UK FSA releases preliminary foodborne disease attribution data
The four pathogens of interest in this report are Enteropathogenic Escherichia coli (EPEC), sapovirus, hepatitis A virus (HAV), and Toxoplasma gondii.
UK – The Food Standards Agency (FSA) has recently published its “Disease Attribution to Foods for Four UK Pathogens” research project, using preliminary data from the third intestinal infectious disease survey (IID3).
In 2021, the FSA commissioned the IID3 to estimate the burden of Intestinal Infectious Diseases within the country, identify their causes, and calculate the proportion of cases not reported to healthcare providers based on data collected from September 2023 to August 2025, for selected pathogens.
Based on this data, the FSA will update the 2018 estimates, which suggest that the UK experiences approximately 2.4 million cases of foodborne disease per year.
So far in the study, diarrheagenic Escherichia coli (enterotoxigenic, enteropathogenic, and enteroaggregative strains), Campylobacter, norovirus, Clostridium perfringens (toxin positive) and sapovirus are among the most commonly detected pathogens.
However, for this report, they covered enteropathogenic Escherichia coli (EPEC), sapovirus, hepatitis A virus (HAV), and Toxoplasma gondii.
A systematic literature review was conducted using articles published after 2012. It included seven studies on T. gondii, nine studies on HAV, one study on EPEC, and five studies on sapovirus.
What about these pathogens?
Sapovirus is a common cause of viral gastroenteritis, predominantly affecting children under the age of five. It occasionally causes outbreaks across all age groups in schools, hospitals and other healthcare facilities. The highly recommended control measure is observing hand hygiene.
Toxoplasma gondii is a common parasite that infects warm-blooded animals, including humans, and causes toxoplasmosis. Cats are the definitive hosts, while humans are intermediate hosts. Infection can occur through the consumption of undercooked meat, contact with cat faeces, or congenital transmission.
Enteropathogenic Escherichia coli are among the most significant pathogens infecting children worldwide and are a primary cause of persistent diarrhoea.
Hepatitis A virus causes inflammation of the liver, typically through person-to-person contact or by consuming contaminated food or drink. It is a highly contagious disease, but often mild.
Preliminary findings
The findings revealed that EPEC had the highest food-attributable portion, at 64%, followed by T. gondii (results ranging from 28% to 61%), HAV (10% to 42%), and sapovirus (13% to 16%).
As only one study was recovered for EPEC, results for grouped diarrheagenic E. coli (DEC) pathotypes, not including Shiga toxin-producing E. coli (STEC), were also included. These suggest that between 25% and 55% of DEC disease could be attributed to foods.
Other studies that apportion foodborne disease to individual food groups attributed fresh produce as the most common foodborne transmission pathway for HAV, with estimates ranging from 45% to 95.4%, and for sapovirus, 58.3%.
Sapovirus transmission was mainly attributed to meat and poultry (20.4–50% across models) compared to leafy greens (0–12.4%).
Meanwhile, pork was suggested as a more significant transmission pathway for T. gondii, with a transmission rate ranging from 20% to 41%. Among beef, pork, and poultry, the majority of T. gondii infections were suggested to be derived from non-ready-to-eat (NRTE) minced products.
No commodity-specific attributions were available for EPEC or grouped DEC.
Alongside food, human contact was a major transmission pathway for HAV, EPEC, and sapovirus, and contributed significantly to the total transmission of disease for sapovirus and HAV in some studies.
For T. gondii, person-to-person transmission was less impactful. Instead, animal contact, waterborne, and environmental (specifically through soil) transmission were identified as having a more significant impact.
The project additionally made recommendations for the continuation of this work for the remaining pathogens within IID3.
One suggests that, given the limited data available for specific E. coli pathotypes (EPEC investigated here), the inclusion of studies reporting grouped results for non-STEC DEC should be considered, and specifically searched for, if included in the final review.
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