Integrated Approaches for the Public Health Prioritization of Foodborne and Zoonotic Pathogens

Abstract

To address the persistent problems of foodborne and zoonotic disease, public health officials worldwide face difficult choices about how to best allocate limited resources and target interventions to reduce morbidity and mortality. Data-driven approaches to informing these decisions have been developed in a number of countries. Integrated comparative frameworks generally share three methodological components: estimating incidence of acute illnesses, chronic sequelae, and mortality; attributing pathogen-specific illnesses to foods; and calculating integrated measures of disease burden such as cost of illness, willingness to pay, and health-adjusted life years (HALYs). To discuss the similarities and differences in these approaches, to seek consensus on principles, and to improve international collaboration, the E.U. MED-VET-NET and the U.S.-based Food Safety Research Consortium organized an international conference convened in Berlin, Germany, on July 19-21, 2006. This article draws in part on the deliberations of the conference and discusses general principles, data needs, methodological issues and challenges, and future research needs pertinent to objective data-driven analyses and their potential use for priority setting of foodborne and zoonotic pathogens in public health policy.

Critical review of methodology and application of risk ranking for prioritisation of food and feed related issues, on the basis of the size of anticipated health impact

“…Five references presented methodology central to risk ranking and disease burden estimation Hofstetter, 2002;Mangen et al, 2010;Mangen et al, 2014;Pennington et al, 2002).…”

“…For each hazard included, experts are requested to indicate the most like proportions and an interval describing uncertainties for all foodborne cases (Lake et al, 2010) or proportions related to specific food categories (Batz et al, 2012;Bouwknegt et al, 2013). Food attributable proportions may also be based on analysis of foodborne outbreaks (Batz et al, 2012;Bouwknegt et al, 2013) and several other methods such as microbial fingerprinting, retrospective case-control studies or exposure assesmentsmethodology and choice of metrics is discussed in (Hofstetter, 2002;Mangen et al, 2010;Mangen et al, 2014).…”

“…Approach: When applying DALY/QALYs in risk ranking, different methodologies must usually be applied to estimate incidences of disease and probability of relevant health outcomes depending on the hazards to be evaluated Hofstetter, 2002;Mangen et al, 2010;Mangen et al, 2014;Pennington et al, 2002 …”

Scientific Opinion on the development of a risk ranking framework on biological hazards

“…A number of different approached has been developed for the monetary valuation of risk (Mangen et al, 2010). There are three general approaches: (1) the human capital approach, measuring a person"s production in the marketplace; (2) and cost of illness (COI) methods and (3) revealed or stated preferences which also include intangibles (not measurable) factors such as suffering and pain.…”

“…HALYs are used in economic cost-effectiveness analyses, also sometimes referred in the literature as cost-utility analysis or weighted cost-effectiveness analysis (Mangen et al, 2010 (Pliskin et al, 1980). QALYs are frequently used to support decisions about allocation of resources to health programmes (curative and preventive).…”