Foodborne illness is frequently characterized in public discourse as a brief, unpleasant ordeal: a day or two of gastrointestinal distress followed by complete recovery. While this description accurately reflects the experience of many, it obscures a more complex and troubling reality. Infections with common foodborne pathogens including Campylobacter, Escherichia coli O157:H7, Listeria monocytogenes, Salmonella, Shigella, and Toxoplasma gondii can result in long-term health consequences affecting multiple organ systems. These chronic conditions impose substantial burdens on individuals, families, and healthcare systems. The economic costs of foodborne illness extend far beyond immediate medical treatment, encompassing lost productivity, long-term disability care, and the immeasurable human cost of lives lost prematurely. For families who lose loved ones to foodborne infections, the aftermath involves profound emotional, financial, and psychological challenges that persist for years. Understanding the full spectrum of consequences associated with foodborne disease is essential for informing public health policy, clinical practice, and consumer awareness.
The Spectrum of Acute Foodborne Illness
Foodborne infections present with a range of acute symptoms that vary depending on the pathogen involved, the dose ingested, and the susceptibility of the host. Common manifestations include nausea, vomiting, diarrhea, abdominal pain, fever, headache, and body aches. Symptoms typically appear between 12 and 72 hours after consumption of contaminated food, though incubation periods can range from as short as 30 minutes to as long as four weeks depending on the specific pathogen (U.S Food & Drug Administration, January 2025).
The severity of acute illness spans a broad continuum. Many individuals experience mild symptoms that resolve without medical intervention. Others require outpatient medical care, and a substantial number necessitate hospitalization. Approximately 128,000 hospitalizations and 3,000 deaths are attributed to foodborne illness in the United States each year (The Centers for Disease Control and Prevention, November 2025). Hospitalizations may involve severe dehydration requiring intravenous fluids, sepsis from systemic infection, and complications requiring intensive care. The U.S. Department of Agriculture’s Economic Research Service notes that hospitalization cost estimates include treatment for sepsis, a serious complication that can result from infections that spread beyond the gastrointestinal tract.
Chronic Sequelae: Long-Term Health Consequences
Research over the past several decades has established that foodborne infections can precipitate chronic health conditions that persist long after the acute illness resolves. These long-term consequences, often termed chronic sequelae, may affect individuals who experienced severe acute illness as well as those whose initial symptoms were relatively mild. The U.S. Department of Agriculture’s 2025 cost estimates include several chronic outcomes supported by scientific literature.
Gastrointestinal Disorders represent one of the most common categories of post-infectious sequelae. Irritable Bowel Syndrome (IBS) has been documented following infections with Campylobacter, Salmonella, and Shigella. Individuals with post-infectious IBS experience chronic abdominal pain, altered bowel habits, and significant impairment in quality of life that may persist for years. Inflammatory bowel disease, including Crohn’s disease, has been investigated for potential associations with foodborne pathogens, though the relationship remains an area of ongoing research.
Neurological Conditions can result from several foodborne infections. Guillain-Barré Syndrome (GBS), an autoimmune disorder in which the body’s immune system attacks peripheral nerves, is a well-established sequela of Campylobacter infection. GBS can cause progressive weakness, paralysis, and respiratory failure requiring mechanical ventilation. While many patients recover, residual neurological deficits are common. Listeria monocytogenes infection during pregnancy can result in severe neurological disorders in newborns, including developmental delays and cognitive impairments. Toxoplasma gondii infection can cause vision impairment in adults and cognitive and hearing impairment in congenitally infected infants.
Rheumatological Conditions following foodborne infection include reactive arthritis, an inflammatory joint condition that typically develops weeks after the initial gastrointestinal illness. Campylobacter, Salmonella, Shigella, and Yersinia have all been associated with reactive arthritis. The condition can cause prolonged joint pain, swelling, and stiffness. In some cases, individuals develop more chronic joint conditions including ankylosing spondylitis, particularly among those with genetic susceptibility marked by the HLA-B27 antigen.
Renal Complications represent one of the most serious long-term outcomes. Infection with Shiga toxin-producing E. coli (STEC), including both O157 and non-O157 strains, can precipitate hemolytic uremic syndrome (HUS), a condition characterized by destruction of red blood cells, low platelet counts, and acute kidney failure. While many children recover renal function with supportive care, a subset develops chronic kidney disease that may progress to end-stage renal disease requiring dialysis or transplantation years or even decades after the initial infection.
