A QMRA for the Transmission of ESBL-Producing Escherichia coli and Campylobacter from Poultry Farms to Humans Through Flies.

The public health significance of transmission of ESBL-producing Escherichia coli and Campylobacter from poultry farms to humans through flies was investigated using a worst-case risk model. Human exposure was modeled by the fraction of contaminated flies, the number of specific bacteria per fly, the number of flies leaving the poultry farm, and the number of positive poultry houses in the Netherlands. Simplified risk calculations for transmission through consumption of chicken fillet were used for comparison, in terms of the number of human exposures, the total human exposure, and, for Campylobacter only, the number of human cases of illness. Comparing estimates of the worst-case risk of transmission through flies with estimates of the real risk of chicken fillet consumption, the number of human exposures to ESBL-producing E. coli was higher for chicken fillet as compared with flies, but the total level of exposure was higher for flies. For Campylobacter, risk values were nearly consistently higher for transmission through flies than for chicken fillet consumption. This indicates that the public health risk of transmission of both ESBL-producing E. coli and Campylobacter to humans through flies might be of importance. It justifies further modeling of transmission through flies for which additional data (fly emigration, human exposure) are required. Similar analyses of other environmental transmission routes from poultry farms are suggested to precede further investigations into flies.

A quantitative microbiological risk assessment for Campylobacter in petting zoos.

The significance of petting zoos for transmission of Campylobacter to humans and the effect of interventions were estimated. A stochastic QMRA model simulating a child or adult visiting a Dutch petting zoo was built. The model describes the transmission of Campylobacter in animal feces from the various animal species, fences, and the playground to ingestion by visitors through touching these so-called carriers and subsequently touching their lips. Extensive field and laboratory research was done to fulfill data needs. Fecal contamination on all carriers was measured by swabbing in 10 petting zoos, using Escherichia coli as an indicator. Carrier-hand and hand-lip touching frequencies were estimated by, in total, 13 days of observations of visitors by two observers at two petting zoos. The transmission from carrier to hand and from hand to lip by touching was measured using preapplied cow feces to which E. coli WG5 was added as an indicator. Via a Beta-Poisson dose-response function, the number of Campylobacter cases for the whole of the Netherlands (16 million population) in a year was estimated at 187 and 52 for children and adults, respectively, so 239 in total. This is significantly lower than previous QMRA results on chicken fillet and drinking water consumption. Scenarios of 90% reduction of the contamination (meant to mimic cleaning) of all fences and just goat fences reduces the number of cases by 82% and 75%, respectively. The model can easily be adapted for other fecally transmitted pathogens.

Variability and uncertainty analysis of the cross-contamination ratios of salmonella during pork cutting.

The transfer ratio of bacteria from one surface to another is often estimated from laboratory experiments and quantified by dividing the expected number of bacteria on the recipient surface by the expected number of bacteria on the donor surface. Yet, the expected number of bacteria on each surface is uncertain due to the limited number of colonies that are counted and/or samples that can be analyzed. The expected transfer ratio is, therefore, also uncertain and its estimate may exceed 1 if real transfer is close to 100%. In addition, the transferred fractions vary over experiments but it is unclear, using this approach, how to combine uncertainty and variability into one estimate for the transfer ratio. A Bayesian network model was proposed that allows the combination of uncertainty within one experiment and variability over multiple experiments and prevents inappropriate values for the transfer ratio. Model functionality was shown using data from a laboratory experiment in which the transfer of Salmonella was determined from contaminated pork meat to a butcher's knife, and vice versa. Recovery efficiency of bacteria from both surfaces was also determined and accounted for in the analysis. Transfer ratio probability distributions showed a large variability, with a mean value of 0.19 for the transfer of Salmonella from pork meat to the knife and 0.58 for the transfer of Salmonella from the knife to pork meat. The proposed Bayesian model can be used for analyzing data from similar study designs in which uncertainty should be combined with variability.

Consumption of fresh fruit juice: how a healthy food practice caused a national outbreak of Salmonella Panama gastroenteritis.

