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Most outbreaks (97.5%), illnesses (98.0%), and deaths (99.1%) were linked to households and catering service locations. Households and catering service locations were the most common settings of reported outbreaks. In 2020, the highest number of outbreaks occurred in households (4,140), followed by catering service locations (2,719), and school campuses (27). Most illnesses (59.9%) were reported in catering service locations, followed by households (37.6%), and 0.5% in campuses. Within catering service locations, street stalls accounted for the largest proportion (26.2%) of outbreaks, and school canteens accounted for the largest proportion (13.6%) of illnesses. However, households had the most deaths, accounting for 89.5% of all deaths (Table 1); poisonous mushrooms (79 deaths), aconite (10 deaths), bongkrek acid (11 deaths), and methanol (8 deaths) were the most common causes of deaths, accounting for 84.4% of total deaths in private home settings.
Setting Outbreaks Illnesses Deaths Fatality rate*
(%)Number Proportion
(%)Number Proportion
(%)Number Proportion
(%)Household 4,140 58.5 14,066 37.6 128 89.5 0.9 Catering Service Places 2,719 38.4 22,432 59.9 15 10.5 0.1 Street stall 712 10.1 2,659 7.1 3 2.1 0.1 Hotel restaurant 508 7.2 4,184 11.2 5 3.5 0.1 Staff canteen 371 5.3 3,607 9.6 1 0.7 0.0 School canteen 310 4.4 5,081 13.6 0 0.0 0.0 Bistro 291 4.1 1,473 3.9 3 2.1 0.2 Fast food restaurant 240 3.4 1,171 3.1 0 0.0 0.0 Rural banquet 130 1.8 2,165 5.8 3 2.1 0.1 Home delivery of meal 110 1.6 1,807 4.8 0 0.0 0.0 Other 47 0.7 285 0.8 0 0.0 0.0 Campus 27 0.4 196 0.5 0 0.0 0.0 Other location 187 2.6 760 2.0 0 0.0 0.0 Total 7,073 100.0 37,454 100.0 143 100.0 0.4 * Fatality rate=number of deaths / number of illnesses. Table 1. Number and proportion of foodborne disease outbreaks, illnesses, and deaths by setting in China, 2020.
In 2020, there were 4,662 outbreaks with confirmed etiology. Poisonous mushrooms were the most common cause of outbreaks and deaths, accounting for 58.0% of outbreaks and 57.6% of deaths; bacterial pathogens were the most common cause of illnesses (41.7%); in poisonous animals and plants and their toxins, undercooked Phaseolus was the most common cause leading to the largest proportion of outbreaks (31.2%) and illnesses (33.3%); aconite had the most deaths, accounting for 57.1%. Within microbial pathogens, Salmonella (286 outbreaks and 3,446 illnesses) was the most common bacterial pathogen associated with outbreaks and illnesses, followed by Vibrio parahaemolyticus (128 outbreaks and 1,848 illnesses), and Staphylococcus aureus (75 outbreaks and 954 illnesses). Bongkrek acid accounted for the largest proportions (75.0%) of deaths and the largest fatality rate (52.2%). Among the chemical agents, nitrite was the most common pathogenic factor associated with outbreaks (49.1%) and illnesses (49.6%), followed by pesticide (32.5% outbreaks and 27.7% illnesses); methanol had the highest death and fatality rates at 63.6% and 25.0%, respectively, followed by nitrite at 22.7% and 1.1%, respectively (Table 2).
