illnesses, deaths, and disability-adjusted life-years (DALYs) for 194 countries for 2000-21 using data from systematic reviews, the 2021 Global Burden of Diseases, Injuries, and Risk Factors Study 2021, a structured expert judgement study, and WHO country consultations. We used disease-specific computational models and hierarchical metaregression modelling with geographical clustering, a global linear time trend, and uncertainty propagation. FINDINGS: In 2021, transmission of these eight hazards by food collectively caused 24·0 million illnesses (95% uncertainty interval 16·9-31·7), 106 000 deaths (63 900-169 000), and 7·26 million DALYs (4·15-12·0). S Typhi, iNTS, and hepatitis A virus caused most DALYs. The greatest burden was in the WHO African region, followed by the South-East Asia region. Mortality was 5·2 times higher and DALY rates were 8·3 times higher in children younger than 5 years compared with people aged 5 years and older. The burden for all hazards, except L monocytogenes, decreased from 2000 to 2021, with S Typhi replacing iNTS as the leading cause of foodborne DALYs. INTERPRETATION: Non-diarrhoeal enteric diseases still cause considerable foodborne disease burden, despite decreases over time. Vulnerable populations, particularly children in low-income countries, bear the greatest burden. Integrated efforts including vaccination, food safety, clean water, sanitation, hygiene, and improved health-care access are required. FUNDING: WHO.