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. 2021 Jan;27(1):182-195.
doi: 10.3201/eid2701.200316.

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

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

Elizabeth Beshearse et al. Emerg Infect Dis. 2021 Jan.

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.

Keywords: United States; bacteria; bacterial diseases; foodborne diseases; parasites; parasitic diseases; pathway attribution; structured expert judgment; viral diseases; viruses; waterborne diseases.

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Figures

Figure 1
Figure 1
Expert selection process for study of attribution of illnesses transmitted by food and water to comprehensive transmission pathways using structured expert judgment, United States, 2017.
Figure 2
Figure 2
Source attribution results for major transmission pathways of bacteria in study of attribution of illnesses transmitted by food and water to comprehensive transmission pathways using structured expert judgment, United States, 2017.
Figure 3
Figure 3
Source attribution results for major transmission pathways of protozoa and viruses for study of attribution of illnesses transmitted by food and water to comprehensive transmission pathways using structured expert judgment, United States, 2017.
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