In spring 2008, 15 Salmonella Panama laboratory-confirmed cases were reported within 2 weeks, twice the average annual number of reported cases of this infrequent serotype in The Netherlands. To identify the source responsible for this national outbreak, we carried out an epidemiological, microbiological, and trace-back investigation. In total, 33 cases were reported, and a matched case-control study (23 cases/24 controls) identified consumption of fresh (unpasteurized) fruit juice purchased from a large retailer (X) as the only significant risk factor for illness (matched odds ratio: 7.4, 95% confidence interval: 1.5-37.2). Though the bacterium could not be isolated from fruit juice, the minimal pH value for growth of the causative strain of the outbreak (3.4) was compatible with survival in fruit juice from X. The outbreak strain showed acid resistance and adaptive properties that may explain how it could have caused infection through fresh orange juice. To our knowledge, this is the first documented outbreak related to fresh fruit juice consumption in western Europe since 1922. A growing number of consumers who are seeking healthy food practices are exposed to the infectious risks related to unpasteurized fresh fruit juice. Labeling regulations should be adapted to properly indicate to the consumers that unpasteurized fresh fruit juices remain vulnerable to microbial contamination. Frequent microbiological screening and strict compliance with food safety procedures should reduce the infectious hazards of fresh fruit juices.

Role of oxidative stress in C. jejuni inactivation during freeze-thaw treatment.

Campylobacter jejuni represents one of the leading causes of bacterial enteritis throughout the world. Poultry is an important source of C. jejuni. Despite hygiene measures taken in the production chain, C. jejuni is frequently isolated from poultry meat. C. jejuni is a microaerophilic pathogen, affected by oxidative stress. Freeze-thaw treatment induces cell death by several mechanisms, including oxidative stress. In this article, we investigate the role of oxidative stress in C. jejuni sensitivity during and after a freeze-thaw treatment. This treatment results in dead and sublethally injured cells. The latter population might have an increased sensitivity to oxidative stress. To test this, cells were stored for another 24 h at 4 degrees C under aerobic conditions and compared to cells that were not treated. C. jejuni survival was measured in different media (water, BHI broth, chicken juice, and chicken fillets) to test the environment protective effect. Different strains were tested, including sodB (encoding the superoxide dismutase) and cj1371 (encoding a periplasmic protein) mutants. Cell death was particularly important in water but similar in BHI, chicken juice, and chicken fillets. The sodB mutant was more sensitive to freeze-thaw treatment, suggesting that the killing mechanism involves production of superoxide anions. On the contrary, the cj1371 mutant was more sensitive to storage at 4 degrees C, suggesting that it does not play a role in the detoxification of reactive oxygen species. Storage at 4 degrees C after freeze-thaw treatment increases cell death of oxidative stress-sensitive populations. Sensitization to oxidative stress, freeze-thaw treatment, and further storage at 4 degrees C could be a way to reduce C. jejuni populations on carcasses.

Cooking practices in the kitchen-observed versus predicted behavior.

Cross-contamination and undercooking are major factors responsible for campylobacteriosis and as such should be incorporated in microbiological risk assessment. A previous paper by van Asselt et al.((1)) quantified cross-contamination routes from chicken breast fillet via hand, cutting board, and knife ending up in a prepared chicken-curry salad in the domestic kitchen. The aim of the current article was to validate the obtained transfer rates with consumer data obtained by video observations and microbial analyses of a home prepared chicken-curry salad. Results showed a wide range of microbial contamination levels in the final salad, caused by various cross-contamination practices and heating times varying from 2'44'' to 41'30''. Model predictions indicated that cooking times should be at least 8 minutes and cutting boards need to be changed after cutting raw chicken in order to obtain safe bacterial levels in the final salad. The model predicted around 75% of the variance in cross-contamination behavior. Accuracy of the model can further be improved by including other cross-contamination routes besides hands, cutting boards, and knives. The model proved to be fail-safe, which implies it can be used as a worst-case estimate to assess the importance of cross-contamination in the home.

Food safety in the domestic environment: the effect of consumer risk information on human disease risks.

