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During 2010–2020, a total of 10,036 mushroom poisoning outbreaks were reported to Foodborne Disease Outbreaks Surveillance System, resulting in 38,676 illnesses, 21,967 hospitalizations, and 788 deaths. The annual number of reported outbreaks increased each year, from 37 reported in 2010 to 2,705 in 2020 (Figure 1). The average number of illnesses per outbreak was 3.9, and average hospitalization and fatality rates were 56.8% and 2.0%, respectively.
Figure 1.Number of reported mushroom poisoning outbreaks by year, Foodborne Disease Outbreak Surveillance System, China, 2010–2020.
Except for Xizang (Tibet) Autonomous Region, the other 30 provincial-level administrative divisions (PLADs) in China reported outbreaks (Figure 2). Southwest China was the region with highest number of outbreaks (6,062), illnesses (24,444), and deaths (454); 1,900 outbreaks occurred in central China, leading to 6,559 illnesses and 137 deaths; 1,132 outbreaks occurred in east China, leading to 4,094 illnesses and 112 deaths; 423 outbreaks occurred in south China, leading to 1,663 illnesses and 30 deaths; and followed by northwest China (213 outbreaks, 749 illnesses, and 20 deaths), north China (153 outbreaks, 621 illnesses, and 25 deaths), and northeast China (153 outbreaks, 546 illnesses, and 10 deaths). The total number of outbreaks reported by each PLAD varied from as low as 1 in Tianjin and Shanghai to as high as 4,010 in Yunnan. The overall national reporting rate during 2010–2020 was 0.3 outbreaks/million population. The top 5 PLADs, including Yunnan, Hunan, Guizhou, Sichuan, and Jiangxi, comprised 79.7% (8,002/10,036) of total outbreaks, 80.3% (31,058/38,676) of total illnesses, and 74.6% (588/788) of total deaths. Yunnan reported the most outbreaks, illnesses, and deaths, accounting for 40.0%, 43.6%, and 41.0%, respectively.
Figure 2.Number of reported mushroom poisoning outbreaks by PLADs in China, 2010–2020.
Abbreviation: PLADs=provincial-level administrative divisions.The locations of food preparation were divided into 2 main categories: household and catering service places (Table 1). Among the 10,036 reported outbreaks, 84.7% were associated with food prepared in private homes (leading to 77.8% illnesses and 92.8% deaths), followed by 8.8% related with food prepared in street stalls (leading to 8.6% illnesses and 2.0% deaths), and 2.5% in canteens (leading to 4.6% illnesses and 1.9% deaths). The major cause of private-home outbreaks was self-harvest of wild mushrooms, which led to 98.1% of all private home outbreaks, 98.2% of illnesses, and 99.6% of deaths. Purchase of wild mushroom was the most common cause of catering service outbreaks, accounting for 63.5% of all catering service outbreaks, 49.0% illnesses, and 28.3% deaths.
Setting Outbreaks Illnesses Hospitalizations Deaths Number % Number % Number % Number % Household 8,495 84.6 30,098 77.8 17,456 79.5 731 92.8 Catering Service Places 1,463 14.6 8,083 20.9 4,196 19.1 46 5.8 Street stall 878 8.7 3,317 8.6 1,677 7.6 16 2.0 Staff canteen 249 2.5 1,783 4.6 899 4.1 15 1.9 Restaurant 175 1.7 1,107 2.9 550 2.5 0 0.0 Rural banquet 58 0.6 1,240 3.2 789 3.6 9 1.1 Cafe 50 0.5 276 0.7 131 0.6 3 0.4 Fast food store 32 0.3 144 0.4 83 0.4 3 0.4 School canteen 7 0.1 71 0.2 30 0.1 0 0.0 Home delivery of meal 5 0.0 109 0.3 12 0.1 0 0.0 Other 9 0.1 36 0.1 25 0.1 0 0.0 Campus 6 0.1 27 0.1 14 0.1 0 0.0 Other location 72 0.7 468 1.2 301 1.4 11 1.4 Total 10,036 100.0 38,676 100.0 21,967 100.0 788 100.0 Table 1. Number and percentage of mushroom poisoning outbreaks, illnesses, hospitalizations, and deaths by settings in China, 2010–2020.
From 2010 to 2020, mushroom poisoning outbreaks annually clearly exhibited seasonality (Figure 3). A large proportion of outbreaks occurred between May and October, accounting for 94.1% of total outbreaks, 92.4% of total illnesses, and 97.2% of total deaths. In Yunnan, there was a clear peak of outbreaks in July, while 2 peaks appearing in June and September were observed in Hunan and Guizhou.
For all the reported outbreaks, 96.8% involved fewer than 10 cases per outbreak, leading to 95.7% of the total deaths. In addition, 12 outbreaks had more than 30 cases, met the limits of the public health emergency incidents of China, and led to 943 illnesses and no reported deaths.
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