# Evolution of foodborne disease surveillance in China: A 32-year journey from monitoring to early warning

## TL;DR

China's foodborne disease surveillance system has evolved over 32 years, shifting from passive to proactive monitoring and improving detection and prevention.

## Contribution

The paper provides a 32-year analysis of China's foodborne disease surveillance evolution and highlights the need for a 'One Health' approach.

## Key findings

- China's surveillance system transitioned from passive to active monitoring and integrated international standards.
- Vibrio parahaemolyticus has been the leading cause of foodborne disease outbreaks in China for 32 years.
- The number of outbreaks has increased, but case fatality rates have decreased due to improved detection technologies.

## Abstract

China's foodborne disease (FBD) surveillance system was implemented later than those in most developed countries. However, in the past 32 years, it has undergone improvements: from pilot projects to full coverage; from a passive mode to an active one; from localized development to the integration of international standards; and from a single function to a comprehensive system.

During this process, China's health administrative departments have adjusted their regulatory departments and functions for FBDs in response to evolving epidemiological patterns of FBD. Simultaneously, they have used a phased, step-by-step approach to promote the use of whole genome sequencing (WGS) technology, according to the level of regional economic development, to facilitate FBD traceability. However, the system must be further improved in terms of traceability capabilities, multi-departmental collaboration, and data sharing mechanisms. At various historical stages, FBD outbreaks in China have shown distinct regional characteristics, and the spectrum of common pathogenic bacteria in China differs from those in the Europe Union (EU) and the United States. In China, diseases caused by microorganisms such as Vibrio parahaemolyticus, Salmonella, Staphylococcus aureus, Bacillus cereus, and Echerichia coli are dominant. Since 2011, the number of FBD outbreaks has increased each year, and has been accompanied by a decline in the case fatality rate, thus reflecting improvements in foodborne detection technology in China. In the future, further integration of advanced technologies such as WGS will be necessary to enhance surveillance sensitivity, strengthen active and targeted surveillance of key populations, and establish a risk warning model tailored to China's dietary characteristics, thereby increasing the effectiveness of FBD prevention and control.

•A thirty-two-year, decadal-level perspective on China's evolving foodborne disease epidemiology.•China's foodborne disease surveillance system has undergone a paradigm shift from crisis-driven, passive legislation to proactive, source-tracing monitoring.•Over the past 32 years, Vibrio parahaemolyticus has consistently been the leading bacterial cause of foodborne disease outbreaks in China.•China needs a "One Health" approach to track foodborne risks from farm to fork and in environmental-animal-human reservoirs.

A thirty-two-year, decadal-level perspective on China's evolving foodborne disease epidemiology.

China's foodborne disease surveillance system has undergone a paradigm shift from crisis-driven, passive legislation to proactive, source-tracing monitoring.

Over the past 32 years, Vibrio parahaemolyticus has consistently been the leading bacterial cause of foodborne disease outbreaks in China.

China needs a "One Health" approach to track foodborne risks from farm to fork and in environmental-animal-human reservoirs.