Evaluation of Proactive and Reactive Strategies for Polio Eradication Activities in Pakistan and Afghanistan

Only Pakistan and Afghanistan reported any polio cases caused by serotype 1 wild polioviruses (WPV1s) in 2017. With the dwindling cases in both countries and pressure to finish eradication with the least possible resources, a danger exists of inappropriate prioritization of efforts between the two countries and insufficient investment in the two countries to finish the job. We used an existing differential‐equation‐based poliovirus transmission and oral poliovirus (OPV) evolution model to simulate a proactive strategy to stop transmission, and different hypothetical reactive strategies that adapt the quality of supplemental immunization activities (SIAs) in response to observed polio cases in Pakistan and Afghanistan. To account for the delay in perception and adaptation, we related the coverage of the SIAs in high‐risk, undervaccinated subpopulations to the perceived (i.e., smoothed) polio incidence. Continuation of the current frequency and quality of SIAs remains insufficient to eradicate WPV1 in Pakistan and Afghanistan. Proactive strategies that significantly improve and sustain SIA quality lead to WPV1 eradication and the prevention of circulating vaccine‐derived poliovirus (cVDPV) outbreaks. Reactive vaccination efforts that adapt moderately quickly and independently to changes in polio incidence in each country may succeed in WPV1 interruption after several cycles of outbreaks, or may interrupt WPV1 transmission in one country but subsequently import WPV1 from the other country or enable the emergence of cVDPV outbreaks. Reactive vaccination efforts that adapt independently and either more rapidly or more slowly to changes in polio incidence in each country may similarly fail to interrupt WPV1 transmission and result in oscillations of the incidence. Reactive strategies that divert resources to the country of highest priority may lead to alternating large outbreaks. Achieving WPV1 eradication and subsequent successful OPV cessation in Pakistan and Afghanistan requires proactive and sustained efforts to improve vaccination intensity in under‐vaccinated subpopulations while maintaining high population immunity elsewhere.     

Modeling Population Immunity to Support Efforts to End the Transmission of Live Polioviruses

Eradication of wild poliovirus (WPV) types 1 and 3, prevention and cessation of circulating vaccine‐derived polioviruses, and achievement and maintenance of a world free of paralytic polio cases requires active risk management by focusing on population immunity and coordinated cessation of oral poliovirus vaccine (OPV). We suggest the need for a complementary and different conceptual approach to achieve eradication compared to the current case‐based approach using surveillance for acute flaccid paralysis (AFP) to identify symptomatic poliovirus infections. Specifically, we describe a modeling approach to characterize overall population immunity to poliovirus transmission. The approach deals with the realities that exposure to live polioviruses (e.g., WPV, OPV) and/or vaccination with inactivated poliovirus vaccine provides protection from paralytic polio (i.e., disease), but does not eliminate the potential for reinfection or asymptomatic participation in poliovirus transmission, which may increase with time because of waning immunity. The AFP surveillance system provides evidence of symptomatic poliovirus infections detected, which indicate immunity gaps after outbreaks occur, and this system represents an appropriate focus for controlling disease outbreaks. We describe a conceptual dynamic model to characterize population immunity to poliovirus transmission that helps identify risks created by immunity gaps before outbreaks occur, which provides an opportunity for national and global policymakers to manage the risk of poliovirus and prevent outbreaks before they occur. We suggest that dynamically modeling risk represents an essential tool as the number of cases approaches zero.     

Modeling Poliovirus Transmission in Pakistan and Afghanistan to Inform Vaccination Strategies in Undervaccinated Subpopulations

Due to security, access, and programmatic challenges in areas of Pakistan and Afghanistan, both countries continue to sustain indigenous wild poliovirus (WPV) transmission and threaten the success of global polio eradication and oral poliovirus vaccine (OPV) cessation. We fitted an existing differential‐equation‐based poliovirus transmission and OPV evolution model to Pakistan and Afghanistan using four subpopulations to characterize the well‐vaccinated and undervaccinated subpopulations in each country. We explored retrospective and prospective scenarios for using inactivated poliovirus vaccine (IPV) in routine immunization or supplemental immunization activities (SIAs). The undervaccinated subpopulations sustain the circulation of serotype 1 WPV and serotype 2 circulating vaccine‐derived poliovirus. We find a moderate impact of past IPV use on polio incidence and population immunity to transmission mainly due to (1) the boosting effect of IPV for individuals with preexisting immunity from a live poliovirus infection and (2) the effect of IPV‐only on oropharyngeal transmission for individuals without preexisting immunity from a live poliovirus infection. Future IPV use may similarly yield moderate benefits, particularly if access to undervaccinated subpopulations dramatically improves. However, OPV provides a much greater impact on transmission and the incremental benefit of IPV in addition to OPV remains limited. This study suggests that despite the moderate effect of using IPV in SIAs, using OPV in SIAs remains the most effective means to stop transmission, while limited IPV resources should prioritize IPV use in routine immunization.     

