{
  "abstract": "BACKGROUND: Foodborne diseases cause significant illness and death globally. We updated WHO estimates of the burden caused by diarrhoeal hazards commonly transmitted by food: Campylobacter jejuni, Campylobacter coli, and other thermotolerant Campylobacter species; Cryptosporidium spp; Cyclospora cayetanensis; Entamoeba histolytica; enteroaggregative Escherichia coli; enteropathogenic E coli; enterotoxigenic E coli; Giardia duodenalis; norovirus; rotavirus; non-typhoidal Salmonella enterica; Shiga toxin-producing E coli; Shigella spp; and Vibrio cholerae. METHODS: We estimated illnesses, deaths, and disability-adjusted life-years (DALYs) for 194 countries for the period 2000-21 using data from systematic reviews; the Global Burden of Diseases, Injuries, and Risk Factors Study 2021; a structured expert judgement study; and country consultations. We used disease-specific computational models, and a hierarchical meta-regression model with geographical clustering, a global linear time trend, and uncertainty propagation. FINDINGS: In 2021, the 14 diarrhoeal hazards caused 666 million (95% UI 483-884) illnesses, 265 000 deaths (196 000-351 000), and 15·2 million (11·6-19·1) DALYs from foodborne transmission. Shigella spp, Campylobacter, and rotavirus caused the most DALYs from foodborne transmission. The greatest burden was in the African region (773·5 DALYs [95% UI 559·7-1033·3] per 100 000 population due to foodborne transmission). Mortality rates were 7·1 times higher and DALY rates 18·9 times higher in children younger than 5 years than in people aged 5 years or older. While the overall foodborne burden decreased between 2000 (692·3 DALYs [517·9-938·1] per 100 000 population) and 2021 (193·6 [147·2-243·0] per 100 000), this trend was not consistent for all hazards. INTERPRETATION: Diarrhoeal hazards continue to cause a substantial foodborne disease burden, despite decreases over time. Children in low-income countries bear the greatest burden. Prevention requires concerted efforts, including expanding global diarrhoeal disease prevention efforts beyond water, sanitation, and hygiene and vaccination to include improvements in the safety of the food supply. FUNDING: WHO.",
  "abstract_shown": true,
  "affiliations": [
    "School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada. Electronic address: smajowic@uwaterloo.ca",
    "Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA, USA",
    "National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT, Australia",
    "National Food Institute, Technical University of Denmark, Kongens Lyngby, Denmark",
    "Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland",
    "Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium; Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium",
    "Department of Molecular Biomedicine, CINVESTAV-IPN, Mexico City, Mexico",
    "Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium",
    "Emerging Pathogens Institute, Global Food Systems Institute, Department of Animal Sciences, University of Florida, Gainesville, FL, USA",
    "School of Environmental Health Sciences, College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia",
    "Indian Council of Agricultural Research, Krishi Bhavan, New Delhi, India",
    "Abu Dhabi Agriculture and Food Safety Authority, Mohamed Bin Zayed City, Abu Dhabi, United Arab Emirates",
    "Institute of Public Health and Forensic Science, Christchurch, New Zealand",
    "Delft Institute of Applied Mathematics, Faculty of Electrical Engineering, Mathematics and Computer Science, Delft University of Technology, Delft, Netherlands",
    "Parasitology Unit, Department of Paraclinical Science, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Ås, Norway",
    "Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 55,
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      "name": "Shannon Elizabeth Majowicz",
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      "name": "Josh Michael Colston",
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      "name": "Yuki Minato",
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    {
      "name": "Luria Leslie Founou",
      "orcid": "0000-0002-3874-8175"
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        5
      ],
      "name": "Brecht Devleesschauwer",
      "orcid": "0000-0002-2867-6892"
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        5
      ],
      "name": "Carlotta Di Bari",
      "orcid": "0000-0003-4061-0818"
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    {
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      ],
      "name": "Teresa Estrada‐García",
      "orcid": "0000-0002-3389-4480"
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    {
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        7
      ],
      "name": "Louise Vaes",
      "orcid": "0009-0002-6829-866X"
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        8
      ],
      "name": "Arie Hendrik Havelaar",
      "orcid": "0000-0002-6456-5460"
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        4
      ],
      "name": "Charlee Law",
      "orcid": "0000-0002-3015-0507"
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      "name": "Tesfaye Gobena",
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      "name": "Ashok Kumar",