Etiology Outbreaks Illnesses Deaths Fatality
rate* (%)Number Proportion (%) Number Proportion(%) Number Proportion(%) Poisonous mushrooms 2,705 38.2 9,111 24.3 80 55.9 0.9 Plant and animal toxicants 1,020 14.4 4,584 12.2 21 14.7 0.5 Undercooked Phaseolus* 318 4.5 1,526 4.1 0 0.0 0.0 Coriaria sinica 111 1.6 354 1.0 0 0.0 0.0 Potherb 93 1.3 355 1.0 1 0.7 0.3 Aconite 84 1.2 337 1.0 12 8.4 3.6 Bitter bottle gourd 48 0.7 381 1.0 0 0.0 0.0 Tungoil or seed 46 0.7 238 0.6 0 0.0 0.0 Hyoscyamine 33 0.5 183 0.5 1 0.7 0.6 Herb-medicine 27 0.4 110 0.3 0 0.0 0.0 Elephant’s-ear 24 0.3 86 0.2 0 0.0 0.0 Sproutedpotato/solanine 17 0.2 97 0.3 2 1.4 2.1 Colchicin 12 0.2 78 0.2 0 0.0 0.0 Gelsemine 11 0.2 64 0.2 3 2.1 4.7 Castor bean 10 0.1 58 0.2 0 0.0 0.0 Pokeberry root 10 0.1 42 0.1 1 0.7 2.4 Sago seed 10 0.1 36 0.1 0 0.0 0.0 Barbados nut 9 0.1 41 0.1 0 0.0 0.0 Undercooked soymilk/Trypsin inhibitor † 3 0.0 18 0.1 0 0.0 0.0 Other plants toxicants§ 83 1.2 285 0.8 0 0.0 0.0 Fish roe 19 0.3 51 0.1 0 0.0 0.0 Tetrodotoxin 15 0.2 53 0.1 1 0.7 1.9 Pupae 13 0.2 60 0.2 0 0.0 0.0 langoustine 10 0.1 25 0.1 0 0.0 0.0 Other animal toxicants** 14 0.2 106 0.3 0 0.0 0.0 Bacterial 766 10.8 10,483 28.0 16 11.2 0.2 Salmonella 286 4.0 3,446 9.2 4 2.8 0.1 Vibrio parahaemolyticus 128 1.8 1,848 4.9 0 0.0 0.0 Staphylococcus aureus 75 1.1 954 2.6 0 0.0 0.0 Escherichia coli 54 0.8 1,520 4.1 0 0.0 0.0 Bacillus cereus 50 0.7 620 1.7 0 0.0 0.0 Bacillus proteus 10 0.1 149 0.4 0 0.0 0.0 Clostridium perfringens 5 0.1 287 0.8 0 0.0 0.0 Bongkrek acid†† 5 0.1 23 0.1 12 8.4 52.2 Campylobacter jejuni 3 0.0 133 0.4 0 0.0 0.0 Clostridium botulinum 3 0.0 10 0.0 0 0.0 0.0 Listeria monocytogenes 1 0.0 28 0.1 0 0.0 0.0 Others 108 1.5 807 2.2 0 0.0 0.0 2 or more pathogens 12 0.2 224 0.6 0 0.0 0.0 Norovirus 26 0.4 434 1.2 0 0.0 0.0 Chemical agents 163 2.3 922 2.5 22 15.4 2.4 Nitrite 80 1.1 457 1.2 5 3.5 1.1 Pesticide§§ 53 0.8 255 0.7 2 1.4 0.8 Prohibited drugs 10 0.1 115 0.3 1 0.7 0.9 Methanol 9 0.1 56 0.2 14 9.8 25.0 Other chemical pollutants*** 11 0.2 39 0.1 0 0.0 0.0 Fungi 7 0.1 27 0.1 0 0.0 0.0 Parasitic 1 0.0 4 0.0 0 0.0 0.0 Unknown etiology 2,411 34.1 12,323 32.9 4 2.8 0.0 Total 7,073 100.0 37,454 100.0 143 100.0 0.4 * Refers to uncooked Phaseolus beans.
† Contained in uncooked soy milk.
§ Including wild flowers, hellebore, wild ginseng, pollen, daffodils, and wild fruits, etc. Including bee pupae and silkworm pupae.
** Including dog liver, insects, fish gall, toads and ants, etc.
†† Including Shigella, Aeromonas, Enterobacter cloacae, Citrobacter flaudus, Schneider, and Enterococcus, etc.
§§ Including Carbamates, organophosphates, pyrethroids, paraquat, bromfamethamine and bromadiolone, etc. Including clenbuterol hydrochloride, xylazine, and tetramine.
*** Including lead, engine oil, desiccant, chlorine dioxide, and detergent, etc.Table 2. Number and proportion of foodborne disease outbreaks, illnesses, and deaths by etiology in China, 2020.
In 2020, outbreaks that occurred at households (7,073) had surpassed those of catering service units (5,652), and outbreaks (485) and outbreak-associated illnesses (6,661) caused by Salmonella surpassed those of Vibrio parahaemolyticus. Foodborne disease illnesses occurred in school canteens (5,081).
The top 10 pathogen-food category pairs resulting in outbreaks, outbreak-associated illnesses, and deaths were analyzed. Salmonella in eggs had the highest occurrence, accounting for 32.8% (75/229) of outbreaks, followed by Salmonella in sauce-marinated meat (Table 3). Salmonella in sauce-marinated meat had the highest proportion (21.7%) of illnesses and 23.2% of hospitalizations, followed by Salmonella in eggs.
Etiology Food category No. outbreaks Proportion (%) Salmonella Egg 75 32.8 Salmonella Sauce-marinated meat 44
19.2Salmonella Pastry 28 12.2 Bacillus cereus Rice flour 22 9.6 Vibrio prahaemolyticus Sauce-marinated meat 17 7.4 Salmonella Livestock meat 13 5.7 Vibrio parahaemolyticus Crustaceans 11 4.8 Escherichia coli Sauce-marinated meat 10
4.4Staphylococcalaureus enterotoxins
Pastry
9
3.9Salmonella Poultry 6 100.0 Total 229 32.8 Table 3. Top 10 number and proportion of most common confirmed pathogen-food category pairs resulting in outbreak in China, 2020.
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