Attribution of Illnesses Transmitted by Food and Water to Comprehensive Transmission Pathways Using Structured Expert Judgment, United States
An analysis of 33 pathogens transmitted by food and water highlights the importance of multiple pathways in the transmission of pathogens, and can also guide prioritization of public health interventions.
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.
Authors
Elizabeth Beshearse
University of Florida, Gainesville FL
Beau B. Bruce
Centers for Disease Control and Prevention, Atlanta GA
Gabriela F. Nane
Delft University of Technology, Delft, the Netherlands
Willy Aspinall
Aspinall & Associates, Tisbury UK; University of Bristol, Bristol UK
Tine Hald
Technical University of Denmark, Lyngby, Denmark
Stacy M. Crim
Centers for Disease Control and Prevention, Atlanta GA
Patricia M. Griffin
Centers for Disease Control and Prevention, Atlanta GA
Kathleen E. Fullerton
Centers for Disease Control and Prevention, Atlanta GA
Sarah A. Collier
Centers for Disease Control and Prevention, Atlanta GA
Katharine M. Benedict
Centers for Disease Control and Prevention, Atlanta GA
Michael J. Beach
Centers for Disease Control and Prevention, Atlanta GA
Aron J. Hall
Centers for Disease Control and Prevention, Atlanta GA
Arie H. Havelaar
University of Florida, Gainesville FL
