Emerging Infectious Diseases (Jan 2021)

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

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

DOI
https://doi.org/10.3201/eid2701.200316
Journal volume & issue
Vol. 27, no. 1
pp. 182 – 195

Abstract

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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.

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