Characterizing Poliovirus Transmission and Evolution: Insights from Modeling Experiences with Wild and Vaccine‐Related Polioviruses

With national and global health policymakers facing numerous complex decisions related to achieving and maintaining polio eradication, we expanded our previously developed dynamic poliovirus transmission model using information from an expert literature review process and including additional immunity states and the evolution of oral poliovirus vaccine (OPV). The model explicitly considers serotype differences and distinguishes fecal‐oral and oropharyngeal transmission. We evaluated the model by simulating diverse historical experiences with polioviruses, including one country that eliminated wild poliovirus using both OPV and inactivated poliovirus vaccine (IPV) (USA), three importation outbreaks of wild poliovirus (Albania, the Netherlands, Tajikistan), one situation in which no circulating vaccine‐derived polioviruses (cVDPVs) emerge despite annual OPV use and cessation (Cuba), three cVDPV outbreaks (Haiti, Madura Island in Indonesia, northern Nigeria), one area of current endemic circulation of all three serotypes (northern Nigeria), and one area with recent endemic circulation and subsequent elimination of multiple serotypes (northern India). We find that when sufficient information about the conditions exists, the model can reproduce the general behavior of poliovirus transmission and outbreaks while maintaining consistency in the generic model inputs. The assumption of spatially homogeneous mixing remains a significant limitation that affects the performance of the differential equation‐based model when significant heterogeneities in immunity and mixing may exist. Further studies on OPV virus evolution and improved understanding of the mechanisms of mixing and transmission may help to better characterize poliovirus transmission in populations. Broad application of the model promises to offer insights in the context of global and national policy and economic models.     

Expert Review on Poliovirus Immunity and Transmission

Successfully managing risks to achieve wild polioviruses (WPVs) eradication and address the complexities of oral poliovirus vaccine (OPV) cessation to stop all cases of paralytic poliomyelitis depends strongly on our collective understanding of poliovirus immunity and transmission. With increased shifting from OPV to inactivated poliovirus vaccine (IPV), numerous risk management choices motivate the need to understand the tradeoffs and uncertainties and to develop models to help inform decisions. The U.S. Centers for Disease Control and Prevention hosted a meeting of international experts in April 2010 to review the available literature relevant to poliovirus immunity and transmission. This expert review evaluates 66 OPV challenge studies and other evidence to support the development of quantitative models of poliovirus transmission and potential outbreaks. This review focuses on characterization of immunity as a function of exposure history in terms of susceptibility to excretion, duration of excretion, and concentration of excreted virus. We also discuss the evidence of waning of host immunity to poliovirus transmission, the relationship between the concentration of poliovirus excreted and infectiousness, the importance of different transmission routes, and the differences in transmissibility between OPV and WPV. We discuss the limitations of the available evidence for use in polio risk models, and conclude that despite the relatively large number of studies on immunity, very limited data exist to directly support quantification of model inputs related to transmission. Given the limitations in the evidence, we identify the need for expert input to derive quantitative model inputs from the existing data.     

