Risk Ranking of Antimicrobial‐Resistant Hazards Found in Meat in Switzerland

Human exposure to bacteria resistant to antimicrobials and transfer of related genes is a complex issue and occurs, among other pathways, via meat consumption. In a context of limited resources, the prioritization of risk management activities is essential. Since the antimicrobial resistance (AMR) situation differs substantially between countries, prioritization should be country specific. The objective of this study was to develop a systematic and transparent framework to rank combinations of bacteria species resistant to selected antimicrobial classes found in meat, based on the risk they represent for public health in Switzerland. A risk assessment model from slaughter to consumption was developed following the Codex Alimentarius guidelines for risk analysis of foodborne AMR. Using data from the Swiss AMR monitoring program, 208 combinations of animal species/bacteria/antimicrobial classes were identified as relevant hazards. Exposure assessment and hazard characterization scores were developed and combined using multicriteria decision analysis. The effect of changing weights of scores was explored with sensitivity analysis. Attributing equal weights to each score, poultry‐associated combinations represented the highest risk. In particular, contamination with extended‐spectrum β‐lactamase/plasmidic AmpC‐producing Escherichia coli in poultry meat ranked high for both exposure and hazard characterization. Tetracycline‐ or macrolide‐resistant Enterococcus spp., as well as fluoroquinolone‐ or macrolide‐resistant Campylobacter jejuni , ranked among combinations with the highest risk. This study provides a basis for prioritizing future activities to mitigate the risk associated with foodborne AMR in Switzerland. A user‐friendly version of the model was provided to risk managers; it can easily be adjusted to the constantly evolving knowledge on AMR.     

Some Limitations of Qualitative Risk Rating Systems

Qualitative systems for rating animal antimicrobial risks using ordered categorical labels such as “high,”“medium,” and “low” can potentially simplify risk assessment input requirements used to inform risk management decisions. But do they improve decisions? This article compares the results of qualitative and quantitative risk assessment systems and establishes some theoretical limitations on the extent to which they are compatible. In general, qualitative risk rating systems satisfying conditions found in real‐world rating systems and guidance documents and proposed as reasonable make two types of errors: (1) Reversed rankings, i.e., assigning higher qualitative risk ratings to situations that have lower quantitative risks; and (2) Uninformative ratings, e.g., frequently assigning the most severe qualitative risk label (such as “high”) to situations with arbitrarily small quantitative risks and assigning the same ratings to risks that differ by many orders of magnitude. Therefore, despite their appealing consensus‐building properties, flexibility, and appearance of thoughtful process in input requirements, qualitative rating systems as currently proposed often do not provide sufficient information to discriminate accurately between quantitatively small and quantitatively large risks. The value of information (VOI) that they provide for improving risk management decisions can be zero if most risks are small but a few are large, since qualitative ratings may then be unable to confidently distinguish the large risks from the small. These limitations suggest that it is important to continue to develop and apply practical quantitative risk assessment methods, since qualitative ones are often unreliable.     

A Risk Assessment Model for Enterotoxigenic Staphylococcus aureus in Pasteurized Milk: A Potential Route to Source‐Level Inference

This article describes a probabilistic model that quantifies hazards that arise from Staphylococcus aureus in milk that is sold as pasteurized in the United Kingdom. The model is centered on coupled dynamics for S. aureus populations, staphylococcal enterotoxins, and the concentration of alkaline phosphatase throughout the milk chain. The chain includes farm collection and storage of pooled milk, further pooling for off‐farm processing, high temperature short time thermal processing, and possible postprocess contamination. The model is implemented as a Bayesian belief network. The results indicate that milk sold as pasteurized is relatively safe with respect to the hazards associated with S. aureus and that most risk is associated with small scale on‐farm processing. An additional analysis of likelihood ratios shows that alkaline phosphatase concentrations in filler tank milk are a good indicator of potential hazards and that these concentrations, in conjunction with other measurements, can be used effectively to discriminate over possible failure modes. The ability to discriminate over potential failure modes can support preemptive actions, such as maintenance or hygiene, which assist with milk chain management and, over extended periods, accumulate to drive improved safety, efficiency, and security.     

