A Global Review of Foodborne Disease Incidence and Definitions Used by Food Safety Agencies to Determine Who are the Clinically Vulnerable Groups?

Introduction: Food safety advice is especially important for groups within society who are at greater risk of severe illness, commonly referred to as clinically vulnerable groups. Food Standards Scotland commissioned independent researchers to review their current definition of “clinically vulnerable groups” to ensure appropriate food safety messaging.
Purpose: To evaluate the appropriateness of current definitions of clinically vulnerable groups in Scotland based on incidence data and global definitions.

Methods: Scottish and global data were analyzed to establish the incidence of Campylobacter, Salmonella, Escherichia coli, Listeria monocytogenes and norovirus among the clinically vulnerable groups. Additionally, a review of clinically vulnerable definitions (n=87) utilized by global food safety agencies (n=30) was undertaken.

Results: The review of language used by global food safety agencies (n=30) to described vulnerable populations yielded 87 definitions. Overall, the definitions of vulnerability varied according to pathogens. Children were most frequently referred to as being vulnerable (n=26; 30%) in general definitions, and specifically E. coli, Salmonella, Campylobacter, norovirus. Pregnant women were mentioned in 21% of general definitions and 34% of definitions in relation to listeriosis. Similarly, the elderly, and neonates were frequently referred to in relation to listeriosis (30%, 14% respectively). Of peer-reviewed studies reporting foodborne disease incidence (n=2,805), 106 were identified for data extraction. Studies corroborated the language used by global agencies; however, they provided detail regarding specific conditions leading to vulnerability such as people with diabetes, or receiving cancer treatment were infrequently included in definitions despite increased incidence. Scottish incidence data suggested a significant increased risk of foodborne illness among people prescribed proton-pump inhibitors (34% campylobacteriosis, 25% salmonellosis, 20% listeriosis) while only one definition referred to this group.

Significance: Findings indicate adjustments to communication regarding clinically vulnerable groups are required and should be based on incidence data. Including reasons for elevated vulnerability may enhance consumer understanding.