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Front. Med.    2018, Vol. 12 Issue (1) : 48-57    https://doi.org/10.1007/s11684-017-0608-6
REVIEW
Trends of foodborne diseases in China: lessons from laboratory-based surveillance since 2011
Jikai Liu1, Li Bai1, Weiwei Li1, Haihong Han1, Ping Fu1, Xiaochen Ma2, Zhenwang Bi3, Xiaorong Yang4, Xiuli Zhang5, Shiqi Zhen6, Xiaoling Deng7, Xiumei Liu1, Yunchang Guo1()
1. Key Laboratory of Food Safety Risk Assessment, Ministry of Health and China National Center for Food Safety Risk Assessment, Beijing 100022, China
2. Center for Disease Control and Prevention of Beijing, Beijing 100013, China
3. Shandong Center for Disease Control and Prevention, Jinan 250014, China
4. Center for Disease Control and Prevention of Sichuan Province, Chengdu 610041, China
5. Center for Disease Control and Prevention of Henan Province, Zhengzhou 450016, China
6. Center for Disease Control and Prevention of Jiangsu Province, Nanjing 210009, China
7. Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
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Abstract

Foodborne disease is one of the most important public health issues worldwide. China faces various and unprecedented challenges in all aspects of the food chain. Data from laboratory-based foodborne disease surveillance systems from 2013 to 2016, as well as different regions and ages, can be found along with differences in the patterns of pathogens detected with diverse characteristics. Vibrio parahaemolyticus has been the leading cause of infectious diarrhea in China, especially among adults in coastal regions. Salmonella has been a serious and widely distributed pathogen responsible for substantial socioeconomic burden. Shigella was mostly identified in Northwest China and the inland province (Henan) with less-developed regions among children under 5 years. Data from foodborne disease outbreak reporting system from 2011 to 2016 showed that poisonous animals and plant factors responsible for most deaths were poisonous mushrooms (54.7%) in remote districts in southwest regions. The biological hazard that caused most cases reported (42.3%) was attributed to V. parahaemolyticus, the leading cause of foodborne outbreaks. In this review, we summarize the recent monitoring approach to foodborne diseases in China and compare the results with those in developed countries.
Keywords foodborne diseases      surveillance      TraNet      China     
Corresponding Author(s): Yunchang Guo   
Just Accepted Date: 08 November 2017   Online First Date: 29 December 2017    Issue Date: 06 February 2018
 Cite this article:   
Jikai Liu,Li Bai,Weiwei Li, et al. Trends of foodborne diseases in China: lessons from laboratory-based surveillance since 2011[J]. Front. Med., 2018, 12(1): 48-57.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-017-0608-6
https://academic.hep.com.cn/fmd/EN/Y2018/V12/I1/48
Year Salmonella
% (no. positive/samples)		 Shigella
% (no. positive/samples)		 V. parahaemolyticus
% (no. positive/samples)		 Diarrheagenic E. coli
% (no. positive/samples)		 Norovirus
% (no. positive/samples)
2016 3.39 (4698/138 555) 0.39 (532/138 019) 2.94 (3986/135 530) 3.13 (3347/106 809) 5.37 (3436/63 972)
2015 2.78 (3443/123 819) 0.49 (605/123 055) 1.68 (2020/120 128) 2.79 (2861/102 495) 7.24 (3849/53 198)
2014 2.64 (2790/105 873) 0.52 (515/99 289) 1.87 (1778/95 028) 1.48 (1391/93 807) 10.14 (1961/18 893)
2013 2.83 (2414/85 316) 0.64 (543/85 312) 1.62 (1251/77 330) 0.97 (738/75 952) / (/)
Total 2.94 (13 345/453 563) 0.49 (2195/445 675) 2.11 (9035/428 016) 2.20 (8337/379 063) 6.76 (9201/136 063)
Tab.1  Isolation rates of foodborne pathogens from diarrheal patients from 2013 to 2016
Fig.1  Proportion of diarrhea cases by age groups of four different pathogens.
Year Poisonous mushroom Microorganism Poisonous animals and plants Chemicals Others
Outbreaks Illness Deaths Outbreaks Illness Deaths Outbreaks Illness Deaths Outbreaks Illness Deaths Outbreaks Illness Deaths
2016 991 4230 146 778 12 910 4 469 3179 34 193 1438 13 1625 11055 16
2015 794 3199 79 444 7861 12 320 3084 23 157 1070 17 686 6160 8
2014 354 1783 61 437 8181 12 252 3089 17 108 1040 18 329 3558 3
2013 226 1309 47 320 7162 2 183 2038 22 81 687 15 191 3217 4
2012 201 831 76 255 6844 11 96 1185 13 107 1305 25 258 3514 12
2011 104 483 31 212 5292 11 108 2526 0 112 1251 45 273 4505 26
Total 2670 11 835 440 2446 48 250 52 1428 15 101 109 758 6791 133 3362 32 009 69
Tab.2  Reported outbreaks caused by etiologies: Foodborne Disease Outbreak Surveillance System, China, from 2011 to 2016
Year V. parahaemolyticus Salmonella Staphylococcus aureus (enterotoxin) DEC Bacillus cereus
Outbreaks Illness Deaths Outbreaks Illness Deaths Outbreaks Illness Deaths Outbreaks Illness Deaths Outbreaks Illness Deaths
2016 275 4567 1 186 2984 0 94 1122 0 54 903 0 61 677 2
2015 147 2315 1 101 2494 1 56 805 0 31 315 0 38 700 2
2014 134 1812 0 73 2122 1 52 825 0 20 457 0 27 617 1
2013 89 1636 2 74 1898 0 40 859 0 14 557 0 31 809 0
2012 73 1280 0 60 2089 1 45 979 1 12 583 0 28 949 0
2011 72 1403 0 45 1632 1 27 606 0 7 102 1 21 590 0
Total 790 13 013 4 539 13 219 4 314 5196 1 138 2917 1 206 4342 5
Tab.3  Foodborne disease outbreaks, outbreak-associated illnesses, and deaths, by bacterial etiologies: Foodborne Disease Outbreak Surveillance System, China, from 2011 to 2016
Etiology Food category No. of outbreaks No. of illnesses No. of hospitalizations No. of deaths
Top five pathogen–food category pairs resulting in outbreaks
Salmonella Egg 39 237 96 0
V. parahaemolyticus Crustacea 31 407 64 0
Salmonella Pork 25 463 302 0
V. parahaemolyticus Shellfish 18 304 16 0
Staphylococcus aureus Pork 18 239 61 0
Top five pathogen–food category pairs resulting in outbreak-associated illnesses 　
Salmonella Pork 25 463 302 0
V. parahaemolyticus Crustacea 31 407 64 0
V. parahaemolyticus Pork 12 325 31 0
V. parahaemolyticus Shellfish 18 304 16 0
Staphylococcus aureus Pork 18 239 61 0
Salmonella Egg 39 237 96 0
Top five pathogen–food category pairs resulting in outbreak-associated hospitalizations
Salmonella Pork 25 463 302 0
Bacillus cereus Rice 18 227 107 0
V. parahaemolyticus Chicken 6 180 105 0
Salmonella Egg 39 237 96 0
Salmonella Chicken 13 205 68 0
Tab.4  Most common confirmed pathogen–food category pairs resulting in outbreaks, outbreak-associated illnesses, hospitalizations, and deaths: Foodborne Disease Outbreak Surveillance System, China, 2016
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