      "orcid": "0000-0001-7678-7573"
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        11
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      "name": "Fadi Al Natour",
      "orcid": "0009-0009-3885-5120"
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      "name": "Robin Lake",
      "orcid": "0000-0002-0049-3218"
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      ],
      "name": "Gabriela F. Nane",
      "orcid": "0000-0002-3614-1820"
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        14
      ],
      "name": "Lucy Jane Robertson",
      "orcid": "0000-0001-5186-4421"
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        7
      ],
      "name": "Kim Fernandez",
      "orcid": "0009-0004-3444-9946"
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        15
      ],
      "name": "Elaine Scallan Walter",
      "orcid": "0000-0003-1766-0307"
    },
    {
      "affs": [
        1
      ],
      "name": "Margaret N. Kosek",
      "orcid": "0000-0001-6340-4852"
    },
    {
      "name": "Antonio Agudo"
    },
    {
      "name": "Mohammed Al Huthiel",
      "orcid": "0009-0008-0648-2924"
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    {
      "affs": [
        11
      ],
      "name": "Fadi Al Natour"
    },
    {
      "name": "Li Bai"
    },
    {
      "name": "Beau Bruce"
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    {
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        5
      ],
      "name": "Brecht Devleesschauwer",
      "orcid": "0000-0002-2867-6892"
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    {
      "name": "Sithar Dorjee",
      "orcid": "0000-0002-2995-0486"
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    {
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      ],
      "name": "Teresa Estrada-Garcia"
    },
    {
      "name": "Luria Leslie Founou",
      "orcid": "0000-0002-3874-8175"
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    {
      "affs": [
        9
      ],
      "name": "Tesfaye Gobena",
      "orcid": "0000-0001-7555-5762"
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    {
      "name": "Sandra Hoffmann",
      "orcid": "0000-0003-2537-8731"
    },
    {
      "name": "Lea Sletting Jakobsen",
      "orcid": "0000-0001-9666-348X"
    },
    {
      "name": "Karen Keddy"
    },
    {
      "affs": [
        2
      ],
      "name": "Martyn Kirk"
    },
    {
      "name": "Mirjam Kretzschmar",
      "orcid": "0000-0002-4394-7697"
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    {
      "name": "Kunihiro Kubota",
      "orcid": "0009-0008-6610-2495"
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    {
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        10
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      "name": "Ashok Kumar"
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    {
      "affs": [
        12
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      "name": "R. Lake"
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    {
      "affs": [
        0
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      "name": "Shannon E Majowicz"
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    {
      "name": "Lapo Mughini‐Gras",
      "orcid": "0000-0001-5420-949X"
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    {
      "affs": [
        3
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      "name": "Sara Monteiro Pires"
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    {
      "name": "Tety Rachmawati",
      "orcid": "0000-0003-0593-2483"
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      "name": "Lucy Robertson"
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      "name": "Tesfaye Gobena",
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      "name": "Sara Monteiro Pires"
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  "bibtex": "https://research.draconitic.com/paper/fxm5xysms92w7.bib",
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  "doi": "10.1016/j.langlo.2026.103997",
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  "id": "fxm5xysms92w7",
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    "2572-116X"
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  "landing_url": "https://doi.org/10.1016/j.langlo.2026.103997",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
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  "pmcid": "PMC13358865",
  "pmid": "42296981",
  "published": "2026-06-15",
  "publisher": "Elsevier BV",
  "ris": "https://research.draconitic.com/paper/fxm5xysms92w7.ris",
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    {
      "field": "medicine",
      "origin": "issn:2214-109X",
      "subfield": "epidemiology-public-health"
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  "title": "WHO estimates of the global, regional, and national burden of 14 foodborne diarrhoeal enteric hazards, 2000–21: an updated data synthesis",
  "title_text": "WHO estimates of the global, regional, and national burden of 14 foodborne diarrhoeal enteric hazards, 2000–21: an updated data synthesis",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T13:20:50Z",
  "url": "https://research.draconitic.com/paper/fxm5xysms92w7",
  "venue": "The Lancet Global Health",
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