The burden of Campylobacter-associated disease in six European countries

Abstract

Background Foodborne pathogens cause significant morbidity and mortality worldwide. Economic evaluations of interventions for Campylobacter are scarce. The aim of this study was to estimate the burden of disease associated with thermophilic Campylobacter spp. in Denmark, the Netherlands, Norway, Poland, Spain and the United Kingdom, to be used in an economic evaluation of interventions to reduce human campylobacteriosis. Methods Burden of disease expressed as Disability-Adjusted-Life-Years (DALYs) was estimated using a disease model developed within the Burden of Communicable Diseases in Europe (BCoDE) project. The model links acute disease and future sequelae to the initial infection by conditional probabilities. Average numbers of country-specific symptomatic incident cases were estimated using reported cases for 2010 and adjusted for underestimation using multiplication factors (MF) based on a Swedish returning traveler study. We applied time discounting and present both discounted and undiscounted DALY estimates. Results Of the countries studied, the Scandinavian countries had the lowest estimated disease burden/100,000 inhabitants for Campylobacter (<10 DALY/100,000). Spain and Poland had the highest disease burden for Campylobacter (>100 DALY/100,000). Disease burden due to acute infections (i.e., gastroenteritits) accounted for <25% of the total disease burden associated with Campylobacter infections in humans. Time-discounting and assumed life-expectancy had an impact on the DALY calculations. Conclusion Differences in reporting systems and practices necessitate country-specific MFs, with model results most sensitive to their uncertainty. Large differences in disease burden estimates were found between the six countries. Not considering sequelae strongly underestimated disease burden. The current country-specific disease burden can be used in future economic evaluation of interventions to reduce human campylobacteriosis.