The application of the Appropriate Level of Protection (ALOP) and Food Safety Objective (FSO) concepts in food safety management, using Listeria monocytogenes in deli meats as a case study

To establish a link between governmental food safety control and operational food safety management, the concepts of the Appropriate Level of Protection (ALOP) and the Food Safety Objective (FSO) have been suggested by international bodies as a means of making food safety control transparent and quantifiable. The purpose of this study was to investigate how the concepts of ALOP and FSO could be applied in practice. As a case study, the risk of severe listeriosis due to consumption of deli meat products in the Netherlands was taken. The link between these concepts was explored for two situations following a “top-down” approach, using epidemiological country data as a starting point, and a “bottom-up” approach, using data on the prevalence and concentration of the pathogen at retail as a starting point. Models based on both approaches were able to describe the link between ALOP and FSO and our results showed that meaningful estimations are feasible, although interpretations need to be made with care. For the top-down approach, the mean estimated value derived for ALOP was 3.2 cases per million inhabitants per year (95% CrI: 1.1-6.6). For the bottom-up approach, ALOP values ranged considerably, 4.7-55 (with 95% CrI ranging from 2.9-162), depending on the input parameters selected. The level of detail considered in the stochastic models considerably influenced the ALOP and FSO estimates. As best practice it is recommended to develop both approaches, although depending on the application context one may appear more appropriate than the other

Measuring underreporting and under-ascertainment in infectious disease datasets: a comparison of methods

Gibbons CL, Mangen M-JJ, Plaß D, et al. Measuring underreporting and under-ascertainment in infectious disease datasets: a comparison of methods. BMC Public Health. 2014;14(1): 147.Background: Efficient and reliable surveillance and notification systems are vital for monitoring public health and disease outbreaks. However, most surveillance and notification systems are affected by a degree of underestimation (UE) and therefore uncertainty surrounds the 'true' incidence of disease affecting morbidity and mortality rates. Surveillance systems fail to capture cases at two distinct levels of the surveillance pyramid: from the community since not all cases seek healthcare (under-ascertainment), and at the healthcare-level, representing a failure to adequately report symptomatic cases that have sought medical advice (underreporting). There are several methods to estimate the extent of under-ascertainment and underreporting. Methods: Within the context of the ECDC-funded Burden of Communicable Diseases in Europe (BCoDE)-project, an extensive literature review was conducted to identify studies that estimate ascertainment or reporting rates for salmonellosis and campylobacteriosis in European Union Member States (MS) plus European Free Trade Area (EFTA) countries Iceland, Norway and Switzerland and four other OECD countries (USA, Canada, Australia and Japan). Multiplication factors (MFs), a measure of the magnitude of underestimation, were taken directly from the literature or derived (where the proportion of underestimated, under-ascertained, or underreported cases was known) and compared for the two pathogens. Results: MFs varied between and within diseases and countries, representing a need to carefully select the most appropriate MFs and methods for calculating them. The most appropriate MFs are often disease-,country-, age-, and sex-specific. Conclusions: When routine data are used to make decisions on resource allocation or to estimate epidemiological parameters in populations, it becomes important to understand when, where and to what extent these data represent the true picture of disease, and in some instances (such as priority setting) it is necessary to adjust for underestimation. MFs can be used to adjust notification and surveillance data to provide more realistic estimates of incidence

The Antimicrobial Activity of the Essential Oil of Pistacia lentiscus var. Chia

The essential oil of the resin of Pistacia lentiscus var. Chia (mastic oil) was studied in vitro against a wide range of foodborne pathogenic and spoilage microorganisms with a diffusion and a dilution method. Furthermore its chemical composition was analyzed by means of Gas Chromatography-Mass Spectrometry (GC-MS) and the possibility of using the essential oil in food preservation was discussed. The Minimal Inhibitory Concentrations (MICs) of mastic oil were estimated for 6 species of bacteria (Bacillus cereus, Campylobacter jejuni, Clostridium perfringens, Escherichia coli, Salmonella Typhimurium, Staphylococcus aureus), 2 species of yeasts (Saccharomyces cerevisiae and Zygosaccharomyces bailii) and 3 species of fungi (Penicillium roquefortii, Aspergillus flavus and Eurotium amstelodami). GC-MS analysis revealed a chemotype dominated by monoterpenes, principally alpha-pinene and beta-myrcene comprising more than 90 % of the mastic oil. Both methods showed Cl. perfringens as the most susceptible microorganism followed by S. cerevisiae and Z. bailii. With the exception of C. jejuni, Gram-positive were found to be more susceptible to the essential oil than Gram-negative microorganisms and all fungi appeared very resistant to mastic oil. Based on the observed MICs, the contribution of mastic oil to the preservation of bakery/confectionary products at the amounts currently used for flavoring purposes is likely to be negligible