Foundational Issues in Risk Assessment and Risk Management

This is a perspective article on foundational issues in risk assessment and management. The aim is to discuss the needs, obstacles, and challenges for the establishment of a renewed, strong scientific foundation for risk assessment and risk management suited for the current and future technological challenges. The focus is on (i) reviewing and discussing the present situation and (ii) identifying how to best proceed in the future, to develop the risk discipline in the directions needed. The article provides some reflections on the interpretation and understanding of the concept of “foundations of risk assessment and risk management” and the challenges therein. One main recommendation is that different arenas and moments for discussion are needed to specifically address foundational issues in a way that embraces the many disciplinary communities involved (from social scientists to engineers, from behavioral scientists to statisticians, from health physicists to lawyers, etc.). One such opportunity is sought in the constitution of a novel specialty group of the Society of Risk Analysis.     

Risk Assessment Can Be a Game‐Changing Information Technology—But Too Often It Isn't

The printing press was a game‐changing information technology. Risk assessment could be also. At present, risk assessments are commonly used as one‐time decision aids: they provide justification for a particular decision, and afterwards usually sit on a shelf. However, when viewed as information technologies, their potential uses are much broader. Risk assessments: (1) are repositories of structured information and a medium for communication; (2) embody evaluative structures for setting priorities; (3) can preserve information over time and permit asynchronous communication, thus encouraging learning and adaptation; and (4) explicitly address uncertain futures. Moreover, because of their “what‐if” capabilities, risk assessments can serve as a platform for constructive discussion among parties that hold different values. The evolution of risk assessment in the nuclear industry shows how such attributes have been used to lower core‐melt risks substantially through improved templates for maintenance and more effective coordination with regulators (although risk assessment has been less commonly used in improving emergency‐response capabilities). The end result of this evolution in the nuclear industry has been the development of “living” risk assessments that are updated more or less in real time to answer even routine operational questions. Similar but untapped opportunities abound for the use of living risk assessments to reduce risks in small operational decisions as well as large policy decisions in other areas of hazard management. They can also help improve understanding of and communication about risks, and future risk assessment and management. Realization of these opportunities will require significant changes in incentives and active promotion by the risk analytic community.     

Quantitative Risk Assessment of Rabies Entering Great Britain from North America via Cats and Dogs

Great Britain has been rabies-free since 1922, which is often considered to be in part due to the strict laws requiring that imported cats and dogs be vaccinated and quarantined for 6 months immediately on entry into the country. Except for two isolated incidents, this quarantine policy has contributed to ensuring that Great Britain has remained free of rabies. In 2000, amendments to the UK quarantine laws were made and the Pet Travel Scheme (PETS) was launched for companion animals traveling from European Union countries and rabies-free islands. Since its introduction, it has been proposed that other countries including North America should be included within the UK scheme. A quantitative risk assessment was developed to assist in the policy decision to amend the long-standing quarantine laws for dogs and cats from North America. It was determined that the risk of rabies entry is very low and is dependent on the level of compliance (i.e., legally conforming to all of the required regulations) with PETS and the number of pets imported. Assuming 100% compliance with PETS and the current level of importation of cats and dogs from North America, the annual probability of importing rabies is lower for animals traveling via PETS (7.22 x 10(-6), 95th percentile) than quarantine (1.01 x 10(-5), 95th percentile). These results, and other scientific evidence, directly informed the decision to expand the PETS scheme to North America as of December 2002.     