The improvement of food safety in the domestic environment requires a transdisciplinary approach, involving interaction between both the social and natural sciences. This approach is applied in a study on risks associated with Campylobacter on broiler meat. First, some web-based information interventions were designed and tested on participant motivation and intentions to cook more safely. Based on these self-reported measures, the intervention supported by the emotion "disgust" was selected as the most promising information intervention. Its effect on microbial cross-contamination was tested by recruiting a set of participants who prepared a salad with chicken breast fillet carrying a known amount of tracer bacteria. The amount of tracer that could be recovered from the salad revealed the transfer and survival of Campylobacter and was used as a measure of hygiene. This was introduced into an existing risk model on Campylobacter in the Netherlands to assess the effect of the information intervention both at the level of exposure and the level of human disease risk. We showed that the information intervention supported by the emotion "disgust" alone had no measurable effect on the health risk. However, when a behavioral cue was embedded within the instruction for the salad preparation, the risk decreased sharply. It is shown that a transdisciplinary approach, involving research on risk perception, microbiology, and risk assessment, is successful in evaluating the efficacy of an information intervention in terms of human health risks. The approach offers a novel tool for science-based risk management in the area of food safety.

Dietary proteins extend the survival of Salmonella Dublin in a gastric acid environment.

The pH of the human stomach is dynamic and changes over time, depending on the composition of the food ingested and a number of host-related factors such as age. To evaluate the number of bacteria surviving the gastric acid barrier, we have developed a simple gastric acid model, in which we mimicked the dynamic pH changes in the human stomach. In the present study, model gastric fluid was set up to imitate pH dynamics in the stomachs of young and elderly people after ingestion of a standard meal. To model a serious foodborne pathogen, we followed the survival of Salmonella enterica serotype Dublin, and found that the addition of proteins such as pepsin, ovalbumin, and blended turkey meat to the simple gastric acid model significantly delayed pathogen inactivation compared with the control, for which no proteins were added. In contrast, no delay in inactivation was observed in the presence of bovine serum albumin, indicating that protection could be protein specific. The simple gastric acid model was validated against a more laborious and complex fermenter model, and similar survival of Salmonella Dublin was observed in both models. Our gastric acid model allowed us to evaluate the influence of food components on survival of pathogens under gastric conditions, and the model could contribute to a broader understanding of the impact of specific food components on the inactivation of pathogens during gastric passage.

The transcriptional heat shock response of Salmonella typhimurium shows hysteresis and heated cells show increased resistance to heat and acid stress.

We investigated if the transcriptional response of Salmonella Typhimurium to temperature and acid variations was hysteretic, i.e. whether the transcriptional regulation caused by environmental stimuli showed memory and remained after the stimuli ceased. The transcriptional activity of non-replicating stationary phase cells of S. Typhimurium caused by the exposure to 45 °C and to pH 5 for 30 min was monitored by microarray hybridizations at the end of the treatment period as well as immediately and 30 minutes after conditions were set back to their initial values, 25 °C and pH 7. One hundred and two out of 120 up-regulated genes during the heat shock remained up-regulated 30 minutes after the temperature was set back to 25 °C, while only 86 out of 293 down regulated genes remained down regulated 30 minutes after the heat shock ceased. Thus, the majority of the induced genes exhibited hysteresis, i.e., they remained up-regulated after the environmental stress ceased. At 25 °C the transcriptional regulation of genes encoding for heat shock proteins was determined by the previous environment. Gene networks constructed with up-regulated genes were significantly more modular than those of down-regulated genes, implying that down-regulation was significantly less synchronized than up-regulation. The hysteretic transcriptional response to heat shock was accompanied by higher resistance to inactivation at 50 °C as well as cross-resistance to inactivation at pH 3; however, growth rates and lag times at 43 °C and at pH 4.5 were not affected. The exposure to pH 5 only caused up-regulation of 12 genes and this response was neither hysteretic nor accompanied of increased resistance to inactivation conditions. Cellular memory at the transcriptional level may represent a mechanism of adaptation to the environment and a deterministic source of variability in gene regulation.

Extreme Heat Resistance of Food Borne Pathogens Campylobacter jejuni, Escherichia coli, and Salmonella typhimurium on Chicken Breast Fillet during Cooking.

The aim of this research was to determine the decimal reduction times of bacteria present on chicken fillet in boiling water. The experiments were conducted with Campylobacter jejuni, Salmonella, and Escherichia coli. Whole chicken breast fillets were inoculated with the pathogens, stored overnight (4°C), and subsequently cooked. The surface temperature reached 70°C within 30 sec and 85°C within one minute. Extremely high decimal reduction times of 1.90, 1.97, and 2.20 min were obtained for C. jejuni, E. coli, and S. typhimurium, respectively. Chicken meat and refrigerated storage before cooking enlarged the heat resistance of the food borne pathogens. Additionally, a high challenge temperature or fast heating rate contributed to the level of heat resistance. The data were used to assess the probability of illness (campylobacteriosis) due to consumption of chicken fillet as a function of cooking time. The data revealed that cooking time may be far more critical than previously assumed.