Preeradication Vaccine Policy Options for Poliovirus Infection and Disease Control

With the circulation of wild poliovirus (WPV) types 1 and 3 continuing more than a decade after the original goal of eradicating all three types of WPVs by 2000, policymakers consider many immunization options as they strive to stop transmission in the remaining endemic and outbreak areas and prevent reintroductions of live polioviruses into nonendemic areas. While polio vaccination choices may appear simple, our analysis of current options shows remarkable complexity. We offer important context for current and future polio vaccine decisions and policy analyses by developing decision trees that clearly identify potential options currently used by countries as they evaluate national polio vaccine choices. Based on a comprehensive review of the literature we (1) identify the current vaccination options that national health leaders consider for polio vaccination, (2) characterize current practices and factors that appear to influence national and international choices, and (3) assess the evidence of vaccine effectiveness considering sources of variability between countries and uncertainties associated with limitations of the data. With low numbers of cases occurring globally, the management of polio risks might seem like a relatively low priority, but stopping live poliovirus circulation requires making proactive and intentional choices to manage population immunity in the remaining endemic areas and to prevent reestablishment in nonendemic areas. Our analysis shows remarkable variability in the current national polio vaccine product choices and schedules, with combination vaccine options containing inactivated poliovirus vaccine and different formulations of oral poliovirus vaccine making choices increasingly difficult for national health leaders.     

Modeling undetected live type 1 wild poliovirus circulation after apparent interruption of transmission: Pakistan and Afghanistan

Since 2013, wild poliovirus (WPV) transmission occurred only for type 1 (WPV1). Following several years of increasing reported incidence (2017–2019) and programmatic disruptions caused by COVID-19 (early 2020), Pakistan and Afghanistan performed a large number of supplementary immunization activities (late 2020–2021). This increased intensity of immunization, following widespread transmission, substantially decreased WPV1 cases and positive environmental samples during 2021. Modeling the potential for undetected circulation of WPV1 after apparent interruption can support regional and global decisions about certification of the eradication of indigenous WPV1 transmission. We apply a stochastic model to estimate the confidence about no circulation (CNC) of WPV1 in Pakistan and Afghanistan as a function of time since the last reported case and/or positive environmental sample. Exploration of different assumptions about surveillance quality suggests a range for CNC for WPV1 as a function of time since the last positive surveillance signal, and supports the potential use of a time with no evidence of transmission of less than 3 years as sufficient to assume die out in the context of good acute flaccid paralysis (AFP) surveillance. We show high expected CNC based on AFP surveillance data alone, even with imperfect surveillance and some use of inactivated poliovirus vaccine masking the ability of AFP surveillance to detect transmission. Ensuring high quality AFP and environmental surveillance may substantially shorten the time required to reach high CNC. The time required for high CNC depends on whether immunization activities maintain high population immunity and the quality of surveillance data.     

Oral Poliovirus Vaccine Evolution and Insights Relevant to Modeling the Risks of Circulating Vaccine‐Derived Polioviruses (cVDPVs)

The live, attenuated oral poliovirus vaccine (OPV) provides a powerful tool for controlling and stopping the transmission of wild polioviruses (WPVs), although the risks of vaccine‐associated paralytic polio (VAPP) and circulating vaccine‐derived poliovirus (cVDPV) outbreaks exist as long as OPV remains in use. Understanding the dynamics of cVDPV emergence and outbreaks as a function of population immunity and other risk factors may help to improve risk management and the development of strategies to respond to possible outbreaks. We performed a comprehensive review of the literature related to the process of OPV evolution and information available from actual experiences with cVDPV outbreaks. Only a relatively small fraction of poliovirus infections cause symptoms, which makes direct observation of the trajectory of OPV evolution within a population impractical and leads to significant uncertainty. Despite a large global surveillance system, the existing genetic sequence data largely provide information about transmitted virulent polioviruses that caused acute flaccid paralysis, and essentially no data track the changes that occur in OPV sequences as the viruses transmit largely asymptomatically through real populations with suboptimal immunity. We updated estimates of cVDPV risks based on actual experiences and identified the many limitations in the existing data on poliovirus transmission and immunity and OPV virus evolution that complicate modeling. Modelers should explore the space of potential model formulations and inputs consistent with the available evidence and future studies should seek to improve our understanding of the OPV virus evolution process to provide better information for policymakers working to manage cVDPV risks.     

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.     

Evaluation of Response Scenarios to Potential Polio Outbreaks Using Mathematical Models

Appropriate response to polio outbreaks represents an important prerequisite for achieving and maintaining global polio eradication. We use an existing dynamic disease transmission model to evaluate the impact of different aspects of immunization campaigns in response to polio outbreaks occurring in previously polio-free areas. This analysis yields several important insights about response strategies. We find that delay in response represents a crucial risk factor for occurrence of large outbreaks and we characterize the tradeoffs associated with delaying the initial response to achieve better population coverage. We also demonstrate that controlling most potential outbreaks will likely require at least three immunization rounds, although the impact of the optimal interval between rounds varies. Finally, long after oral poliovirus vaccine cessation the choice of target age groups during a response represents an important consideration.     

