Foodborne disease cases reporting watermelon consumption before illness onset in Hubei Province, China, 2013–2023: a descriptive analysis
Year: 2026
Type: article
Abstract: Introduction To address foodborne disease outbreaks in China, the national surveillance system has been implemented to enhance attribution analysis. Using this system as the data source, we conducted a descriptive surveillance analysis of the temporal, demographic, exposure, and spatial patterns of watermelon-associated foodborne disease in Hubei Province. In this study, “watermelon-associated” is used as shorthand for cases in which watermelon consumption was reported before illness onset; it does not imply microbiological or epidemiological confirmation of watermelon as the transmission vehicle. Background Hubei Province is located in central China, along the middle reaches of the Yangtze River. As a widely cultivated and consumed fruit in China, watermelon has been associated with documented foodborne disease cases. This study aimed to describe the temporal, demographic, exposure, and spatial patterns of watermelon-associated foodborne disease in Hubei Province, China, from 2013 to 2023, and to identify areas and populations with high reported case counts for risk communication and targeted interventions. Methods We conducted a retrospective descriptive surveillance study using data from the Hubei Provincial Center for Disease Control and Prevention (HBCDC) foodborne disease surveillance system for the period 2013–2023. Cases were defined as patients with diarrhea clinically suspected to be foodborne who reported watermelon consumption before illness onset. Exposure was classified into five mutually exclusive and exhaustive categories: exclusive watermelon, cold watermelon, overnight cold watermelon, watermelon products, and mixed foods. Descriptive statistics, visualization, and spatial autocorrelation analyses (global and local Moran's I) were performed using R (version 4.4.2; R Foundation for Statistical Computing, Vienna, Austria), GeoDa (version 1.20; Center for Spatial Data Science, University of Chicago, Chicago, IL, USA), and ArcMap 10.8 (Esri, Redlands, CA, USA). Results During the study period, the HBCDC recorded 227,099 foodborne disease cases, of which 20,034 (8.82%) were associated with reported consumption of fruits and fruit products. Among these, 9,662 cases reported watermelon consumption, accounting for 48.22% of the cases reporting fruits and fruit products. The number of reported cases increased from 33 (0.3%) in 2013 to 2,641 (27.3%) in 2023. Cases were reported across all 17 prefecture-level cities, ranging from 30 (Shennongjia) to 1,318 (Shiyan). Shiyan (1,318, 13.64%) and Wuhan (1,267, 13.11%) had the highest counts. The age distribution showed peaks in children aged < 6 years and adults aged >40 years, together accounting for 66.8% of cases; the 41–60-year group accounted for the largest proportion of reported cases (26.1%). Male and female counts were comparable. Farmers constituted 40.3% of cases, 2.6 times the proportion of the second-ranked group. Digestive symptoms predominated (99.35%), with diarrhea (94.52%) and abdominal pain (53.08%) being the most frequently reported symptoms. The exposure categories were distributed as follows: exclusive watermelon, 32.55%; cold watermelon, 47.51%; overnight cold watermelon, 7.45%; watermelon products, 1.79%; and mixed foods, 10.70%. Among the 1,676 sampled cases, 47 (2.80%) had a bacterial or viral pathogen explicitly identified in the diagnosis field; norovirus ( n = 22) was the most common, followed by non-typhoidal Salmonella ( n = 7), Escherichia coli ( n = 6), rotavirus ( n = 4), and other named pathogens ( n = 8). Spatial analysis revealed significant global clustering (Moran's I = 0.186, p < 0.001) and local clusters, with high-count clusters concentrated in southeastern Hubei. Conclusion The number of reported watermelon-associated foodborne disease cases in Hubei Province increased over the study period, likely reflecting enhanced surveillance rather than a direct increase in population incidence. These findings highlight the need for targeted interventions at critical control points in watermelon production and cold chain logistics, as well as strengthened risk communication among growers, distributors, and regulatory authorities.
Source: Frontiers in Public Health
Language: English
Subfield: Food Science
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7225733770