Autoimmune Conditions have been linked to foodborne pathogens through mechanisms of molecular mimicry, in which bacterial antigens trigger immune responses that cross-react with host tissues. Autoimmune thyroid disease, including Graves’ disease, has been associated with Yersinia enterocolitica infection, with studies demonstrating cross-reactivity between Yersinia envelope proteins and the thyrotropin receptor.
The cumulative burden of these chronic conditions is substantial. The U.S. Department of Agriculture’s 2025 economic analysis estimates that chronic outcomes account for 31 percent of the total cost of foodborne illness in the United States. This figure reflects both direct medical costs for ongoing care and productivity losses from disability and premature death.
The Economic Burden of Foodborne Disease
The economic consequences of foodborne illness operate at multiple levels: individual, familial, and societal. The most comprehensive recent analysis, published in 2025 by Hoffmann and colleagues, estimates the annual cost of foodborne illness in the United States at $75 billion, adjusted for 2023 dollars (“Economic Burden of Foodborne Illnesses Acquired in the United States,” Sage Journals, January 2025). This figure encompasses medical treatment costs, lost wages and productivity, and the value of statistical life assigned to premature deaths.
Medical Treatment Costs vary substantially depending on the severity of illness and the development of chronic sequelae. For hospitalized patients, costs include room and board, diagnostic testing, medications, surgical interventions when necessary, and rehabilitation services. The USDA’s Economic Research Service utilizes the National Inpatient Sample database to derive average hospitalization costs for pathogen-specific infections, employing data from 2016 through 2019 to smooth annual variations. For non-hospitalized patients seeking outpatient care, treatment costs are estimated using commercial insurance claims data.
Productivity Losses reflect the opportunity cost of time spent away from work due to illness. These estimates account for both the duration of acute illness and, for individuals with chronic sequelae, extended or permanent work disability. Lost wages are calculated as the product of workdays lost and daily wage rates, adjusted for employment rates.
The Value of Premature Death constitutes the largest component of economic cost, accounting for 56 percent of the total $75 billion estimate. The USDA employs a value of statistical life (VSL) of $13.5 million (2023 dollars), derived from a meta-analysis conducted by the U.S. Environmental Protection Agency. This approach quantifies society’s willingness to pay to reduce mortality risk, providing a consistent metric for comparing the burden of different pathogens and evaluating the cost-effectiveness of interventions.
Per-case costs vary dramatically across pathogens, reflecting differences in severity and likelihood of chronic outcomes. Nontyphoidal Salmonella carries the highest total cost at $17.1 billion annually, followed by Campylobacter at $11.3 billion. Toxoplasma gondii ($5.7 billion) and Listeria monocytogenes ($4 billion) follow due primarily to deaths and chronic outcomes associated with pregnancy-related cases. At the individual level, per-case costs range from approximately $196 for Bacillus cereus to $4.6 million for Vibrio vulnificus, a pathogen associated with high mortality rates.
International studies corroborate these findings. Research from Australia estimated the annual cost of six modeled pathogens at 721 million Australian dollars (“Attributions of Pathogen-Specific Costs of Foodborne Illness to Food Commodity Groups – Combining a Costing Model with Expert Judgement,” Australian National University, December 2025), with campylobacteriosis accounting for the greatest share at 420 million Australian dollars. Poultry was identified as the food commodity responsible for the largest proportion of costs, with 69 percent of Campylobacter cases attributed to poultry consumption.
Populations at Heightened Risk
While foodborne illness can affect anyone, certain populations face substantially elevated risks of severe outcomes. The U.S. Food and Drug Administration identifies several groups as particularly vulnerable.
Pregnant Women, Their Unborn Babies, and Young Children constitute a critically at-risk population. Physiological changes during pregnancy alter maternal immune function, increasing susceptibility to foodborne infections. Moreover, certain pathogens can cross the placental barrier, directly infecting the developing fetus whose immune system is insufficiently developed to mount an effective defense. Listeria monocytogenes infection during pregnancy is especially dangerous, potentially causing miscarriage, stillbirth, premature delivery, or severe neonatal illness and death. Toxoplasma gondii infection acquired during pregnancy can lead to congenital toxoplasmosis, resulting in vision impairment, cognitive deficits, and hearing loss in affected infants. Children under five years of age face increased risk because their immune systems remain immature, limiting their ability to resist infection.
Older Adults experience age-related declines in immune function that increase susceptibility to foodborne infections and their complications. Chronic medical conditions common in older populations, including diabetes and cardiovascular disease, may further compromise host defenses.
Immunocompromised Individuals, including those with HIV/AIDS, cancer undergoing chemotherapy, organ transplant recipients taking immunosuppressive medications, and individuals with autoimmune diseases, face markedly elevated risks. Their impaired immune responses allow pathogens to proliferate more readily and disseminate beyond the gastrointestinal tract, increasing the likelihood of severe outcomes including sepsis, meningitis, and death.