Modeling Undetected Live Poliovirus Circulation After Apparent Interruption of Transmission: Pakistan and Afghanistan

Since most poliovirus infections occur with no paralytic symptoms, the possibility of silent circulation complicates the confirmation of the end of poliovirus transmission. Based on empirical field experience and theoretical modeling results, the Global Polio Eradication Initiative identified three years without observing paralytic cases from wild polioviruses with good acute flaccid paralysis surveillance as an indication of sufficient confidence that poliovirus circulation stopped. The complexities of real populations and the imperfect nature of real surveillance systems subsequently demonstrated the importance of specific modeling for areas at high risk of undetected circulation, resulting in varying periods of time required to obtain the same level of confidence about no undetected circulation. Using a poliovirus transmission model that accounts for variability in transmissibility and neurovirulence for different poliovirus serotypes and characterizes country‐specific factors (e.g., vaccination and surveillance activities, demographics) related to wild and vaccine‐derived poliovirus transmission in Pakistan and Afghanistan, we consider the probability of undetected poliovirus circulation for those countries once apparent die‐out occurs (i.e., in the absence of any epidemiological signals). We find that gaps in poliovirus surveillance or reaching elimination with borderline sufficient population immunity could significantly increase the time to reach high confidence about interruption of live poliovirus transmission, such that the path taken to achieve and maintain poliovirus elimination matters. Pakistan and Afghanistan will need to sustain high‐quality surveillance for polioviruses after apparent interruption of transmission and recognize that as efforts to identify cases or circulating live polioviruses decrease, the risks of undetected circulation increase and significantly delay the global polio endgame.     

Coupling the Biophysical and Social Dimensions of Wildfire Risk to Improve Wildfire Mitigation Planning

We describe recent advances in biophysical and social aspects of risk and their potential combined contribution to improve mitigation planning on fire‐prone landscapes. The methods and tools provide an improved method for defining the spatial extent of wildfire risk to communities compared to current planning processes. They also propose an expanded role for social science to improve understanding of community‐wide risk perceptions and to predict property owners’ capacities and willingness to mitigate risk by treating hazardous fuels and reducing the susceptibility of dwellings. In particular, we identify spatial scale mismatches in wildfire mitigation planning and their potential adverse impact on risk mitigation goals. Studies in other fire‐prone regions suggest that these scale mismatches are widespread and contribute to continued wildfire dwelling losses. We discuss how risk perceptions and behavior contribute to scale mismatches and how they can be minimized through integrated analyses of landscape wildfire transmission and social factors that describe the potential for collaboration among landowners and land management agencies. These concepts are then used to outline an integrated socioecological planning framework to identify optimal strategies for local community risk mitigation and improve landscape‐scale prioritization of fuel management investments by government entities.     

An Integrated Framework for Environmental Multi‐Impact Spatial Risk Analysis

Quantitative risk analysis is being extensively employed to support policymakers and provides a strong conceptual framework for evaluating decision alternatives under uncertainty. Many problems involving environmental risks are, however, of a spatial nature, i.e., containing spatial impacts, spatial vulnerabilities, and spatial risk‐mitigation alternatives. Recent developments in multicriteria spatial analysis have enabled the assessment and aggregation of multiple impacts, supporting policymakers in spatial evaluation problems. However, recent attempts to conduct spatial multicriteria risk analysis have generally been weakly conceptualized, without adequate roots in quantitative risk analysis. Moreover, assessments of spatial risk often neglect the multidimensional nature of spatial impacts (e.g., social, economic, human) that are typically occurring in such decision problems. The aim of this article is therefore to suggest a conceptual quantitative framework for environmental multicriteria spatial risk analysis based on expected multi‐attribute utility theory. The framework proposes: (i) the formal assessment of multiple spatial impacts; (ii) the aggregation of these multiple spatial impacts; (iii) the assessment of spatial vulnerabilities and probabilities of occurrence of adverse events; (iv) the computation of spatial risks; (v) the assessment of spatial risk mitigation alternatives; and (vi) the design and comparison of spatial risk mitigation alternatives (e.g., reductions of vulnerabilities and/or impacts). We illustrate the use of the framework in practice with a case study based on a flood‐prone area in northern Italy.     

