MICROBIOLOGICAL RISK ASSESSMENT SERIES ISSN 1726-5274 23 Multicriteria-based ranking for risk management of food-borne parasites MICROBIOLOGICAL RISK ASSESSMENT SERIES 23 Multicriteria-based ranking for risk management of food-borne parasites Report of a Joint FAO/WHO Expert Meeting, 3–7 September 2012, FAO Headquarters, Rome, Italy Food and Agriculture Organization of the United Nations World Health Organization 2014 The designations employed and the presentation of material in this information product do not imply the expression of any opinion whatsoever on the part of the Food and Agriculture Organization of the United Nations (FAO) or of the World Health Organization (WHO) concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. 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II.Food and Agriculture Organization of the United Nations. ISBN 978 92 4 156470 0 (WHO) (NLM classification: WA 701) ISBN 978-92-5-108199-0 (print) (FAO) E-ISBN 978-92-5-108200-3 (PDF) (FAO) ISSN 1726-5274 Recommended citation: FAO/WHO [Food and Agriculture Organization of the United Nations/World Health Organization]. 2014. Multicriteria-based ranking for risk management of food-borne parasites. Microbiological Risk Assessment Series No. 23. Rome. 302pp FAO and WHO encourage the use, reproduction and dissemination of material in this information product. Except where otherwise indicated, material may be copied, downloaded and printed for private study, research and teaching purposes, or for use in non-commercial products or services, provided that appropriate acknowledgement of FAO and WHO as the source and copyright holder is given and that their endorsement of users’ views, products or services is not implied in any way. 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FAO information products are available on the FAO website (www.fao.org/publications) and can be purchased through [email protected]. © FAO/WHO 2014 Contents Acknowledgments x Contributors xi Abbreviations used in the report xiv Executive Summary xv 1 Background 1 2 Objectives and approach 4 2.1 Identication of parasites 7 2.2 Denition of primary and secondary parasite and food pathways 7 2.3 Denition of criteria for parasite scoring 8 2.4 Scoring parasites according to criteria 11 2.5 Denition of criteria weights 12 2.6 Calculation of parasite scores 13 3 Results 14 3.1 The global ranking of food-borne parasites 3.2 Trade scores for the ranked parasites 14 3.3 Socio-economic impacts for the ranked parasites 18 3.4 Conclusions 20 4 Risk management options for the higher ranked parasites 23 4.1 General risk management considerations 23 4.2 Generic risk management options 24 4.3 Some specic considerations for risk management 26 5 Conclusions and recommendations 32 References 35 ANNEXES Annex 1 Identication of food-borne parasites for consideration 40 Annex 2 Food-borne parasite ranking exercise: summary card 44 Annex 3 Food-borne parasite ranking exercise form: explanation of criteria 45 Criterion No. 1. Number of global food-borne illnesses 45 Criterion No. 2. Geographical distribution (endemic regions) 46 Criterion No. 3. Acute Morbidity Severity 47 Criterion No. 4. Chronic Morbidity Severity 48 Criterion No. 5. Fraction chronic 49 Criterion No. 6. Mortality rate 50 Criterion No. 7. Increasing trend in disease 50 Criterion No. 8. International trade 50 Criterion No. 9. Distributional impacts (socio-economic impact) 51 Criterion No. 10. Quality of evidence 52 Comments 52 References 52 Annex 4. Criteria weights worksheet 53 Annex 5. Sensitivity analysis 54 Annex 6. Risk management actions 62 Annex 7. Specic information for the ranked parasites 63 A7.1 Anisakidae and anisakiasis 63 General information 63 Geographical distribution 63 Disease 64 Trade relevance 65 Impact on economically vulnerable populations 65 References 65 A7.2 Ascaris spp. 66 General information 66 Geographical distribution 67 Disease 67 Trade relevance 68 Impact on economically vulnerable populations 68 Other relevant information 68 References 69 A7.3 Balantidium coli 70 General information 70 Geographical distribution 70 Disease 70 iv Trade relevance 71 Impact on economically vulnerable populations 71 References 71 A7.4 