Trends of Major Foodborne Outbreaks in the European Union during the Years 2015–2019
Round 1
Reviewer 1 Report
The manuscript process a particulary important problem. There were several ariticles in the topic of foodborne diseases, thus I would suggest to increase the cited references in this review. The structure of the article is acceptable (separating the foodborne diseases by its pathogens), however, I would collide today's data with data from the past decade or recent years. I also miss the references of the figures and tables.
Main text:
Lines 18-19: Please give the correct definition of "foodborne" diseases (including heavy metals and chemical substances). A short outlook to the economical reasons of foodborne diseases would be nice (developing countries, poverty, ect...)
Line 41: Citation 5 is not pointing at a WHO link as it says in the text. It is also not Hou et al. 2021. 420 000 deaths due to pathogens were described by Shan et al, 2019.
Line 67: Data in Table 1 should be presented on a graph, it would be more informative.
Lines 72-76: Add references
Figures
Add the standard deviations to all figures
Figures 2-4-8-11: Please add a reference of the word cloud generator software
Figure 9: Unknown food source with weak evidence causing 70% of foodborne outbreaks...it does not make any sense to me
Were the data compared with any statistical tests? If authors have the WHO and EFSA data it would be nice to see the differences between years. If not, it is advisable to add the figures it is all descriptive statistics
Tables:
Table 1 should be presented as a graph
Table 2 should contain the severity of the foodborn disease by country (e.g.: Add a color palette for the number of death cases, ect.)
Author Response
The manuscript process a particulary important problem. There were several ariticles in the topic of foodborne diseases, thus I would suggest to increase the cited references in this review. The structure of the article is acceptable (separating the foodborne diseases by its pathogens), however, I would collide today's data with data from the past decade or recent years. I also miss the references of the figures and tables.
The authors added more information about the foodborne outbreaks occurred in the past decade and increased the cited references. They also added references of figures and tables.
Main text:
Lines 18-19: Please give the correct definition of "foodborne" diseases (including heavy metals and chemical substances).
The authors provided the correct definition of foodborne disease including chemicals and toxicants.
A short outlook to the economical reasons of foodborne diseases would be nice (developing countries, poverty, ect...)
The authors added the required information in the text.
Line 41: Citation 5 is not pointing at a WHO link as it says in the text. It is also not Hou et al. 2021. 420 000 deaths due to pathogens were described by Shan et al, 2019.
The authors modified the citation 5 substituting Hou et al. 2021 with Shan et al. 2019.
Line 67: Data in Table 1 should be presented on a graph, it would be more informative.
The authors changed Table 1 with Figures 1 and 2.
Lines 72-76: Add references
The authors added the required reference.
Figures
Add the standard deviations to all figures
The authors added SD to all figures.
Figures 2-4-8-11: Please add a reference of the word cloud generator software
The authors added reference of the word cloud generator software.
Figure 9: Unknown food source with weak evidence causing 70% of foodborne outbreaks...it does not make any sense to me
The authors agree with the suggestion and deleted the unknown food source rates from all figures.
Were the data compared with any statistical tests? If authors have the WHO and EFSA data it would be nice to see the differences between years. If not, it is advisable to add the figures it is all descriptive statistics
The authors analyzed by ANOVA all data regarding the number of outbreaks in the investigated years and found no statistical significance. They added such results in the text.
Tables:
Table 1 should be presented as a graph
The authors changed Table 1 with Figures 1 and 2.
Table 2 should contain the severity of the foodborn disease by country (e.g.: Add a color palette for the number of death cases, ect.)
The authors added the required information in the text but only as total death cases not referred to each country. Such data are not included in the EFSA and ECDC reports.
Reviewer 2 Report
The study by Schirone et al. describes trends and incidence of foodborne outbreaks in the European Union during 2015-2019. The authors focused on four specific microorganisms – Campylobacter, Salmonella, Listeria monocytogenes and Yersinia enterocolitica. They identified the risk foods that may be potentially associated with the infection and also symptoms experienced upon infection.
Main issues:
- The depth of information was quite limited for a review, mainly rewording statements made in the reports which were reviewed. The findings could have been investigated further or more statistical analyses could have been made, e.g., whether incidence rates were statistically significant, percentage of cases in outbreaks or number of outbreaks in relevance to reported overall case numbers, statistical significance between years, etc. Considering the review is describing foodborne outbreak trends, numbers does not seem to be statistically analysed enough.
- The authors mentions “the trend remained stable” for all of the microorganisms. However, looking at the graphs, some went up and then down, or vice versa. It is not clear why this is called “stable” if the numbers are not trending in one particular direction. Or do you mean the number of outbreaks were relatively stable, although even for Salmonella, the number of outbreak went up quite a lot from 2014-2018, then went down again in 2019. Perhaps a better wording might be “increase or decrease was not statistically significant” if that is what the authors mean.