A Quantitative Assessment of the Risks from Illegally Imported Meat Contaminated with Foot and Mouth Disease Virus to Great Britain

Foot and mouth disease (FMD) is considered by many as the most important animal disease in the world. FMD is highly contagious and outbreaks incur significant costs as affected countries are severely limited in their ability to trade. A number of trade commodities may be contaminated with FMD virus (FMDV) including animal products, for example, meat. As a member of the European Union, Great Britain (GB) has put in place a number of regulations to prevent the importation of pathogens in imported meat products. However, the illegal importation of meat provides a route by which safety controls may be circumvented and meat from FMD affected areas may be imported. This study assesses the FMD infection risk posed to the livestock population of GB from the illegal importation of meat, and estimates the major contributors to this overall risk, through the development of a quantitative risk assessment model. From model results, the total amount of illegal meat entering GB each year is estimated on average to be 11,875 tonnes. with 90% certainty that this is between 4,398 and 28,626 tonnes per year; of which between 64.5 and 565 kg are contaminated with FMDV. This flow of illegal meat results in an estimate of a frequency of FMD infection in GB livestock of 0.015 cases of infected animals per year, with 90% certainty it is between 0.0017 and 0.053. Imports from the region Near and Middle East account for 47% of this risk, and 68% of the risk is attributed to bone-in and dried de-boned products.     

Spatial Risk Analysis of Power Systems Resilience During Extreme Events

The increased frequency of extreme events in recent years highlights the emerging need for the development of methods that could contribute to the mitigation of the impact of such events on critical infrastructures, as well as boost their resilience against them. This article proposes an online spatial risk analysis capable of providing an indication of the evolving risk of power systems regions subject to extreme events. A Severity Risk Index (SRI) with the support of real‐time monitoring assesses the impact of the extreme events on the power system resilience, with application to the effect of windstorms on transmission networks. The index considers the spatial and temporal evolution of the extreme event, system operating conditions, and the degraded system performance during the event. SRI is based on probabilistic risk by condensing the probability and impact of possible failure scenarios while the event is spatially moving across a power system. Due to the large number of possible failures during an extreme event, a scenario generation and reduction algorithm is applied in order to reduce the computation time. SRI provides the operator with a probabilistic assessment that could lead to effective resilience‐based decisions for risk mitigation. The IEEE 24‐bus Reliability Test System has been used to demonstrate the effectiveness of the proposed online risk analysis, which was embedded in a sequential Monte Carlo simulation for capturing the spatiotemporal effects of extreme events and evaluating the effectiveness of the proposed method.     

The Contrast Between Risk Assessment and Rules of Evidence in the Context of International Trade Disputes: Can the U.S. Experience Inform the Process?

Risk assessment provides a formalized process to evaluate human, animal, and ecological responses associated with exposure to environmental agents. The purpose of risk assessment is to answer two related questions.

• ? How likely is an (adverse) event to occur?
• ? If it does, how severe will the impact be?

In the United States, the science of risk assessment has evolved out of the necessity to make public health decisions in the face of scientific uncertainty. Its basic propositions have been established over the past three decades and its applications have impacted virtually every aspect of public health and environmental protection in many countries, including the United States. More recently, the World Trade Organization's (WTO) dispute‐settlement process has provided additional incentive for the reliance on risk assessments internationally through the requirement that member countries be able to provide scientific justification, based on a risk assessment, for public health and environmental regulatory measures that are challenged. The purpose of this article is to review the history of risk assessment in the United States, emphasizing the development of both its scientific and policy aspects, as one example of the development of institutional capacity for risk assessment. This article discusses the importance of the social, political, and economic contexts of risk assessment and risk management in shaping the approaches taken while highlighting the reality that the analytic or risk assessment part of the decision‐making process, in the absence of scientific data, can be completed only by inserting inferences, or policy judgments, which may differ among countries. This article recognizes these differences, and the consequent difference between risk assessment that incorporates public health protective assumptions and the rules of evidence that seek to answer questions of causality, and discusses implications for the WTO dispute‐settlement process. It further explores the value of country‐specific risk assessment guidelines to facilitate consistency within a country along with the appropriateness and feasibility of international risk assessment guidelines.     