A Risk Assessment of Campylobacteriosis and Salmonellosis Linked to Chicken Meals Prepared in Households in Dakar,Senegal

We used a quantitative microbiological risk assessment model to describe the risk of Campylobacter and Salmonella infection linked to chicken meals prepared in households in Dakar, Senegal. The model uses data collected specifically for this study, such as the prevalence and level of bacteria on the neck skin of chickens bought in Dakar markets, time‐temperature profiles recorded from purchase to consumption, an observational survey of meal preparation in private kitchens, and detection and enumeration of pathogens on kitchenware and cooks’ hands. Thorough heating kills all bacteria present on chicken during cooking, but cross‐contamination of cooked chicken or ready‐to‐eat food prepared for the meal via kitchenware and cooks’ hands leads to a high expected frequency of pathogen ingestion. Additionally, significant growth of Salmonella is predicted during food storage at ambient temperature before and after meal preparation. These high exposures lead to a high estimated risk of campylobacteriosis and/or salmonellosis in Dakar households. The public health consequences could be amplified by the high level of antimicrobial resistance of Salmonella and Campylobacter observed in this setting. A significant decrease in the number of ingested bacteria and in the risk could be achieved through a reduction of the prevalence of chicken contamination at slaughter, and by the use of simple hygienic measures in the kitchen. There is an urgent need to reinforce the hygiene education of food handlers in Senegal.     

A Fuzzy‐Based Risk Assessment Framework for Autonomous Underwater Vehicle Under‐Ice Missions

The use of autonomous underwater vehicles (AUVs) for various scientific, commercial, and military applications has become more common with maturing technology and improved accessibility. One relatively new development lies in the use of AUVs for under‐ice marine science research in the Antarctic. The extreme environment, ice cover, and inaccessibility as compared to open‐water missions can result in a higher risk of loss. Therefore, having an effective assessment of risks before undertaking any Antarctic under‐ice missions is crucial to ensure an AUV's survival. Existing risk assessment approaches predominantly focused on the use of historical fault log data of an AUV and elicitation of experts’ opinions for probabilistic quantification. However, an AUV program in its early phases lacks historical data and any assessment of risk may be vague and ambiguous. In this article, a fuzzy‐based risk assessment framework is proposed for quantifying the risk of AUV loss under ice. The framework uses the knowledge, prior experience of available subject matter experts, and the widely used semiquantitative risk assessment matrix, albeit in a new form. A well‐developed example based on an upcoming mission by an ISE‐explorer class AUV is presented to demonstrate the application and effectiveness of the proposed framework. The example demonstrates that the proposed fuzzy‐based risk assessment framework is pragmatically useful for future under‐ice AUV deployments. Sensitivity analysis demonstrates the validity of the proposed method.     

A Bayesian Approach to Integrated Ecological and Human Health Risk Assessment for the South River,Virginia Mercury‐Contaminated Site

We conducted a regional‐scale integrated ecological and human health risk assessment by applying the relative risk model with Bayesian networks (BN‐RRM) to a case study of the South River, Virginia mercury‐contaminated site. Risk to four ecological services of the South River (human health, water quality, recreation, and the recreational fishery) was evaluated using a multiple stressor–multiple endpoint approach. These four ecological services were selected as endpoints based on stakeholder feedback and prioritized management goals for the river. The BN‐RRM approach allowed for the calculation of relative risk to 14 biotic, human health, recreation, and water quality endpoints from chemical and ecological stressors in five risk regions of the South River. Results indicated that water quality and the recreational fishery were the ecological services at highest risk in the South River. Human health risk for users of the South River was low relative to the risk to other endpoints. Risk to recreation in the South River was moderate with little spatial variability among the five risk regions. Sensitivity and uncertainty analysis identified stressors and other parameters that influence risk for each endpoint in each risk region. This research demonstrates a probabilistic approach to integrated ecological and human health risk assessment that considers the effects of chemical and ecological stressors across the landscape.     

Ensuring the Quality of Occupational Safety Risk Assessment

In work environments, the main aim of occupational safety risk assessment (OSRA) is to improve the safety level of an installation or site by either preventing accidents and injuries or minimizing their consequences. To this end, it is of paramount importance to identify all sources of hazards and assess their potential to cause problems in the respective context. If the OSRA process is inadequate and/or not applied effectively, it results in an ineffective safety prevention program and inefficient use of resources. An appropriate OSRA is an essential component of the occupational safety risk management process in industries. In this article, we performed a survey to elicit the relative importance for identified OSRA tasks to enable an in‐depth evaluation of the quality of risk assessments related to occupational safety aspects on industrial sites. The survey involved defining a questionnaire with the most important elements (tasks) for OSRA quality assessment, which was then presented to safety experts in the mining, electrical power production, transportation, and petrochemical industries. With this work, we expect to contribute to the main question of OSRA in industries: “What constitutes a good occupational safety risk assessment?” The results obtained from the questionnaire showed that experts agree with the proposed OSRA process decomposition in steps and tasks (taxonomy) and also with the importance of assigning weights to obtain knowledge about OSRA task relevance. The knowledge gained will enable us, in the near future, to build a framework to evaluate OSRA quality for industrial sites.     

