In order to design effective public health strategies, and, in particular, effective food safety interventions to reduce the burden of foodborne disease, the most important sources of enteric illnesses should be identified. Both case-control and cohort observational studies have for long been powerful approaches among epidemiologists to investigate the association of exposure and illness. In the literature, there are numerous case-control and cohort studies reporting results on risk factors and routes of transmission of sporadic foodborne infections. The objective of this article is to describe, in depth, the strategies implemented for systematic review and meta-analysis of the associations between multiple risk factors and eleven food and waterborne diseases, namely, non-typhoidal salmonellosis, campylobacteriosis, Shiga-toxin E. coli infection, listeriosis, yersiniosis, toxoplasmosis, norovirus infection, hepatitis A, hepatitis E, cryptosporidiosis and giardiasis. First, this article describes the procedures of systematic searches in five bibliographic engines, screening of relevance and assessment of methodological quality according to pre-set criteria. It proceeds with the explanation of a broad data categorisation scheme established to hierarchically group the risk factors into travel, host-specific factors and pathways of exposure (i.e., person-to-person, animal, environment and food routes), with views to harmonising and supporting the integration of outcomes from studies investigating a variety of potential determinants of disease. Next, the article describes the four meta-analysis models that were devised in order to calculate: (i) overall oddsratios of acquiring the disease due to a specific risk factor by geographical region; (ii) overall odds-ratios of acquiring the disease from the different risk factors; (iii) overall risks of disease from consumption of ready-toeat and barbecued foods; and (iv) overall effects of food handling (i.e., consuming food in raw, undercooked or unwashed state) and food preparation setting (i.e., eating food prepared outside the home) on risk of disease. The procedures for sensitivity analysis and removal of any influential and potentially-biased odds-ratio; and two methods for publication bias assessment are outlined. Finally, details are given on deviations from the standard risk categorisation scheme for specific foodborne hazards.

With increased interest in source attribution of foodborne pathogens, there is a need to sort and assess the applicability of currently available methods. Herewith we reviewed the most frequently applied methods for source attribution of foodborne diseases, discussing their main strengths and weaknesses to be considered when choosing the most appropriate methods based on the type, quality, and quantity of data available, the research questions to be addressed, and the (epidemiological and microbiological) characteristics of the pathogens in question. A variety of source attribution approaches have been applied in recent years. These methods can be defined as top–down, bottom–up, or combined. Top–down approaches assign the human cases back to their sources of infection based on epidemiological (e.g., outbreak data analysis, case-control/cohort studies, etc.), microbiological (i.e., microbial subtyping), or combined (e.g., the so-called ‘source-assigned case-control study’ design) methods. Methods based on microbial subtyping are further differentiable according to the modeling framework adopted as frequency-matching (e.g., the Dutch and Danish models) or population genetics (e.g., Asymmetric Island Models and STRUCTURE) models, relying on the modeling of either phenotyping or genotyping data of pathogen strains from human cases and putative sources. Conversely, bottom–up approaches like comparative exposure assessment start from the level of contamination (prevalence and concentration) of a given pathogen in each source, and then go upwards in the transmission chain incorporating factors related to human exposure to these sources and dose-response relationships. Other approaches are intervention studies, including ‘natural experiments,’ and expert elicitations. A number of methodological challenges concerning all these approaches are discussed. In absence of an universally agreed upon ‘gold’ standard, i.e., a single method that satisfies all situations and needs for all pathogens, combining different approaches or applying them in a comparative fashion seems to be a promising way forward.

No abstract

Botulism is a human and animal neurological disease caused by the action of bacterial neurotoxins (botulinum toxins) produced by bacteria from the genus Clostridium. This disease induces flaccid paralysis that can result in respiratory paralysis and heart failure. Due to its serious potential impact on public health, botulism is a closely monitored notifiable disease in France through a case-based passive surveillance system. In humans, this disease is rare, with an average of 10 outbreaks reported each year, mainly due to the consumption of contaminated foods. Type B and to a lesser extend type A are responsible for the majority of cases of foodborne botulism. Each year, an average of 30 outbreaks are recorded on poultry farms, about 20 cases in wild birds and about 10 outbreaks in cattle, involving a large number of animals. Mosaic forms C/D and D/C in birds and cattle, respectively, are the predominant types in animals in France. Types C and D have also been observed to a lesser extent in animals. With the exception of botulinum toxin E, which was exceptionally detected throughout the period in wild birds, the types of botulism found in animal outbreaks are different from those identified in human outbreaks over the last ten years in France and no human botulism outbreaks investigated have been linked to animal botulism. In line with the One Health concept, we present the first integrative approach to the routine surveillance of botulism in humans and animals in France.

Entomophagy has been part of human diets for a long time in a significant part of the world, but insects are considered to be a novel food everywhere else. It would appear to be a strategic alternative in the future of human diet to face the challenge of ensuring food security for a growing world population, using more environmentally sustainable production systems than those required for the rearing of other animals. Tenebrio molitor, called yellow mealworm, is one of the most interesting insect species in view of mass rearing, and can be processed into a powder that ensures a long shelf life for its use in many potential products. When considering insects as food or feed, it is necessary to guarantee their safety. Therefore, manufacturers must implement a Hazard Analysis Critical Control plan (HACCP), to limit risks for consumers’ health. The aim of this case study was to develop a HACCP plan for Tenebrio molitor larvae powders for food in a risk-based approach to support their implementation in industry. Specific purposes were to identify related significant biological hazards and to assess the efficiency of different manufacturing process steps when used as Critical Control Points. Then, combinations of four different processes with four potential uses of powders by consumers in burger, protein shake, baby porridge, and biscuits were analyzed with regard to their safety.