public health-based risk ranking of (microbial) hazards in the food … · 2019. 12. 19. · rivm...

Public health-based risk Public health based risk ranking of (microbial) hazards in the food chain

Arie Havelaar

S @ 0EFSA@10

Parma, 7 November 2012,

1

Risk rankingg● Why?

– Limited resources24/7 news cycle ↔ science based decision making– 24/7 news cycle ↔ science based decision making

● Consequences– Helps define focus for risk management– Does not directly determine actions

› Options, costs, stakeholder views● Limitations

– Different definitions of risk● Multi-dimensional problem● Technical information ánd value judgements● Technical information ánd value judgements

– Interaction between researchers and policy makers c.q. general population

2

Definitions of risk● Public health metrics

V l● Values– Voluntary– Equityq y– Dread– Control

Uncertainty– Uncertainty– Immediacy– Novelty

3

Value-based risk rankingg

4Slovic, Science 1987;236:280Slovic, Science 1987;236:280--285285

EFSA BIOHAZ Risk Ranking Frameworkg

5BIOHAZ Panel, EFSA Journal 2012;10(6):2724BIOHAZ Panel, EFSA Journal 2012;10(6):2724

What to be ranked?● Single hazard in multiple foods

– IncidenceM lti l h d i i l f d● Multiple hazards in single food– Severity

● Multiple hazards in multiple foodsp p– Incidence and severity

6

Risk metrics● Public health

– IllnessG l l ti lti ti t h it li ti› General population, consulting patients, hospitalisations

– Deaths› Catastrophic (identifiable) vs. chronic (statistical)p ( ) ( )

– Years of life lost– Summary metrics of public health (DALY, QALY)

● Economic● Economic– Cost of illness– Willingness to pay (accept)

› Revealed or stated preferences

● Incorporation of value judgements inevitable!

7

● Incorporation of value judgements inevitable!

Risk ranking approachesg pp


Modelling approachesg pp● Opinion based● Qualitative

● One time or continuous?● Resources, data, timelines

– Decision tree – MatrixSemi quantitative

● Simplicity vs. Precision● Reproducibility

Resolution● Semi-quantitative– Multi Criteria Decision

Analysis

● Resolution● Transparancy● Separate science and values

● Quantitative– Comparative risk

assessment

Separate science and values● Information management● End user(s)

assessment– Disease burden– Attribution

9

tt but o

Decision tree for ranking hazards in poultryg p y


Qualitative risk rankingQ g

How to define these terms?

● Rules of probability should be respected in qualitative matrices

● Some quantification of probabilities ● Some quantification of probabilities underlying risk qualifiers is necessary

● Marginal qualifiers should be different from those for the joint probabilities

Is Minor x

Very Unlikely really

equal to Low??

11 http://herdingcats.typepad.com/my_weblog/2010/07/riskhttp://herdingcats.typepad.com/my_weblog/2010/07/risk--matrix.htmlmatrix.html

equal to Low??

Risk matrix proposed by ANSESp p y

12 ANSES: A qualitative risk assessment method in animal health, November 2008ANSES: A qualitative risk assessment method in animal health, November 2008

Semi-quantitative risk ranking - Discontoolsq g

13www.discontools.euwww.discontools.eu

Criteria for ranking of emerging zoonosesg g g

1. Introduction 4. Animal-humantransmission2. Transmissionbetween animals

5. Transmissionbetweenhumans

3. Economicdamage in

animalreservoir

8. Mortality7. Morbidity

Public health impact

14Havelaar et al., PLoS One Havelaar et al., PLoS One 2010:e139652010:e13965

Ranking of emerging zoonoses in NLg g g

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Havelaar et al., PLoS One Havelaar et al., PLoS One 2010:e139652010:e13965

Risk ranking: comparative risk assessmentg p

150

200

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s)

