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Strains of pathogenic Escherichia coli that are characterized by their ability to produce Shiga toxins are referred to as Shiga toxin-producing E. coli (STEC). STEC are an important cause of foodborne disease and infections have been associated with a wide range of human clinical illnesses ranging from mild non-bloody diarrhoea to bloody diarrhoea (BD) and haemolytic uraemic syndrome (HUS) which often includes kidney failure. A high proportion of patients are hospitalized, some develop end-stage renal disease (ESRD) and some die. The information requested by CCFH is divided into three main areas: the global burden of disease and source attribution; hazard identification and characterization; and monitoring, including the status of the currently available analytical methods. This report provides an overview of the work undertaken in response to the request from the CCFH and provides the conclusions and advice of the Expert Group based on the currently available information.
Shiga toxin-producing Escherichia coli (STEC) infections are a substantial health issue worldwide. Circa 2010, foodborne STEC caused > 1 million human illnesses, 128 deaths, and ~ 13,000 Disability Adjusted Life Years (DALYs). Targeting interventions appropriately relies on identifying those strains of greatest risk to human health and determining the types of foods that cause STEC infections. There are hundreds of STEC serotypes; however, based on the evidence gathered during the review, the Expert Group concluded that the serotype of the STEC strain should not be considered a virulence criterion. All STEC strains with the same serotype should not be assumed to carry the same virulence genes and to pose the same risk, as many STEC virulence genes are mobile and can be lost or transferred to other bacteria. this report proposes a set of criteria for categorizing the potential risk of severity of illness associated with a STEC in food is recommended based on evidence of virulence gene profiles and associations with clinical severity. The criteria could be applied by risk managers in a risk-based management approach to control STEC in food. While ruminants and, other land animals are considered the main reservoirs for STEC, various largescale outbreaks have been linked to other foods. Thus, the report also addresses source attribution of foodborne STEC infections globally in order to inform the development of international standards by the Codex Alimentarius on the control of STEC, and in particular identify the foods which should be the focus of those standards. Finally it provides a review of monitoring programmes and methodology for STEC which can serve as a reference for countries planning to develop such programmes.
Since the publication of the 2004 risk assessment, outbreaks of illness and resultant deaths due to L. monocytogenes continue to occur across the globe. Continued effort is needed to summarize and critically evaluate the most recent information on L. monocytogenes in RTE foods. New data to improve and further inform the 2004 Risk Assessment is available for nearly every factor considered previously, including new quantitative data on L. monocytogenes contamination of foods. To facilitate this work, an FAO/WHO expert meeting was held by virtual means from 20 October to 6 November 2020 to review and discuss the available data and background documents, and to assess the need to modify and update risk assessment models/tools. This report focuses on the deliberations and conclusions of the expert meeting.
Although Shiga toxin-producing Escherichia coli (STEC) have been isolated from a variety of food production animals, they are most commonly associated with ruminants from which we derive meat and milk. Because of the widespread and diverse nature of ruminant-derived food production, coupled with the near ubiquity of STEC worldwide, there is no single definitive solution for controlling STEC that will work alone or in all situations. Instead, the introduction of multiple interventions applied in sequence, as a “multiple-hurdle scheme” at several points throughout the food chain (including processing, transport and handling) will be most effective. This report summarises the review and evaluation of interventions applied for the control of STEC in cattle, raw beef and raw milk and raw milk cheese manufactured from cows’ milk, and also evaluated available evidence for other small ruminants, swine and other animals. The information is presented from primary production, to the end of processing, providing the reader with information on the currently available interventions based on the latest scientific evidence. This work was undertaken to support the development of guidelines for the control of STEC in beef, raw milk and cheese produced from raw milk by the Codex Committee on Food Hygiene (CCFH).
Shiga toxin-producing Escherichia coli (STEC) infections are a substantial public health issue worldwide, causing more than 1 million illnesses, 128 deaths and nearly 13 000 Disability-Adjusted Life Years (DALYs) annually. To appropriately target interventions to prevent STEC infections transmitted through food, it is important to determine the specific types of foods leading to these illnesses. An analysis of data from STEC foodborne outbreak investigations reported globally, and a systematic review and meta-analysis of case-control studies of sporadic STEC infections published for all dates and locations, were conducted. A total of 957 STEC outbreaks from 27 different countries were included in the analysis. Overall, outbreak data identified that 16% (95% UI, 2-17%) of outbreaks were attributed to beef, 15% (95% UI, 2-15%) to produce and 6% (95% UI, 1-6%) to dairy products. The food sources involved in 57% of all outbreaks could not be identified. The attribution proportions were calculated by WHO region and the attribution of specific food commodities varied between geographic regions. In the European and American sub-regions of the WHO, the primary sources of outbreaks were beef and produce. In contrast, produce and dairy were identified as the primary sources of STEC outbreaks in the WHO Western Pacific sub-region. The systematic search of the literature identified useable data from 21 publications of case-control studies of sporadic STEC infections. The results of the meta-analysis identified, overall, beef and meat-unspecified as significant risk factors for STEC infection. Geographic region and age of the study population contributed to significant sources of
This document provides guidance on undertaking risk assessment of all microbial hazards which may adversely affect human health in foods along a food chain. This document is also intended to provide practical guidance on a structured framework for carrying out risk assessment of microbiological hazards in foods, focussing on the four components including hazard identification, hazard characterization, exposure assessment and risk characterization. These guidelines therefore represent the best practice at the time of their preparation, and it is hoped that they will help stimulate further developments and disseminate the current knowledge.
In 2020, the 43rd Session of the Codex Alimentarius Commission approved the “Development of Guidelines for the Safe Use and Reuse of Water in Food Production” proposed at the 51st Session of the Codex Committee on Food Hygiene. To support this work, JEMRA was asked to provide scientific advice on sector-specific applications and case studies for determining appropriate and fit-for-purpose microbiological criteria for water sourcing, use and reuse in fish and fishery products from primary production to retail. This report presented the outcome from the JEMRA meeting, which includes the: situation analysis concerning water use and reuse in the production and processing of fish and fishery products, analysis of case studies for different risk-based water use and reuse processing scenarios and species, water quality monitoring and the use of non-culture based microbiological methods, recommendations concerning the safety and quality of water used in fish production and processing, and critical research gaps and policy developments.