A quantitative approach towards a better understanding of the dynamics of Salmonella spp. in a pork slaughter-line.

Pork contributes significantly to the public health disease burden caused by Salmonella infections. During the slaughter process pig carcasses can become contaminated with Salmonella. Contamination at the slaughter-line is initiated by pigs carrying Salmonella on their skin or in their faeces. Another contamination route could be resident flora present on the slaughter equipment. To unravel the contribution of these two potential sources of Salmonella a quantitative study was conducted. Process equipment (belly openers and carcass splitters), faeces and carcasses (skin and cutting surfaces) along the slaughter-line were sampled at 11 sampling days spanning a period of 4 months. Most samples taken directly after killing were positive for Salmonella. On 96.6% of the skin samples Salmonella was identified, whereas a lower number of animals tested positive in their rectum (62.5%). The prevalence of Salmonella clearly declined on the carcasses at the re-work station, either on the cut section or on the skin of the carcass or both (35.9%). Throughout the sampling period of the slaughter-line the total number of Salmonella per animal was almost 2 log lower at the re-work station in comparison to directly after slaughter. Seven different serovars were identified during the study with S. Derby (41%) and S. Typhimurium (29%) as the most prominent types. A recurring S. Rissen contamination of one of the carcass splitters indicated the presence of an endemic 'house flora' in the slaughterhouse studied. On many instances several serotypes per individual sample were found. The enumeration of Salmonella and the genotyping data gave unique insight in the dynamics of transmission of this pathogen in a slaughter-line. The data of the presented study support the hypothesis that resident flora on slaughter equipment was a relevant source for contamination of pork.

Gene expression profiles induced by Salmonella infection in resistant and susceptible mice.

Mouse models have been extensively used to investigate the mechanisms of salmonellosis. However, the role of the hosts' local intestinal responses during early stages of infection remain unclear. In this study, transcript array analysis was employed to investigate regulation of gene expression in the murine intestine following oral challenge with Salmonella enterica serovar Enteritidis. Salmonella resistant C3H/HeN mice elicited only weak transcription responses in the ileum even in the presence of bacterial replication and systemic infection. This poor response was surprising given previously published results using in vitro models. Susceptible TLR4-deficient C3H/HeJ mice displayed a stronger response, suggesting a role for TLR4 in dampening the response to Salmonella. Responses of susceptible BALB/c mice were also unremarkable. In contrast, in vitro infection of murine rectal epithelial cells induced a strong transcription response consistent with previous in vitro studies. Although the pattern of genes expressed by the ileal tissue upon in vivo infection were similar in all three mouse lines, the genes up-regulated during in vitro infection were different, indicating that the responses seen in vitro do not mimic those seen in vivo. Taken together these data indicate that in vivo responses to Salmonella, at the level of the intestine, are tightly regulated by the host.

Future challenges to microbial food safety.

Despite significant efforts by all parties involved, there is still a considerable burden of foodborne illness, in which micro-organisms play a prominent role. Microbes can enter the food chain at different steps, are highly versatile and can adapt to the environment allowing survival, growth and production of toxic compounds. This sets them apart from chemical agents and thus their study from food toxicology. We summarize the discussions of a conference organized by the Dutch Food and Consumer Products Safety Authority and the European Food Safety Authority. The goal of the conference was to discuss new challenges to food safety that are caused by micro-organisms as well as strategies and methodologies to counter these. Management of food safety is based on generally accepted principles of Hazard Analysis Critical Control Points and of Good Manufacturing Practices. However, a more pro-active, science-based approach is required, starting with the ability to predict where problems might arise by applying the risk analysis framework. Developments that may influence food safety in the future occur on different scales (from global to molecular) and in different time frames (from decades to less than a minute). This necessitates development of new risk assessment approaches, taking the impact of different drivers of change into account. We provide an overview of drivers that may affect food safety and their potential impact on foodborne pathogens and human disease risks. We conclude that many drivers may result in increased food safety risks, requiring active governmental policy setting and anticipation by food industries whereas other drivers may decrease food safety risks. Monitoring of contamination in the food chain, combined with surveillance of human illness and epidemiological investigations of outbreaks and sporadic cases continue to be important sources of information. New approaches in human illness surveillance include the use of molecular markers for improved outbreak detection and source attribution, sero-epidemiology and disease burden estimation. Current developments in molecular techniques make it possible to rapidly assemble information on the genome of various isolates of microbial species of concern. Such information can be used to develop new tracking and tracing methods, and to investigate the behavior of micro-organisms under environmentally relevant stress conditions. These novel tools and insight need to be applied to objectives for food safety strategies, as well as to models that predict microbial behavior. In addition, the increasing complexity of the global food systems necessitates improved communication between all parties involved: scientists, risk assessors and risk managers, as well as consumers.

