Article 2026-04-23 posted v1

World Health Organization Attribution of Burden of Foodborne Diseases to Transmission Pathways and Foods

S
Sara Pires National Food Institute, Technical University of Denmark
L
Lapo Mughini-Gras National Institute for Public Health and the Environment
S
Sandra Hoffmann George Washington University
K
Kunihiro Kubota National Institute of Health Sciences
S
Shannon Majowicz School of Public Health Sciences, University of Waterloo
M
Martyn Kirk National Centre for Epidemiology and Population Health, Australian National University
L
Lucy Robertson Faculty of Veterinary Medicine, Norwegian University of Life Sciences
P
Paul Torgerson Vetsuisse Faculty, University of Zürich
L
Lea Jakobsen National Food Institute, Technical University of Denmark
A
Antonio Agudo Unit of Nutrition and Cancer, Catalan Institute of Oncology - ICO
L
Li Bai China National Center for Food Safety Risk Assessment
T
Tety Rachmawati Research Centre for Public Health and Nutrition, National Research and Innovation Agency
Y
Yuki Minato World Health Organization
C
Charlee Roberts World Health Organization
A
Arie Havelaar University of Florida
B
Brecht Devleesschauwer Health Information, Department of Epidemiology and Public Health, Sciensano
E
Elisa Benincà National Institute for Public Health and the Environment
R
Robin Lake Institute of Public Health and Forensic Science
T
Tine Hald DTU
R
Roger Cooke Delft University of Technology
W
Willy Aspinall Aspinall Consulting Ltd
G
Gabriela Nane Delft University of Technology

Abstract

Identifying the sources of foodborne diseases is crucial for guiding national food safety strategies and supporting policies that promote safe and sustainable diets. We present global estimates of the proportions of burden of disease attributable to foodborne transmission, other major pathways, and food categories for 29 viral, bacterial, parasitic, and chemical hazards, based on a structured expert judgment (SEJ) study commissioned by the World Health Organization (WHO) and supervised by the WHO Foodborne Disease Burden Epidemiology Reference Group (FERG) for 2021-2025. One-hundred forty-six experts provided 1,463 assessments across 17 subregions within six WHO regions. Expert judgments were weighted using Cooke’s Classical Model and reviewed by FERG. We found that 13 of 29 hazards were >50% foodborne. Vegetables and “fruits and nuts” were important sources for multiple enteric and invasive pathogens, and animal-source foods, including poultry, beef, eggs, seafood, and dairy remained critical targets for intervention. Regional differences highlight the influence of local epidemiology, food systems, sanitation, and cultural practices. These estimates provide a global, uncertainty-quantified knowledge base to guide context-specific food safety interventions and future empirical data collection. Given persistent data gaps, SEJ remains the most feasible approach to generate evidence supporting efforts to reduce foodborne disease.

Citation Information

@article{sarapires2026,
  title={World Health Organization Attribution of Burden of Foodborne Diseases to Transmission Pathways and Foods},
  author={Sara Pires and Lapo Mughini-Gras and Sandra Hoffmann and Kunihiro Kubota and Shannon Majowicz and Martyn Kirk and Lucy Robertson and Paul Torgerson and Lea Jakobsen and Antonio Agudo and Li Bai and Tety Rachmawati and Yuki Minato and Charlee Roberts and Arie Havelaar and Brecht Devleesschauwer and Elisa Benincà and Robin Lake and Tine Hald and Roger Cooke and Willy Aspinall and Gabriela Nane},
  journal={Research Square},
  year={2026},
  doi={https://doi.org/10.21203/rs.3.rs-9449162/v1}
}
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