- Perhaps figures can include number of outbreaks/cases from outbreaks to provide more detail how foodborne outbreaks are trending with reported cases.
- The word cloud generated figures looked interesting at first sight, but when studied, the figure was not very informative. It would be useful if a bigger font was used for symptoms or food products which had a higher impact, smaller font for ones with less incidence, and no repetition of words used in the figure. This would give a clearer picture of the food sources associated with the microorganisms and the symptoms which may be encountered following infection.
- What is the definition of “strong” and “weak” evidence of a food source being responsible for an outbreak? This is not clearly defined which makes it difficult to interpret the findings. Also when a food category is labelled as “unknown”, how is it possible to define whether it has a strong or weak evidence to the outbreak? More definitions need to be included to understand the review rather than just stating what has been written in the reports.
- What about the relevance of the foodborne disease acquisition to different locations, e.g., home, school, restaurants, etc., or whether how the food was prepared, e.g., boxed meals, ready-to-eat, cooked, etc. Or the relevance to seasons?
- Is there any studies or reports that surveys the incidence of antimicrobial resistance in these cases, this is one of the current hot topics which should give more significance to your review.
Minor issues:
- Figures 1, 5, 7, 10: The y-axis is labelled notification rate, but the numbers are the case numbers per year.
- Line 59: results “was” stable
- Line 79: “although” instead of even if
- Line 111: “give a positive result”
- Line 129: “in” instead of to
- Lines 172 and onwards: overcome or prevent would be a better word than “hurdle”, which is used in the wrong context
- Some of the references are incorrect, e.g., reference 18 in line 187, it is a paper which has mentioned that NZ has fixed MC, but it is not the actual report.
Author Response
The study by Schirone et al. describes trends and incidence of foodborne outbreaks in the European Union during 2015-2019. The authors focused on four specific microorganisms – Campylobacter, Salmonella, Listeria monocytogenes and Yersinia enterocolitica. They identified the risk foods that may be potentially associated with the infection and also symptoms experienced upon infection.
Main issues:
The depth of information was quite limited for a review, mainly rewording statements made in the reports which were reviewed. The findings could have been investigated further or more statistical analyses could have been made, e.g., whether incidence rates were statistically significant, percentage of cases in outbreaks or number of outbreaks in relevance to reported overall case numbers, statistical significance between years, etc. Considering the review is describing foodborne outbreak trends, numbers does not seem to be statistically analysed enough.
The authors added more information about foodborne outbreaks due to the investigated pathogens occurred worldwide. Moreover, they analyzed by ANOVA all data regarding the number of outbreaks in the investigated years and found no statistical significance. They added such result in the text.
The authors mentions “the trend remained stable” for all of the microorganisms. However, looking at the graphs, some went up and then down, or vice versa. It is not clear why this is called “stable” if the numbers are not trending in one particular direction. Or do you mean the number of outbreaks were relatively stable, although even for Salmonella, the number of outbreak went up quite a lot from 2014-2018, then went down again in 2019. Perhaps a better wording might be “increase or decrease was not statistically significant” if that is what the authors mean.
The authors used the word “stable” as it was what the EFSA-ECDC reported for the investigated years. However, they statistically analyzed the data as reported before and found no significance.
Perhaps figures can include number of outbreaks/cases from outbreaks to provide more detail how foodborne outbreaks are trending with reported cases.
The authors reported the number of outbreaks/cases for the investigated years in Figure 1, while the total number of outbreaks was shown in Figure 2.
The word cloud generated figures looked interesting at first sight, but when studied, the figure was not very informative. It would be useful if a bigger font was used for symptoms or food products which had a higher impact, smaller font for ones with less incidence, and no repetition of words used in the figure. This would give a clearer picture of the food sources associated with the microorganisms and the symptoms which may be encountered following infection.
The authors modified all word cloud generated figures as suggested.
What is the definition of “strong” and “weak” evidence of a food source being responsible for an outbreak? This is not clearly defined which makes it difficult to interpret the findings. Also when a food category is labelled as “unknown”, how is it possible to define whether it has a strong or weak evidence to the outbreak? More definitions need to be included to understand the review rather than just stating what has been written in the reports.
The authors included more definitions (i.e., strong- and weak-evidence) and deleted the food category labelled as “unknown” from all figures.
What about the relevance of the foodborne disease acquisition to different locations, e.g., home, school, restaurants, etc., or whether how the food was prepared, e.g., boxed meals, ready-to-eat, cooked, etc. Or the relevance to seasons?
The authors added (when available) the different locations as well as food manufacturing information or seasonal relevance on the reported foodborne outbreaks.
Is there any studies or reports that surveys the incidence of antimicrobial resistance in these cases, this is one of the current hot topics which should give more significance to your review.
The authors added some information about antimicrobial resistance in cases of foodborne outbreaks reported in literature.