100

tive

risk

(%, h

uman

c

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50

Campy-chicken

Campy-steaktartare

Campy-eggs Salmonella-chicken

Salmonella-steak tartare

Salmonella-eggs

Rel

at

sQMRA tool

16 Evers et al. Food Control 2010;21:319-330www.foodrisk.org

iRISK: an interactive, web-based system for risk ranking, y g

17http://foodrisk.org/exclusives/fdae28099shttp://foodrisk.org/exclusives/fdae28099s--iriskirisk--aa--comparativecomparative--riskrisk--assessmentassessment--tool/tool/

Burden of disease● Outcome tree

● DALY = YLL + YLD

∑ ×=l

ll edYLL

∑ ××=l

lll wtnYLDl

18

Disease burden of enteric pathogens in NL (all sources)

4 500

5,000

5,500

6,000 T. gondii has the highest burden

3,000

3,500

4,000

4,500

en (DALY

s pe

r ye

ar) Burden of

Campylobacter similar

1,500

2,000

2,500

,

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se b

urd

e

Low burden for protozoa,

STEC O157 and

0

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ndii

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rus

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oxin

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s tox

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19Havelaar et al., Int J Food Microbiol 2012; 156:231Havelaar et al., Int J Food Microbiol 2012; 156:231--238238

Disease burden per caseDiseases affecting unborn or young

100,000

pchildren have the highest burden

Systemic

10,000

case

s)

Systemic infections also

have a high burden

100

1,000

den (DALY

s pe

r 10

00 c

Lowest burden

10

100

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ease

bur

d Lowest burden for protozoa

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7

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.

20

L. m

L. m C C Cry

Havelaar et al., Int J Food Microbiol 2012; 156:231Havelaar et al., Int J Food Microbiol 2012; 156:231--238238

Ranking of pathogens by population and individual burdeng p g y p p


Attribution of disease burden to major pathwaysj p y

Travel9%

Animal8%

9%

Food45%

Human17%

Environment21%


Attribution of disease burden to food groupsg p

Beef/mutton

Human/animal9%

16%

Beverages

Cereal products3%

Other food7%

Pork23%

Fruit/vegetables6%

Beverages2%

Dairy7%

Fish/shellfish6%

Poultry17%

Eggs4%

7%


How to interpret results?p

Our food is safer than everOur food is safer than everThe health loss due to unhealthy

diet is many times greater than that attributable to unsafe food

● Unfavourable dietary composition: 245,000 DALYs

● Overweight: 215,000 DALYs● Microbiological infection by known

pathogens: 1,000-4,000 DALYs● Chemical constituents: 1,500-2,000

DALYs

⇒ No need for further action?

24Van Kreijl et al., 2006. RIVM report number 270555009Van Kreijl et al., 2006. RIVM report number 270555009

Conclusions● Comparing risks is not impossible or immoral, but it is very difficult;

more so than either supporters or detractors of the practice seem to realize - Adam Finkel

● Risk ranking should take a structured approach● Risk ranking approaches should be fit for purpose

– Selection of risk metricsSelection of risk metrics– Selection of risk ranking model– Resources and time vs. transparency and repeatability

● Whenever possible quantitative risk ranking approaches are ● Whenever possible quantitative risk ranking approaches are preferable

● Good risk ranking models are simplified risk assessment models● Interaction between risk managers and risk assessors is a critical ● Interaction between risk managers and risk assessors is a critical

success factor● Risk ranking is only the beginning of a decision making process

25

Thanks to …● EFSA BIOHAZ Panels, secretariat and WG on risk ranking, chair

Kostas Kotsoumanis● Floor van Rosse Marieta Braks Joke van der Giessen● Floor van Rosse, Marieta Braks, Joke van der Giessen● Eric Evers, Jurgen Chardon● Juanita Haagsma, Marie-Josée Mangen, Wilfrid van Pelt, Ingrid

Friesema, Yvonne van Duynhoven● Roger Cooke

26

public health-based risk ranking of (microbial) hazards in the food … · 2019. 12. 19. · rivm...

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