Abstract
We developed a quantitative microbiological risk assessment (QMRA) of haemolytic uremic syndrome (HUS) associated with Shiga toxin-producing Escherichia coli (STEC)-contaminated beef (intact beef cuts, ground beef and commercial hamburgers) in children under 15 years of age from Argentina. The QMRA was used to characterize STEC prevalence and concentration levels in each product through the Argentinean beef supply chain, including cattle primary production, cattle transport, processing and storage in the abattoir, retail and home preparation, and consumption. Median HUS probability from beef cut, ground beef and commercial hamburger consumption was <10−15, 5.4x10-8 and 3.5x10-8, respectively. The expected average annual number of HUS cases was 0, 28 and 4, respectively. Risk of infection and HUS probability were sensitive to the type of abattoir, the application or not of Hazard Analysis and Critical Control Points (HACCP) for STEC (HACCP-STEC), stx prevalence in carcasses and trimmings, storage conditions from the abattoir to retailers and home, the joint consumption of salads and beef products, and cooking preference. The QMRA results showed that the probability of HUS was higher if beef cuts (1.7x) and ground beef (1.2x) were from carcasses provided by abattoirs not applying HACCP-STEC. Thus, the use of a single sanitary standard that included the application of HACCP-STEC in all Argentinean abattoirs would greatly reduce HUS incidence. The average number of annual HUS cases estimated by the QMRA (n = 32) would explain about 10.0% of cases in children under 15 years per year in Argentina. Since other routes of contamination can be involved, including those not related to food, further research on the beef production chain, other food chains, person-to-person transmission and outbreak studies should be conducted to reduce the impact of HUS on the child population of Argentina.
Highlights
Shiga toxin-producing Escherichia coli (STEC) are foodborne pathogens associated with a wide spectrum of human diseases, from mild diarrhea to hemorrhagic colitis, thrombocytopenia and haemolytic uremic syndrome (HUS), which can lead to death [1]
Between 2011 and 2015, 1,953 HUS cases were reported in Argentina, 70.7% of which corresponded to E. coli O157:H7 [5]
A risk assessment of HUS from hamburger consumption had already been carried out in Argentina [37], the relevance of the current quantitative microbiological risk assessment (QMRA) is concerned with the inclusion of new information that responds to the uncertainties identified in the previous risk assessment [37], such as a) risk factors associated with the presence of STEC in primary production, b) effect of the transport of live animals, c) identification of abattoirs with different risk levels, d) evaluation of the effect of cross-contamination in butcher shops, e) application of a survey to assess beef consumption habits at home at national level, not just regional, and f) consideration of other meat matrices
Summary
Shiga toxin-producing Escherichia coli (STEC) are foodborne pathogens associated with a wide spectrum of human diseases, from mild diarrhea to hemorrhagic colitis, thrombocytopenia and haemolytic uremic syndrome (HUS), which can lead to death [1]. Information about HUS cases around the world is scarce, primary studies and notifiable disease data from different World Health Organization (WHO) regions, and population estimates on exposure, age distribution and clinical course of illness [2]. In Argentina, STEC are the primary etiological agent of post-enteric HUS, and serotype O157:H7 is most frequently associated with HUS confirmed cases [4]. Between 2011 and 2015, 1,953 HUS cases were reported in Argentina, 70.7% of which corresponded to E. coli O157:H7 [5]. The last available report confirmed 290 HUS cases in 2019 [7]
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