Cryptosporidium spp. 72 General information 72 Geographical distribution 73 Disease 74 Trade relevance 74 Impact on economically vulnerable populations 74 References 75 A7.5 Cyclospora cayetanensis 77 General information 77 Geographical distribution 78 Disease 78 Trade relevance and impact on economically vulnerable populations 79 References 79 A7.6 Diphyllobothrium spp. 82 General information 82 Geographical distribution 82 Disease 83 Trade relevance 84 Impact on economically vulnerable populations 84 Other relevant information 84 References 84 A7.7 Echinococcus granulosus 88 General information 88 Geographical distribution 89 Disease 89 Trade relevance of cystic echinococcosis 90 Impact of CE on economically vulnerable populations 91 References 92 A7.8 Echinococcus multilocularis 95 General information 95 Geographical distribution 95 Disease 96 Trade relevance 97 Impact on economically vulnerable populations 98 References 98 A7.9 Entamoeba histolytica 101 General information 101 Geographical distribution 101 Disease 101 Trade relevance 102 v Impact on economically vulnerable populations 102 References 102 A7.10 Fasciola spp. 104 General information 104 Geographical distribution 104 Disease 104 Trade relevance 105 Impact on economically vulnerable populations 105 References 106 A7.11 Giardia duodenalis 108 General information 108 Geographical distribution 108 Disease 108 Trade relevance 110 Impact on economically vulnerable populations 110 References 110 A7.12 Heterophyidae and heterophyidiasis 112 General information 112 Geographical distribution 112 Disease 112 Trade relevance 113 Impact on economically vulnerable populations 113 Other relevant information 113 References 114 A7.13 Opisthorchiidae 115 General information 115 Geographical distribution (endemic regions) 115 Disease 115 Trade relevance 117 Impact on economically vulnerable populations 117 Other relevant information 117 References 117 A7.14 Paragonimus spp. 119 General information 119 Geographical distribution 119 Disease 120 Trade relevance 122 Impact on economically vulnerable populations 122 References 122 A7.15 Sarcocystis spp. 124 General information 124 Geographical distribution 124 Prevalence in food animals 124 Prevalence in humans 125 vi Disease 126 Trade relevance 126 Impact on economically vulnerable populations 126 References 127 A7.16 Spirometra spp. 129 General information 129 Geographical distribution 129 Disease 130 Trade relevance and impact on vulnerable populations 130 References 131 A7.17 Taenia saginata 133 General information 133 Geographical distribution 133 Disease 134 Trade relevance 135 Impact on economically vulnerable populations 135 References 135 A7.18 Taenia solium 137 General information on the parasite 137 Geographical distribution 137 Disease 137 Trade relevance 138 Impact on economically vulnerable populations 138 References 139 A7.19 Toxocara spp. 141 General information 141 Geographical distribution 141 Disease 142 Trade relevance 143 Impact on economically vulnerable populations 143 References 143 A7.20 Toxoplasma gondii 145 General Information 145 Geographical distribution 146 Disease 147 Trade relevance and Impact on economically vulnerable populations 149 References 149 A7.21 Trichinella spp. other than T. spiralis 152 General information 152 Geographical distribution 152 Disease 153 Trade relevance 154 Impact on economically vulnerable populations 154 References 154 vii A7.22 Trichinella spiralis 156 General information 156 Geographical distribution 156 Disease 156 Trade relevance 157 Impact on economically vulnerable populations 158 Other relevant information 158 References 158 A7.23 Trichuris trichiura 160 General information 160 Geographical distribution 160 Disease 160 Trade relevance 161 Impact on economically vulnerable populations 161 References 161 A7.24 Trypanosoma cruzi 163 General information 163 Geographical distribution 163 Disease 164 Chagas disease by oral transmission 164 Trade relevance 165 Impact on economically vulnerable populations 165 References 165 A7.25 Glossary of Parasitological Terms 167 Annex 8. Regional Reports 171 Annex 8.1 – Africa 172 A8.1.1 Introduction 172 A8.1.2 Data availability in humans, and food attribution