Executive summary
Dissemination of food safety advice to consumers in Scotland is a key priority for Food Standards Scotland to reduce the risk of foodborne illness. Although food safety advice is relevant for all consumers, the level of risk from foodborne illness is not equal across consumer groups.
Some groups within society are more susceptible to foodborne illness. These groups are known as the “clinically vulnerable groups” to foodborne illness. This research focused on individuals whose physiological conditions predisposes them to foodborne infections, these are traditionally recognised as the YOPI (Young, Old, Pregnant, and Immunosuppressed) categories. Food Standards Scotland commissioned this research to undertake a comprehensive review of the current definition of “clinically vulnerable groups” and make recommendations for the updated definition of clinically vulnerable groups in relation to foodborne illness.
The research aimed to:
- Undertake a narrative review to obtain an in-depth understanding of the physiological background to susceptibility among clinically vulnerable groups.
- Consolidate Scottish prevalence data to determine who are the clinically vulnerable groups in Scotland, with regards to Campylobacter, Salmonella, Shiga toxin-producing Escherichia coli (STEC), Listeria monocytogenes and norovirus.
- Collate additional evidence from comparable developed countries to undertake a systematic review of foodborne illness prevalence among clinically vulnerable groups.
- Identify the current definitions of clinically vulnerable groups used by other food safety organisations to establish the groups most referred to as being clinically vulnerable.
- Present research findings in an expert panel consultation to help inform recommendations regarding the clinically vulnerable group definition.
- Explore suitable food safety messaging for clinically vulnerable groups with people in Scotland.
By integrating physiological explanations with prevalence data, the study has successfully provided a comprehensive understanding of foodborne illness susceptibility among clinically vulnerable groups. Among older adults and children, susceptibility is heightened due to immune system factors, while chronic conditions and associated medications further increase vulnerability. Prevalence of foodborne illnesses varies among different groups and regions, with Scotland showing higher rates of foodborne illness among older adults compared to similar countries.
The study identified clinically vulnerable groups beyond the traditionally recognised YOPI (Young, Old, Pregnant, and Immunosuppressed) categories, such as proton pump inhibitor users, people with cancer, diabetes, rheumatoid arthritis, and inflammatory bowel disease. However, existing definitions of clinically vulnerable groups used by food safety organisations often overlook these groups, emphasizing the need for broader recognition and surveillance efforts.
The expert panel consultation discussions considered categorisation of older adults, the need for enhanced surveillance for clinically vulnerable groups, the importance of targeted communication and the role of health care professionals and food safety organisations in dissemination, and the need to explore socio-demographic and behavioural factors.
Prevalence data associated with specific behaviours, socio-economic and lifestyle factors were beyond the scope of this report and are considered as part of the SEFARI Fellowship project with Food Standards Scotland which specifically explores the lifestyle factors of older adults associated with foodborne illness (SEFARI, 2023).
During the discussions with people over the age of 65 years, pregnant individuals and people undergoing cancer treatment were identified as being clinically vulnerable to foodborne illness. Participants were generally unaware that they may be at an increased risk of foodborne illness due to age or underlying conditions, nevertheless, many were able to comprehend immune system modifications when given a rationale. Discussions indicated the need to enable people to self-identify if they are at increased risk of foodborne illness. Some found it easier to accept vulnerability resulting from a medical conditions or medications, rather than age alone, as denial about ageing was also discussed. Recommendations and preferences for future food safety education communication were made.
The recommendations for future research arising from this report relate to:
- Exploring consumer perceptions and preferences for effective food safety messaging.
- Undertaking consumer food safety research with overlooked groups such as proton pump inhibitor users and people with diabetes, rheumatoid arthritis, and inflammatory bowel disease.
- Obtaining an in-depth understanding of the lifestyle factors among older adults that may contribute to food safety perceptions and practices.
- Investigate the role and associated perceptions of healthcare professionals and care providers with regards to food safety communication.
Lay summary
Food Standards Scotland provides food safety advice to the public to reduce the risk of food poisoning in Scotland. However, there are some groups of people that are more likely of becoming ill with food poisoning, and these groups need targeted advice and information. Therefore, to better understand which groups are most affected by food poisoning, Food Standards Scotland commissioned this study.
The study confirmed that groups normally associated with food poisoning such as children, pregnant individuals, older adults, and people with suppressed immune systems were affected by food poisoning, however the rates of food poisoning among older adults were higher in Scotland than in other countries. It also highlighted that there are groups who are often overlooked such as people who use proton pump inhibitors, people with cancer, diabetes, rheumatoid arthritis, and inflammatory bowel disease.
Specific recommendations include improving surveillance, targeted communication, and understanding consumer perceptions. Future research needs to explore lifestyle factors among older adults, the food safety perceptions and practices of the overlooked groups, and the role of healthcare professionals in food safety communication.