Individuals with Chronic Diseases, such as diabetes, may experience altered gastrointestinal motility that allows pathogens extended opportunity to multiply before elimination. Liver disease, particularly cirrhosis, substantially increases susceptibility to severe Vibrio vulnificus infection.
The Human Toll: Family Impact After Severe Illness or Death
Beyond the quantifiable economic costs, foodborne illness exacts a profound human toll on affected individuals and their families. For those who survive with chronic sequelae, the burden includes ongoing medical management, potential disability, and altered life trajectories. For families who lose loved ones, the aftermath involves navigating grief while often simultaneously confronting systemic failures that contributed to the death.
Dr. Darin Detwiler, a food safety expert at Northeastern University, experienced this reality firsthand when his sixteen-month-old son Riley died in 1993 as part of a multi-state E. coli O157:H7 outbreak linked to contaminated hamburgers (Western Washington University, 2021) . Riley had not consumed the contaminated meat himself; rather, he was infected through secondary transmission from a classmate whose mother worked at the implicated fast food restaurant. The bacteria destroyed portions of Riley’s intestines, requiring surgical resection. Despite aggressive medical intervention, Riley developed multiple organ failure and was removed from life support, dying in his father’s arms.
The Detwiler family’s experience illustrates how foodborne illness can affect individuals who never directly consumed contaminated food, as pathogens spread through households and childcare settings. It also demonstrates that even families with awareness of food safety issues are not immune to tragedy. In the aftermath, Dr. Detwiler channeled his grief into advocacy, eventually serving on the U.S. Department of Agriculture’s National Advisory Committee for Meat and Poultry Inspection and supporting implementation of the FDA Food Safety Modernization Act. His story underscores how a single preventable death creates a ripple effect, transforming family dynamics, career trajectories, and life purpose.
The Costello family of Centennial, Wyoming, experienced parallel devastation during the 2006 E. coli outbreak traced to contaminated spinach (The Pew Charitable Trusts, March 2013). Polly Costello’s 81-year-old mother, Ruby Trautz, a retired nurse, became ill with flu-like symptoms in August of that year. Five days later, she died, the first confirmed fatality in an outbreak that would ultimately sicken approximately 200 people, hospitalize more than 100, and claim three lives. On the same day as Ruby’s death, Polly’s husband Ken began experiencing symptoms of what was initially diagnosed as diverticulitis but later confirmed as E. coli O157:H7 infection from the same contaminated spinach.
The Costellos’ experience illuminates several dimensions of foodborne illness impact. First, it demonstrates how a single contaminated product can affect multiple family members, with outcomes ranging from full recovery to death. Second, it highlights the uncertainty and confusion that often accompany foodborne illness, as patients and providers struggle to identify the cause while symptoms progress. Third, it reveals the emotional complexity of grieving one loss while fearing another, as Polly simultaneously mourned her mother and worried for her husband’s survival.
In her testimony before the FDA, Polly Costello articulated the enduring absence: “I miss my mom and am thankful to have my husband. My heart hurts for her and others who have been affected by a preventable foodborne illness”. Her statement captures the dual reality for families affected by severe foodborne illness: gratitude for survivors coexisting with persistent grief for those lost. The “preventable” nature of these deaths adds an additional layer of anguish, as families recognize that different decisions by food producers, regulators, or food handlers might have altered the outcome.
The case of Elijah Silvera, a three-year-old New York City child who died in 2017 after consuming a grilled cheese sandwich at his daycare despite documented severe dairy allergy (Allergy & Asthma Network, November 2024), illustrates another dimension of food-related fatality. While technically anaphylaxis rather than infection, Elijah’s death shares critical features with foodborne infection fatalities: it resulted from failures in food safety systems, occurred in a setting where families entrusted their child to professionals, and left parents to grapple with preventable loss. Elijah’s father, Thomas Silvera, described the family’s meticulous efforts to protect their son, providing documentation, medication, and instructions to daycare staff, only to learn that when Elijah experienced anaphylaxis, staff called his mother rather than 911 and failed to administer the prescribed epinephrine auto-injector.
The Silvera family’s response to the tragedy paralleled that of other food safety advocates. Thomas Silvera established the Elijah-Alavi Foundation to raise awareness and advocate for policy change. His efforts contributed to passage of “Elijah’s Law” in New York State, requiring daycares to implement food allergy guidelines including staff training, prevention protocols, and emergency response procedures. This transformation of personal tragedy into public advocacy reflects a pattern observed among families affected by food-related deaths, who often channel their grief toward preventing similar losses for others.
