Impact of the COVID-19 pandemic on five food- and waterborne diseases in six European countries, 2016-21.

The COVID-19 pandemic required a shift in healthcare and public health focus and led to numerous public health measures also affecting food- and waterborne diseases (FWDs). We describe the impact of the pandemic using the number of confirmed domestically-acquired and travel-related cases of campylobacteriosis, salmonellosis, hepatitis A, shigellosis, and listeriosis notified to ECDC between 2016 and 2021 by Czechia, Denmark, Greece, the Netherlands, Norway, and Sweden. We compared the monthly median number of cases from the pre-pandemic period to those during the pandemic. We used data on international travel controls from the Oxford COVID-19 Government Response Tracker to assess the impact of travel-related measures on these diseases across the countries. This study emphasizes the substantial differences in transmission routes, surveillance, notification and detection methodologies, as well as testing and sampling practices of these diseases across the different countries. Despite these variations, the overall recorded case numbers for most of the five FWDs decreased during the pandemic (March 2020-December 2021), except for the more severe disease listeriosis, suggesting that health-seeking behaviour and healthcare access played a role in the decline of FWDs with milder symptoms. The proportion of travel-associated cases decreased for most diseases in all countries, particularly for campylobacteriosis and salmonellosis, likely due to the travel restrictions. Declines were also observed in the number of domestically-acquired cases. An improved understanding of healthcare-seeking behaviour and testing rates during the pandemic can provide insights into the extent of under-diagnosis in the reduction of cases.