The economic and social impact of human salmonellosis in England and Wales: a study of the costs and epidemiology of illness and the benefits of prevention.
This thesis presents a detailed analysis of illness related costs of
human salmonellosis In England and Wales, estimated at £263 million
(minimum), including intangible costs, in 1988, and explores potential
benefits of preventive activities aimed at the poultry industry.
To explore trends In reported infection and the factors which may
influence those trends, salmonella reporting between 1960 and 1989 was
examined. Trends in foodborne Illness were associated with increased
reporting of salmonella infection. The factors which contributed to
this increase included Intrinsic factors such as the microbiological
quality of food, and extrinsic factors such as ambient temperature
which may amplify intrinsic effects. Evidence that poultry products
were important vehicles of human Illness was supported by trends in
infections in animals and poultry, and food consumption patterns. Thus
a significant decrease in human infection would result from reduction
in poultry contamination.
The findings of a unique and detailed survey of 1,482 human salmonella
cases, presented in this thesis, indicated tangible costs of illness of
£996,350 to £1,091,131. Over a third (E392,822 - £426,887) were costs
related to investigation and treatment of cases and over half (E507,555
-E559,401) was production loss associated with sickness related absence
from work. The remaining costs Identified represented important costs
to affected Individuals and their families. Additional intangible costs
of £1.57 million to £5.07 million were ascribed to value of lives lost
and to pain and suffering estimates.
Extrapolation of costs, utilizing an index of severity developed for
this study and categorisation of cases by level of treatment demanded,
indicated national, tangible, costs of £231 million to £331 million;
additional intangible costs were £32 million to £119 million). The
cost-effectiveness of limiting these totals was explored by two
approaches. Cost reduction by changes in cases management (eg. reducing
faecal specimens tested and time off work) indicated small potential
savings. However, substantial benefits were indicated by cost-benefit
analysis of preventive activities including irradiation of poultry
carcasses and use of competitive exclusion methods in poultry rearing