Food safety in the domestic environment: an interdisciplinary investigation of microbial hazards during food preparation.

It has been established that, to a considerable extent, the domestic hygiene practices adopted by consumers can result in a greater or lesser microbial load in prepared meals. In the research presented here, an interdisciplinary study is reported in which interviews, observations of consumers preparing a recipe, and microbial contamination of the finished meals were compared. The results suggest that, while most consumers are knowledgeable about the importance of cross-contamination and heating in preventing the occurrence of foodborne illness, this knowledge is not necessarily translated into behavior. The adoption of habitual cooking practices may also be important. Potentially risky behaviors were, indeed, observed in the domestic food preparation environment. Eighteen of the participants made errors in food preparation that could potentially result in cross-contamination, and seven participants allowed raw meat juices to come in contact with the final meal. Using a tracer microorganism the log reduction as a result of consumer preparation was estimated at an average of log 4.1 cfu/salad. When combining these findings, it was found that cross-contamination errors were a good predictor for log reduction. Procedural food safety knowledge (i.e., knowledge proffered after general open questions) was a better predictor of efficacious bacterial reduction than declarative food safety knowledge (i.e., knowledge proffered after formal questioning). This suggests that motivation to prepare safe food was a better indicator of actual behavior than knowledge about food safety per se.

Release kinetics and cell trafficking in relation to bacterial growth explain the time course of blood neutrophils and monocytes during primary Salmonella infection.

Granulocytes and neutrophils are predominantly responding cells during the early phase of infection of rats with Salmonella. We propose mathematical and experimental models of the kinetics of neutrophil and monocyte responses in Salmonella infection via the oral route. Using the models, we estimate that approximately 1 in 500 inoculated Salmonella cells actually infected the rat and multiplied with a doubling time of 5 h in Peyer's patches, reaching a maximum of approximately 10(6) c.f.u./g. In low-dose infection, neutrophil and monocyte responses are delayed, but further resemble the responses in high-dose infection. Important processes influencing neutrophil and monocyte recruitment are: massive migration into the infected tissue, and non-linear release kinetics of neutrophils and monocytes from the bone marrow. In conclusion, we can predict time series of neutrophil and monocyte responses in low-dose and high-dose experimental infection via the oral route.

Improving food safety in the domestic environment: the need for a transdisciplinary approach.

Microbial food safety has been the focus of research across various disciplines within the risk analysis community. Natural scientists involved in food microbiology and related disciplines work on the identification of health hazards, and the detection of pathogenic microorganisms. To perform risk assessment, research activities are increasingly focused on the quantification of microbial contamination of food products at various stages in the food chain, and modeling the impact of this contamination on human health. Social scientists conduct research into how consumers perceive food risks, and how best to develop effective risk communication with consumers in order to improve public health through improved food handling practices. The two approaches converge at the end of the food chain, where the activities regarding food preparation and food consumption are considered. Both natural and social sciences may benefit from input and expertise from the perspective of the alternative discipline, although, to date, the integration of social and natural sciences has been somewhat limited. This article therefore explores the potential of a transdisciplinary approach to food risk analysis in terms of delivering additional improvements to public health. Developing knowledge arising from research in both the natural and social sciences, we present a novel framework involving the integration of the two approaches that might provide the most effective way to improve the consumer health associated with food-borne illness.