Risk assessment of Clostridium perfringens in Cornish pasties in the UK

To assess the risk of C. perfringens toxico-infections related to the consumption of Cornish pasties in the United Kingdom, a stochastic risk assessment model was created. Exposure to the pathogen was modelled as the result of contamination of different ingredients (i.e. beef and pepper), application of different cooling scenarios at room temperature and considering pasties of a number of common sizes. The model predicted a mean of 213 cases of gastroenteritis per million people in the UK per year (95% CI: 128–317), which might explain a significant proportion of annual C. perfringens toxico-infections according to epidemiological data. Major factors influencing this estimate and possible targets for interventions were the time to consumption and the concentration of the pathogen in contaminated ingredients, the impact of which in reducing the risk was tested in different intervention scenarios. The results of the model together with a number of possible risk mitigation measures are used as a basis to discuss the potential of setting of risk-based metrics as a risk management option in the context of food safety decision-making.</p

The application of the Appropriate Level of Protection (ALOP) and Food Safety Objective (FSO) concepts in food safety management, using Listeria monocytogenes in deli meats as a case study

To establish a link between governmental food safety control and operational food safety management, the concepts of the Appropriate Level of Protection (ALOP) and the Food Safety Objective (FSO) have been suggested by international governmental bodies as a means for competent authorities to make food safety control transparent and quantifiable. The purpose of this study was to investigate how the concepts of ALOP and FSO could be practically linked using currently available data. As a case study, the risk of severe listeriosis due to consumption of deli meat products in the Netherlands was taken. The link between the concepts was explored following a “top-down” approach, using epidemiological country data as the starting point, and following a “bottom-up” approach, using data on the prevalence and concentration of the pathogen at retail as the starting point. For the top-down approach, the mean estimated value derived for ALOP was 3.2 cases per million inhabitants per year due to deli meats (95% CrI: 1.1–6.6). For the bottom-up approach, mean ALOP values ranged considerably, 12–44 cases per million inhabitants per year due to deli meats (with 95% CrI ranging from 5.2 to 122), depending on the combination of input parameters used in the risk assessment model. The level of detail considered in the stochastic models applied considerably influenced the ALOP and FSO estimates. Models based on both approaches however were able to describe the link between ALOP and FSO and our results showed that meaningful estimations are feasible, although interpretations need to be made with care

Perspective on the risk to infants in the Netherlands associated with Cronobacter spp. occurring in powdered infant formula

Cronobacter spp. has been responsible for severe infections in infants. Relative risks associated with this organism in powdered infant formula (PIF) have been described in several studies. To set priorities and decide on risk management options, it is important for risk managers to have a quantitative perspective on the absolute level of risk of this pathogen within the totality of the burden of illnesses in the population. This study set-out to establish such a perspective for The Netherlands. It addresses the impact of heterogeneity in the distribution of the micro-organism in PIF on risk levels. Based on the assumptions in this study, 60% of formula-fed infants are estimated not to be exposed to Cronobacter spp. during their neonatal period. The mean exposure was calculated to be about 1 cfu per infant over the total neonatal period. Even after thorough mixing, artificially contaminated powder shows counts which are more variable than expected from a normal, homogeneous distribution. Therefore, mean exposure levels may not represent a good basis for calculating risks. The burden of disease of Cronobacter infections to the Dutch population was estimated to be 19–24 Disability Adjusted Life Years (DALYs) per year, of which 95% are due to meningitis. As compared to other illnesses Cronobacter infections represent 0.5–2.4% of the total estimated burden of foodborne infections and intoxications. The organism is estimated to be responsible for 0.5–0.7% of the meningitis burden to the entire population of The Netherland

Risk assessment strategies as a tool in the application of the Appropriate Level of Protection (ALOP) and Food Safety Objective (FSO) by risk managers

In the course of the last decade, the Appropriate Level of Protection (ALOP), the Food Safety Objective (FSO) and their associated metrics have been proposed by the World Trade Organization and Codex Alimentarius as a means for competent authorities to ultimately translate governmental public health policy regarding food safety into risk-based targets for the food industry. The industry needs to meet these targets through the effective choice of control measures that are part of its operational food safety management system. The aim of this study was to put the practical application of ALOP and FSO to the test in the case of Salmonella in chicken meat in the Netherlands. Two different risk assessment approaches were applied to derive potential ALOP and FSO values, a ‘top-down’ approach based on epidemiological data and a ‘bottom-up’ approach based on food supply chain data. To this end, two stochastic models specific to the Dutch situation were built. Comparisons between 23 countries in Europe were also made using the top-down model. The mean estimated current Level Of Protection values were similar for the two approaches applied, with the bottom-up model yielding 87 cases per 100,000 inhabitants per year (95% CI: 0.03, 904) and the top-down model 71 (95% CI: 9.9, 155). The estimated FSO values on the other hand were considerably different with the mean ‘top down’ FSO being - 4.6 log CFU/g (95% CI: - 5.4, - 4.1) and the mean ‘bottom-up’ FSO - 6.0 log CFU/g (95% CI: - 8.1, - 2.9) reflecting major differences in the output distributions of this parameter obtained with the two approaches. Significant differences were observed between current LOP values for different EU countries, although it was not clear whether this was due to actual differences in the factors influencing the risk of salmonellosis or due to the quality of the available data. Keywords Risk assessment; Stochastic modelling; Salmonellosis; Foodborne disease; Public health target