Risk Assessment and Risk Governance of Liquefied Natural Gas Development in Gladstone,Australia

This article is a retrospective analysis of liquefied natural gas development (LNG) in Gladstone, Australia by using the structure of the risk governance framework developed by the International Risk Governance Council (IRGC). Since 2010 the port of Gladstone has undergone extensive expansion to facilitate the increasing coal export as well as the new development of three recently completed LNG facilities. Significant environmental and socio‐economic impacts and concerns have occurred as a result of these developments. The overall aim of the article, therefore, is to identify the risk governance deficits that arose and to formulate processes capable of improving similar decision‐making problems in the future. The structure of the IRGC framework is followed because it represents a broad analytical approach for considering risk assessment and risk governance in Gladstone in ways that include, but also go beyond, the risk approach of the ISO 31000:2009 standard that was employed at the time. The IRGC risk framework is argued to be a consistent and comprehensive risk governance framework that integrates scientific, economic, social, and cultural aspects and advocates the notion of inclusive risk governance through stakeholder communication and involvement. Key aspects related to risk preassessment, risk appraisal, risk tolerability and acceptability, risk management, and stakeholder communication and involvement are considered. The results indicate that the risk governance deficits include aspects related to (i) the risk matrix methodology, (ii) reflecting uncertainties, (iii) cumulative risks, (iv) the regulatory process, and (v) stakeholder communication and involvement.     

Life-Cycle Assessment in Relation to Risk Assessment: An Evolving Perspective

A life-cycle approach takes a cradle-to-grave perspective of a product's numerous activities from the raw material extraction to final disposal. There have been recent efforts to develop life-cycle assessment (LCA) to assess both environmental and human health issues. The question then arises: what are the capabilities of LCA, especially in relation to risk assessment? To address this question, this paper first describes the LCA mass-based accounting system and then analyzes the use of this approach for environmental and human health assessment. The key LCA limitations in this respect are loss of spatial, temporal, dose-response, and threshold information. These limitations affect LCA's capability to assess several environmental issues, and human health in particular. This leads to the conclusion that LCA impact assessment does not predict or measure actual effects, quantitate risks, or address safety. Instead, LCA uses mass loadings with simplifying assumptions and subjective judgments to add independent effects and exposures into an overall score. As a result, LCA identifies possible human health issues on a systemwide basis from a worst case, hypothetical hazard perspective. Ideally, the identified issues would then be addressed by more detailed assessment methods, such as risk assessment.     

Issues in Ecological Risk Assessment: The CRAM Perspective

In 1989, a Committee on Risk Assessment Methodology (CRAM) was convened by the National Research Council (NRC) to identify and investigate important scientific issues in risk assessment. One of the first issues considered by the committee was the development of a conceptual framework for ecological risk assessment, defined as "the characterization of the adverse ecological effects of environmental exposures to hazards imposed by human activities." Adverse ecological effects include all biological and nonbiological environmental changes that society perceives as undesirable. The committee's opinion was that a general framework is needed to define the relationship of ecological risk assessment to environmental management and to facilitate the development of uniform technical guidelines. The framework for human health risk assessment proposed by the NRC in 1983 was adopted as a starting point for discussion. CRAM concluded that, although ecological risk assessment and human health risk assessment differ substantially in terms of scientific disciplines and technical problems, the underlying decision process is the same for both. Therefore, CRAM recommended that the 1983 risk assessment framework be modified to accommodate both human health and ecological risk assessment. CRAM defined an integrated health/ ecological risk assessment framework consisting of the four components: Hazard Identification, Exposure Assessment, Exposure-Response Assessment, and Risk Characterization. CRAM further provided recommendations on the scope of issues to be addressed in ecological risk assessment, critical research needs, and mechanisms for providing more detailed guidance on the scientific content of ecological risk assessments.     