The recent death of Miller Gardner, fourteen-year-old son of baseball legend Brett Gardner, during a family vacation in Costa Rica in March 2025, brought renewed attention to the devastating potential of foodborne illness. The family’s tragedy, suspected to be related to food poisoning, prompted Dr. Detwiler to share his own experience and offer guidance to grieving families. “No parent should ever have to carry that burden, especially not when the cause was something preventable,” he wrote.
Analysis and Next Steps
The understanding of foodborne illness has evolved substantially from a narrow focus on acute gastrointestinal symptoms to a comprehensive appreciation of multisystem chronic sequelae. What is new in this field includes the systematic incorporation of long-term outcomes into economic burden calculations, with the U.S. Department of Agriculture’s 2025 estimates documenting that chronic sequelae account for nearly one-third of total costs. Also new is the recognition that deaths, while representing a small fraction of cases, account for 56 percent of economic burden when valued through willingness-to-pay methodologies. The identification of specific pathogen-outcome pairs, Campylobacter with Guillain-Barré syndrome, E. coli with chronic kidney disease, Listeria with neonatal neurological devastation, allows for targeted prevention strategies.
This expanded understanding matters because it reframes the stakes of food safety policy. If foodborne illness were merely a transient inconvenience, tolerance for occasional outbreaks might be defensible. But when infections can precipitate lifelong disability, chronic disease requiring decades of medical management, and preventable deaths of children and adults, the imperative for robust prevention becomes clear. The annual cost of $75 billion represents not merely an economic abstraction but real resources diverted from other priorities and real lives permanently altered.
The populations affected by these outcomes are not evenly distributed. Pregnant women and their unborn children face unique vulnerabilities, with Listeria and Toxoplasma capable of causing fetal death or lifelong disability. Young children, whose immune systems remain immature, experience higher rates of severe outcomes. Older adults and immunocompromised individuals confront elevated risks of hospitalization and death. But the ripple effects extend beyond the individual patient to encompass entire families, as the testimonies of the Detwiler, Costello, and Silvera families demonstrate. Spouses lose partners, children lose parents, and parents lose children, losses that cannot be captured in economic models.
For families who have lost loved ones, the aftermath involves navigating grief while confronting the knowledge that death was preventable. Many channel this pain into advocacy, working to strengthen food safety systems and spare others similar suffering. Their testimonies before regulatory agencies and in public forums provide compelling evidence of the human stakes underlying technical policy debates.
What to do now requires action at multiple levels. For public health agencies, continued investment in surveillance systems capable of detecting outbreaks quickly and tracing them to sources is essential. Whole genome sequencing technologies allow investigators to link illnesses with precision, identifying contaminated products before additional consumers are affected. For regulators, full implementation of preventive controls mandated by the Food Safety Modernization Act remains critical, shifting the paradigm from reactive response to proactive prevention.
For healthcare providers, awareness of the potential for chronic sequelae following foodborne infections should inform patient education and follow-up care. Individuals recovering from Campylobacter infection should be counseled regarding symptoms of Guillain-Barré syndrome. Children recovering from E. coli O157:H7 infection require long-term monitoring of renal function. Pregnant women diagnosed with listeriosis need specialized obstetric and neonatal care.
For consumers, understanding that foodborne illness can have consequences beyond transient discomfort should motivate adherence to established food safety practices. The FDA recommends that individuals at increased risk avoid specific high-risk foods including raw or undercooked meat, poultry, eggs, and seafood; unpasteurized dairy products and juices; raw sprouts; and deli meats and hot dogs unless reheated to steaming hot. These precautions, while potentially inconvenient, reflect the reality that for vulnerable populations, a single meal can have life-altering consequences.
For families who have experienced foodborne illness, whether mild or severe, the experience often transforms their relationship with food. Hypervigilance about food preparation, anxiety about eating outside the home, and persistent awareness of risk may persist for years. Support groups and mental health resources can assist individuals and families in processing these experiences and developing balanced approaches to food consumption that acknowledge risk without permitting fear to dominate daily life.
The ultimate goal of food safety policy is not merely reducing economic costs or achieving regulatory compliance, but preventing the specific, identifiable human tragedies that occur when food meant to nourish instead harms. Each of the 3,000 annual deaths from foodborne illness in the United States represents a family forever changed, a chair that remains empty at the table, a potential unrealized. The science of chronic sequelae and the economics of burden estimation provide essential tools for prioritizing interventions, but the moral imperative for food safety derives from these human stakes.
