Title: Campylobacter source attribution by exposure assessment

Authors: E.G. Evers, H.J. Van Der Fels-Klerx, M.J. Nauta, J.F. Schijven, A.H. Havelaar

Addresses: Microbiological Laboratory for Health Protection, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands. ' Microbiological Laboratory for Health Protection, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands. ' Microbiological Laboratory for Health Protection, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands. ' Microbiological Laboratory for Health Protection, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands. ' Microbiological Laboratory for Health Protection, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands

Abstract: A new application of exposure assessment aimed at improving insight into source attribution of human infectious diseases, i.e. estimation of the relative contribution of sources and transmission routes, is developed and explored. Human exposure, calculated as the mean number of Campylobacters ingested per person per day, is used as an indication of the relative importance of Campylobacter transmission routes in the Netherlands. Thirty-one routes were investigated, related to ingestion of food, direct contact with animals and water. Preliminary results suggest that raw food consumption and direct contact are significant transmission routes, but huge data gaps exist and no solid conclusions can be drawn. More data will have to be obtained to reduce uncertainty and thereby make this tool applicable for source attribution. Methodological improvements are necessary to take the step to numbers of cases as model output and thereby to risk assessment.

Keywords: Campylobacters; direct contact; exposure assessment; raw food consumption; risk assessment; risk ranking; source attribution; transmission routes; water; infectious diseases; The Netherlands.

DOI: 10.1504/IJRAM.2008.016151

International Journal of Risk Assessment and Management, 2008 Vol.8 No.1/2, pp.174 - 190

Published online: 07 Dec 2007 *

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