Characterizing the Risk of Infection from Mycobacterium tuberculosis in Commercial Passenger Aircraft Using Quantitative Microbial Risk Assessment

Quantitative microbial risk assessment was used to predict the likelihood and spatial organization of Mycobacterium tuberculosis ( Mtb ) transmission in a commercial aircraft. Passenger exposure was predicted via a multizone Markov model in four scenarios: seated or moving infectious passengers and with or without filtration of recirculated cabin air. The traditional exponential ( k  = 1) and a new exponential ( k  = 0.0218) dose-response function were used to compute infection risk. Emission variability was included by Monte Carlo simulation. Infection risks were higher nearer and aft of the source; steady state airborne concentration levels were not attained. Expected incidence was low to moderate, with the central 95% ranging from 10⁻⁶ to 10⁻¹ per 169 passengers in the four scenarios. Emission rates used were low compared to measurements from active TB patients in wards, thus a "superspreader" emitting 44 quanta/h could produce 6.2 cases or more under these scenarios. Use of respiratory protection by the infectious source and/or susceptible passengers reduced infection incidence up to one order of magnitude.     

Quantitative Assessment of the Risk of Release of Foot‐and‐Mouth Disease Virus via Export of Bull Semen from Israel

Various foot‐and‐mouth disease (FMD) virus strains circulate in the Middle East, causing frequent episodes of FMD outbreaks among Israeli livestock. Since the virus is highly resistant in semen, artificial insemination with contaminated bull semen may lead to the infection of the receiver cow. As a non‐FMD‐free country with vaccination, Israel is currently engaged in trading bull semen only with countries of the same status. The purpose of this study was to assess the risk of release of FMD virus through export of bull semen in order to estimate the risk for FMD‐free countries considering purchasing Israeli bull semen. A stochastic risk assessment model was used to estimate this risk, defined as the annual likelihood of exporting at least one ejaculate of bull semen contaminated with viable FMD virus. A total of 45 scenarios were assessed to account for uncertainty and variability around specific parameter estimates and to evaluate the effect of various mitigation measures, such as performing a preexport test on semen ejaculates. Under the most plausible scenario, the annual likelihood of exporting bull semen contaminated with FMD virus had a median of 1.3 * 10^?7 for an export of 100 ejaculates per year. This corresponds to one infected ejaculate exported every 7 million years. Under the worst‐case scenario, the median of the risk rose to 7.9 * 10^?5, which is equivalent to the export of one infected ejaculate every 12,000 years. Sensitivity analysis indicated that the most influential parameter is the probability of viral excretion in infected bulls.     

One Agency's Use of Risk Assessment and Risk Communication1

Few organizations have the courage to evaluate their own use of risk assessment (identifying hazards and estimating their probability and magnitude) and risk communication (interacting with internal and external stakeholder groups about risks). The USDA Animal and Plant Health Inspection Service (APHIS) wants to enhance its overall risk analysis process for managing a wide range of risks to animals, plants, and human health. We gathered survey data for a baseline of APHIS professionals’ understanding and use of risk assessment and risk communication. APHIS professionals spend a surprisingly large share of their time communicating about risks. They perceive that risk estimates influence decisions, but that risk estimates should have more influence. Respondents reported little opposition to APHIS risk management decisions, and little use of channels such as USDA Extension Service for disseminating risk messages. Substantial variance across responses is explained mostly by differences in the roles of the 11 work units (now 10) within the agency. Location also contributes to the variance. Demographic variables seem less important.     

