VKM Report 2021: 10 Risk ranking and source attribution of food- and waterborne pathogens for surveillance purposes Opinion of the Panel on Biological Hazards of the Norwegian Scientific Committee for Food and Environment Final 09.06.2021 Report from the Norwegian Scientific Committee for Food and Environment (VKM) 2021: 10 Risk ranking and source attribution of food- and waterborne pathogens for surveillance purposes. Opinion of the Panel on Biological Hazards of the Norwegian Scientific Committee for Food and Environment 09.06.2021 ISBN: 978-82-8259-364-9 ISSN: 2535-4019 Norwegian Scientific Committee for Food and Environment (VKM) Po 222 Skøyen N – 0213 Oslo Norway Phone: +47 21 62 28 00 Email: [email protected] vkm.no vkm.no/english Cover photo: Tanya Samuelsen Kristiansen Suggested citation: VKM, Taran Skjerdal, Marina Aspholm, Danica Grahek-Ogden, Solveig Jore, Georg Kapperud, Kjetil K. Melby, Mette Myrmel, Trond Møretrø, Truls Nesbakken, Lucy Robertson, Norval Strachan (2021). Risk ranking and source attribution of food- and waterborne pathogens for surveillance purposes. Opinion of the Panel on Biological Hazards of the Norwegian Scientific Committee for Food and Environment. VKM report 2021:10, ISBN: 978-82-8259-364-9, ISSN: 2535-4019. Norwegian Scientific Committee for Food and Environment (VKM), Oslo, Norway. VKM Report 2021: 10 Final 09.06.2021 Risk ranking and source attribution of food- and waterborne pathogens for surveillance purposes Authors of the opinion VKM has appointed a project group consisting of 8 VKM members and one external expert to answer the request from the Norwegian Food Safety Authority. Members of the project group that contributed to the drafting of the opinion (in alphabetical order after chair of the project group): Taran Skjerdal – Chair of the project group and member of the Panel on Biological Hazards in VKM. Affiliation: 1) VKM; 2) Norwegian Veterinary Institute Marina Aspholm - Member of the project group. Affiliation: VKM, 2) Norwegian University of Life Sciences Danica Grahek-Ogden – Member of the project group and project leader in the VKM secretariat. Affiliation: VKM. Solveig Jore – Member of the project group. Affiliation: 1) VKM, 2) Norwegian Institute of Public Health Georg Kapperud – Member of the project group. Affiliation: 1) VKM, 2) Norwegian Institute of Public Health, 3) Norwegian University of Life Sciences Kjetil K. Melby – Member of the project group. Affiliation: 1) VKM, 2) University of Oslo; 3) Oslo University Hospital Trond Møretrø – Member of the project group. Affiliation: 1) VKM, 2) Nofima Mette Myrmel – Member of the project group. Affiliation: 1) Norwegian University of Life Sciences Truls Nesbakken – Member of the project group. Affiliation: 1) VKM, 2) Norwegian University of Life Sciences Lucy Robertson – Member of the project group. Affiliation: 1) VKM, 2) Norwegian University of Life Sciences Norval Strachan – Member of the project group. Affiliation: 1) University of Aberdeen The opinion has been assessed and approved by the Panel on Biological Hazards. Members of the Panel on Biological Hazards that contributed to the assessment and approval of the opinion (in alphabetical order before chair/vice-chair of the Panel/Committee): VKM Report 2021: 10 Final 09.06.2021 Marina Aspholm - Member of the project group. Affiliation: VKM, 2) Norwegian University of Life Sciences Solveig Jore – Member of the project group. Affiliation: 1) VKM, 2) Norwegian Institute of Public Health Georg Kapperud – Member of the project group. Affiliation: 1) VKM, 2) Norwegian Institute of Public Health, 3) Norwegian University of Life Sciences Kjetil K. Melby – Member of the project group. Affiliation: 1) VKM, 2) University of Oslo; 3) Oslo University Hospital Trond Møretrø – Member of the project group. Affiliation: 1) VKM, 2) Nofima Truls Nesbakken – Member of the project group. Affiliation: 1) VKM, 2) Norwegian University of Life Sciences Lucy Robertson – Member of the project group. Affiliation: 1) VKM, 2) Norwegian University of Life Sciences Taran Skjerdal – Chair/Vice-chair of the Panel on on Biological Hazards in VKM. Affiliation: 1) VKM; 2) Norwegian Veterinary Institute Acknowledgment VKM acknowledge the referees Monika Matt (AGES - Austrian Agency for Health and Food Safety), Martijn Bouwknegt (VionFood) for peer-review of the risk ranking. Project leader from the VKM secretariat, Danica Grahek-Ogden, is acknowledged for coordinating the work with the opinion. Competence of VKM experts Persons working for VKM, either as appointed members of the Committee or as external experts, do this by virtue of their scientific expertise, not as representatives for their employers or third-party interests. The Civil Services Act instructions on legal competence apply for all work prepared by VKM. VKM Report 2021: 10 Final 09.06.2021 Table of Contents 1 Summary ...................................................................................................... 20 2 Sammendrag på norsk ................................................................................. 22 3 Background and terms of reference as provided by the Norwegian Food Safety Authority/ Norwegian Environment Agency ..................................... 24 4 Literature and data ...................................................................................... 25 4.1 Literature search .................................................................................................. 25 4.2 Data ................................................................................................................... 26 5 Method for risk ranking ................................................................................ 26 5.1 Identification and definition of criteria for ranking ................................................... 27 Number of illnesses (C1) ............................................................................ 28 5.1.1.1 Number of illnesses attributable to food- and waterborne transmission ....... 28 Morbidity severity and lethality (C2 – C5) .................................................... 29 5.1.2.1 C234 – a combined criterion for morbidity severity .................................... 29 Probability for increased human burden of disease (C6) ................................ 30 5.2 Expert knowledge elicitation (EKE) ........................................................................ 30 5.3 Expert scoring of each pathogen based on the criteria ............................................ 31 5.4 Weighting of each criterion ................................................................................... 34 5.5 Calculation of overall pathogen scores and subsequent ranking ............................... 35 5.6 Calculation of standard deviation and confidence interval ........................................ 35 Calculating standard deviation .................................................................... 35 Calculating the 95% confidence interval ...................................................... 37 6 Risk ranking ................................................................................................. 37 7 Source attribution ........................................................................................ 39 7.1 Identification of key foods of concern in Norway for each pathogen ......................... 39 8 Data gaps ..................................................................................................... 49 8.1 Identification and definition of criteria for scoring of data gaps ................................ 49 8.2 Expert scoring of data gaps based on the criteria .................................................... 49 9 Discussion – reliability and validity of the results ........................................ 52 9.1 Reliability of expert knowledge elicitation (EKE) ...................................................... 52 9.2 Reliability of the risk ranking ................................................................................. 53 9.3 Reliability of the source attribution ........................................................................ 56 10 Conclusion .................................................................................................... 56 11 References ................................................................................................... 58 VKM Report 2021: 10 Final 09.06.2021 12 Appendix I - Hazard identification and characterisation .............................. 92 12.1 Anisakidae ........................................................................................................... 92 Organism ................................................................................................ 92 Illness and consequences ......................................................................... 92 12.1.2.1 Acute morbidity .................................................................................... 92 12.1.2.2 Chronic morbidity ................................................................................. 93 12.1.2.3 Case-fatality ratio ................................................................................. 93 12.1.2.4 Occurrence .......................................................................................... 93 12.1.2.5 Likelihood of increased human burden .................................................... 94 12.1.2.6 Scorecard ............................................................................................. 94 12.2 Echinococcus multilocularis ..................................................................................