Minor issues:
Figures 1, 5, 7, 10: The y-axis is labelled notification rate, but the numbers are the case numbers per year.
Line 59: results “was” stable
Line 79: “although” instead of even if
Line 111: “give a positive result”
Line 129: “in” instead of to
Lines 172 and onwards: overcome or prevent would be a better word than “hurdle”, which is used in the wrong context
Some of the references are incorrect, e.g., reference 18 in line 187, it is a paper which has mentioned that NZ has fixed MC, but it is not the actual report.
The authors changed the text point by point as suggested. They also modified reference 18.
Reviewer 3 Report
The purpose of this review is to describe some of the most commonly reported foodborne diseases.
The aim of the study was clearly defined in the introducti. The conclusions of the conducted research are clear and result from the obtained research results. The arrangement of the figures is not of a scientific nature, the presented graphs can only be included in popular science publications. Needs a change.
Discussing the results against the background of other authors is very detailed. The publications cited by the authors of the article are well selected. For the most part, the authors refer to the latest knowledge published in renowned scientific journals.
A few punctuation problems are present in the manuscript. I suggest the Authors to double-check the text.
Author Response
The purpose of this review is to describe some of the most commonly reported foodborne diseases.
The aim of the study was clearly defined in the introduction. The conclusions of the conducted research are clear and result from the obtained research results. The arrangement of the figures is not of a scientific nature, the presented graphs can only be included in popular science publications. Needs a change.
The authors modified tables/figures where applicable. The data were statistically analyzed, and standard deviation was added to most figures. Moreover, some references, including the data about outbreaks in other countries were added.
Discussing the results against the background of other authors is very detailed. The publications cited by the authors of the article are well selected. For the most part, the authors refer to the latest knowledge published in renowned scientific journals.
A few punctuation problems are present in the manuscript. I suggest the Authors to double-check the text.
The authors checked the whole text for punctuation problems.
Round 2
Reviewer 1 Report
The main text was corrected according to recommendations however, I cannot find the figures in this version of the manuscript. Maybe they were not uploaded. If the suggested corrections are presented on the figures I can accept the manuscript at its current form.
Author Response
The main text was corrected according to recommendations however, I cannot find the figures in this version of the manuscript. Maybe they were not uploaded. If the suggested corrections are presented on the figures I can accept the manuscript at its current form.
The authors modified the Figures as suggested
Reviewer 2 Report
There are still some issues with the figures and manuscript.
- Figure 1: Figure legend is “Number of outbreaks/cases”, meaning number of outbreaks per cases? Or do you mean number of cases associated with outbreaks? Please specify correctly. Also, it would be better to label the y-axis of graphs with better wordings than just “N”.
- Figure 1: I would prefer if four panels were used to present the data rather than grouping to minimize complexity of the data especially when error bars are shown.
- Figure 2: Is it showing the number of cases associated with strong/weak evidence outbreaks? Or the actual number of outbreaks? If it is number of outbreaks, how can hospitalized cases be compared using the same axis? Again, please label the y-axis clearly.
- Figure 2d: “Year” in x-axis is in a different format to the other graphs
- Hospitalization: why is this only mentioned briefly for campylobacteriosis but not for the other agents? Especially with the high rate of hospitalization for salmonellosis. Please add some more information.
- All figures: some error bars are floating in space, please correct.
- Figure 13: Fish is mentioned twice.
- Line 113-115: Please rephrase.
- Line 211: “reported with” instead of “included in”
Author Response
1. Figure 1: Figure legend is “Number of outbreaks/cases”, meaning number of outbreaks per cases? Or do you mean number of cases associated with outbreaks? Please specify correctly. Also, it would be better to label the y-axis of graphs with better wordings than just “N”.
The authors modified the label on the y-axis in all figures
2. Figure 1: I would prefer if four panels were used to present the data rather than grouping to minimize complexity of the data especially when error bars are shown.
The authors divided the Figure 1 in four panels
3. Figure 2: Is it showing the number of cases associated with strong/weak evidence outbreaks? Or the actual number of outbreaks? If it is number of outbreaks, how can hospitalized cases be compared using the same axis? Again, please label the y-axis clearly.
The authors modified the label on the y-axis
4. Figure 2d: “Year” in x-axis is in a different format to the other graphs
The authors modified as requested
5. Hospitalization: why is this only mentioned briefly for campylobacteriosis but not for the other agents? Especially with the high rate of hospitalization for salmonellosis. Please add some more information.
The authors added information about hospitalization cases for other pathogens in the text (highlighted in yellow) and were deleted from the Figure 2.
6. All figures: some error bars are floating in space, please correct.
The authors corrected error bars
Figure 13: Fish is mentioned twice.
The authors deleted as requested
Line 113-115: Please rephrase.
The authors rephrased such sentence
Line 211: “reported with” instead of “included in”
The authors changed as requested