Role of Comparative Risk Assessment in Addressing Environmental Security in the Middle East

During the 21st century, environmental challenges are likely to intensify across the world and possibly lead to violent conflicts. Strategies for conflict avoidance will be incomplete unless they recognize, discuss, and mitigate regional environmental stress factors. Comparative risk assessment (CRA) is one of the most critical tools emerging to influence modern environmental policies and is increasingly used to create a common language to help reconcile competing interests in development and environmental disputes around the world. This article considers the environmental challenges facing the Middle East in light of their "transboundary" nature and proposes CRA as a framework for setting environmental priorities and reducing tensions in the region.     

A Comparative Exposure Assessment of Campylobacter in Ontario,Canada

To inform source attribution efforts, a comparative exposure assessment was developed to estimate the relative exposure to Campylobacter, the leading bacterial gastrointestinal disease in Canada, for 13 different transmission routes within Ontario, Canada, during the summer. Exposure was quantified with stochastic models at the population level, which incorporated measures of frequency, quantity ingested, prevalence, and concentration, using data from FoodNet Canada surveillance, the peer‐reviewed and gray literature, other Ontario data, and data that were specifically collected for this study. Models were run with @Risk software using Monte Carlo simulations. The mean number of cells of Campylobacter ingested per Ontarian per day during the summer, ranked from highest to lowest is as follows: household pets, chicken, living on a farm, raw milk, visiting a farm, recreational water, beef, drinking water, pork, vegetables, seafood, petting zoos, and fruits. The study results identify knowledge gaps for some transmission routes, and indicate that some transmission routes for Campylobacter are underestimated in the current literature, such as household pets and raw milk. Many data gaps were identified for future data collection consideration, especially for the concentration of Campylobacter in all transmission routes.     

Risk Assessment of the Carbon Nanotube Group

This study assessed the health risks via inhalation and derived the occupational exposure limit (OEL) for the carbon nanotube (CNT) group rather than individual CNT material. We devised two methods: the integration of the intratracheal instillation (IT) data with the inhalation (IH) data, and the “biaxial approach.” A four‐week IH test and IT test were performed in rats exposed to representative materials to obtain the no observed adverse effect level, based on which the OEL was derived. We used the biaxial approach to conduct a relative toxicity assessment of six types of CNTs. An OEL of 0.03 mg/m³ was selected as the criterion for the CNT group. We proposed that the OEL be limited to 15 years. We adopted adaptive management, in which the values are reviewed whenever new data are obtained. The toxicity level was found to be correlated with the Brunauer‐Emmett‐Teller (BET)‐specific surface area (BET‐SSA) of CNT, suggesting the BET‐SSA to have potential for use in toxicity estimation. We used the published exposure data and measurement results of dustiness tests to compute the risk in relation to particle size at the workplace and showed that controlling micron‐sized respirable particles was of utmost importance. Our genotoxicity studies indicated that CNT did not directly interact with genetic materials. They supported the concept that, even if CNT is genotoxic, it is secondary genotoxicity mediated via a pathway of genotoxic damage resulting from oxidative DNA attack by free radicals generated during CNT‐elicited inflammation. Secondary genotoxicity appears to involve a threshold.     

Exploring the Uncertainties in Cancer Risk Assessment Using the Integrated Probabilistic Risk Assessment (IPRA) Approach

Current methods for cancer risk assessment result in single values, without any quantitative information on the uncertainties in these values. Therefore, single risk values could easily be overinterpreted. In this study, we discuss a full probabilistic cancer risk assessment approach in which all the generally recognized uncertainties in both exposure and hazard assessment are quantitatively characterized and probabilistically evaluated, resulting in a confidence interval for the final risk estimate. The methodology is applied to three example chemicals (aflatoxin, N‐nitrosodimethylamine, and methyleugenol). These examples illustrate that the uncertainty in a cancer risk estimate may be huge, making single value estimates of cancer risk meaningless. Further, a risk based on linear extrapolation tends to be lower than the upper 95% confidence limit of a probabilistic risk estimate, and in that sense it is not conservative. Our conceptual analysis showed that there are two possible basic approaches for cancer risk assessment, depending on the interpretation of the dose‐incidence data measured in animals. However, it remains unclear which of the two interpretations is the more adequate one, adding an additional uncertainty to the already huge confidence intervals for cancer risk estimates.