Attribution of Illnesses Transmitted by Food and Water to Comprehensive Transmission Pathways Using Structured Expert Judgment, United States.

Elizabeth Beshearse,Aron J Hall,Tine Hald,Patricia M Griffin,Arie H Havelaar,Katharine M Benedict,Michael J Beach,Beau B Bruce,Willy Aspinall,Sarah A Collier,Gabriela F Nane,Kathleen E Fullerton,Stacy M Crim,Roger M Cooke

doi:10.3201/eid2701.200316

Abstract

Illnesses transmitted by food and water cause a major disease burden in the United States despite advancements in food safety, water treatment, and sanitation. We report estimates from a structured expert judgment study using 48 experts who applied Cooke’s classical model of the proportion of disease attributable to 5 major transmission pathways (foodborne, waterborne, person-to-person, animal contact, and environmental) and 6 subpathways (food handler–related, under foodborne; recreational, drinking, and nonrecreational/nondrinking, under waterborne; and presumed person-to-person-associated and presumed animal contact-associated, under environmental). Estimates for 33 pathogens were elicited, including bacteria such as Salmonella enterica, Campylobacter spp., Legionella spp., and Pseudomonas spp.; protozoa such as Acanthamoeba spp., Cyclospora cayetanensis, and Naegleria fowleri; and viruses such as norovirus, rotavirus, and hepatitis A virus. The results highlight the importance of multiple pathways in the transmission of the included pathogens and can be used to guide prioritization of public health interventions.

Highlights

Illnesses transmitted by food and water cause a major disease burden in the United States despite advancements in food safety, water treatment, and sanitation
One method to address these barriers is structured expert judgment (SEJ), a method to use and combine estimates produced by experts and quantify uncertainty for the purpose of risk analysis when the ability to gather data is hindered by high expense, data scarcity, or lack of reliable data
The Centers for Disease Control and Prevention (CDC) works to control and prevent illness caused by foodborne and waterborne pathogens in the United States

Summary

Introduction

Illnesses transmitted by food and water cause a major disease burden in the United States despite advancements in food safety, water treatment, and sanitation. One method to address these barriers is structured expert judgment (SEJ), a method to use and combine estimates produced by experts and quantify uncertainty for the purpose of risk analysis when the ability to gather data is hindered by high expense, data scarcity, or lack of reliable data. This method, when executed well, is formal, reproducible, and mathematically and scientifically rigorous [9,10,11]. We implemented an SEJ study using Cooke’s classical model to estimate the proportion of domestically acquired illnesses for 33 pathogens transmitted through food and water that can be attributed to each of 5 major transmission pathways and 6 subpathways [12]

Methods

Results

Conclusion