Norway – Research – Risk ranking and source attribution of food- and waterborne pathogens for surveillance purposes – Toxoplasma the top risk!



Providing risk managers with the information that they need for decision making is an important element in food-safety management. The present risk assessment was undertaken to establish a scientific basis that could be used to assist the Norwegian Food Safety Authority (NFSA) in implementing risk-based surveillance, monitoring, and control programmes for pathogens in food and water. The assessment approach used here consisted of two steps:(1) risk ranking of 20 selected pathogens based on the incidence and severity of their associated diseases following infection with the pathogens via food or water, and(2) a source attribution process aimed at identifying the main pathogen-food combinations that may pose a risk to human health for each of the ranked pathogens. We used an expert knowledge elicitation (EKE) procedure with a panel of nine experts, including all eight members of the Panel on Biological Hazards of the Norwegian Scientific Committee for Food and Environment (NSCFE) and one invited expert on food/water-borne viral infections.
Risk Ranking
The 20 pathogens selected for risk ranking were defined in the terms of reference (ToR) received from NFSA. We performed a multicriteria-based ranking of the pathogens in terms of their public health impact from food/water-borne transmission in Norway. The risk ranking utilized six criteria that estimated the incidence of food- and waterborne illness attributable to each pathogen, the severity of acute and chronic illness, the fraction of chronic illness, fatality rate, and the probability for future increased disease burden. For each pathogen, all criteria were scored by the expert panel members, and individual criterion scores were combined into an overall score for every pathogen. To achieve this, each criterion was weighted in terms of its relative importance, as judged by the expert panel. The overall scores so calculated were the basis for the ranking.
Source attribution
For each of the ranked pathogens, the subsequent source-attribution process aimed to identify the main food vehicles, reservoirs, and sources of infection for outbreak-related and sporadic cases of illness, the relative importance of food sources, and preventable risk factors in Norway. To achieve this, both microbiological and epidemiological data were scrutinized. These encompassed results from national surveillance and monitoring programmes, prevalence surveys, outbreak investigations, and research, including analytic epidemiological studies. When Norwegian data were sparse or absent, international reports and research were used.
The six highest-ranked pathogens were, in descending order: Toxoplasma gondii, Campylobacter spp., Echinococcus multilocularis, enterohaemorrhagic E. coli (EHEC), Listeria monocytogenes, and non-typhoid Salmonella. It should be emphasized, however, that confidence intervals revealed considerable overlaps between the scores. The food vehicles associated with the pathogens varied widely. It is notable, however, that fresh produce was identified as being among the main food vehicles for 12 of the 20 pathogens, drinking water was associated with 8, and 5 were linked to raw milk or products thereof

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