An Integrated Risk Assessment Model of Township‐Scaled Land Subsidence Based on an Evidential Reasoning Algorithm and Fuzzy Set Theory

Land subsidence risk assessment (LSRA) is a multi‐attribute decision analysis (MADA) problem and is often characterized by both quantitative and qualitative attributes with various types of uncertainty. Therefore, the problem needs to be modeled and analyzed using methods that can handle uncertainty. In this article, we propose an integrated assessment model based on the evidential reasoning (ER) algorithm and fuzzy set theory. The assessment model is structured as a hierarchical framework that regards land subsidence risk as a composite of two key factors: hazard and vulnerability. These factors can be described by a set of basic indicators defined by assessment grades with attributes for transforming both numerical data and subjective judgments into a belief structure. The factor‐level attributes of hazard and vulnerability are combined using the ER algorithm, which is based on the information from a belief structure calculated by the Dempster‐Shafer (D‐S) theory, and a distributed fuzzy belief structure calculated by fuzzy set theory. The results from the combined algorithms yield distributed assessment grade matrices. The application of the model to the Xixi‐Chengnan area, China, illustrates its usefulness and validity for LSRA. The model utilizes a combination of all types of evidence, including all assessment information—quantitative or qualitative, complete or incomplete, and precise or imprecise—to provide assessment grades that define risk assessment on the basis of hazard and vulnerability. The results will enable risk managers to apply different risk prevention measures and mitigation planning based on the calculated risk states.     

Risk Management in a Polio-Free World

Inherent in the decision to launch the Global Polio Eradication Initiative in 1988 was the expectation for many people that immunization against poliomyelitis would eventually simply stop, as had been the case with smallpox following its eradication in 1977. However, the strategies for managing the risks associated with a "polio-free" world must be continuously refined to reflect new developments, particularly in our understanding of the live polioviruses in the oral poliovirus vaccine (OPV) and in the international approach to managing potential biohazards. The most important of these developments has been the confirmation in 2000 that vaccine-derived polioviruses (VDPVs) can circulate and cause polio outbreaks, making the use of OPV after interruption of wild poliovirus transmission incompatible with a polio-free world. A comprehensive strategy has been developed to minimize the risks associated with eventual OPV cessation, centered on appropriate long-term biocontainment of poliovirus stocks (whether for vaccine production, diagnosis, or research), the controlled reintroduction of any live poliovirus vaccine (i.e., from an OPV stockpile), and appropriate use of the inactivated poliovirus vaccine (IPV). Although some aspects of this risk management strategy are still debated, there is wide agreement that no strategy would entirely eliminate the potential risks to a polio-free world. The current strategy for risk management in a polio-free world will continue to evolve with better characterization of these risks and the development of more effective approaches both to reduce those risks and to limit their consequences should they occur.     

Risk Assessment of Human Toxoplasmosis Associated with the Consumption of Pork Meat in Italy

Toxoplasmosis is a cosmopolitan disease and has a broad range of hosts, including humans and several wild and domestic animals. The human infection is mostly acquired through the consumption of contaminated food and pork meat has been recognized as one of the major sources of transmission. There are, however, certain fundamental differences between countries; therefore, the present study specifically aims to evaluate the exposure of the Italian population to Toxoplasma gondii through the ingestion of several types of pork meat products habitually consumed in Italy and to estimate the annual number of human infections within two subgroups of the population. A quantitative risk assessment model was built for this reason and was enriched with new elements in comparison to other similar risk assessments in order to enhance its accuracy. Sensitivity analysis and two alternative scenarios were implemented to identify the factors that have the highest impact on risk and to simulate different plausible conditions, respectively. The estimated overall average number of new infections per year among adults is 12,513 and 92 for pregnant women. The baseline model showed that almost all these infections are associated with the consumption of fresh meat cuts and preparations (mean risk of infection varied between 4.5 × 10⁻⁵ and 5.5 × 10⁻⁵) and only a small percentage is due to fermented sausages/salami. On the contrary, salt‐cured meat products seem to pose minor risk but further investigations are needed to clarify still unclear aspects. Among all the considered variables, cooking temperature and bradyzoites’ concentration in muscle impacted most the risk.