Effect of detection methods on risk estimates of exposure to biosolids-associated human enteric viruses

This study illustrates the effect of virus detection methods on estimates of risks of infection of biosolids-associated viruses for occupational workers and residential population during a hypothetical exposure of biosolids. Five gastroenteritis-associated human enteric viruses--enteroviruses (echovirus-12, enteroviruse types 68-71), adenoviruses, rotaviruses, and noroviruses genotype--I-were considered to represent human enteric viruses for risk estimation purposes. Ingested viral doses were calculated using literature-reported total infectious virus concentrations (based on BGM and A549 cell lines) and genome copies (GCs) in Michigan dewatered and class B biosolids. Cell-line-based infectivity parameters (i.e., ratio of total infectious virus concentration to GCs) were developed for different viruses in biosolids to use GCs for calculating ingested viral dose, addressing the issue of integration of molecular methods with biosolids-based virus risk assessment. Use of virus concentrations from molecular methods (with and without using cell-line-based infectivity parameter) resulted in higher risk estimates than culture methods, indicating the effect of the virus detection method on risk estimates. Further, use of virus concentrations from A549 cell lines resulted in higher risk estimates compared to those from BGM cell lines, suggesting the need for a proper choice of cell lines in determining infectious viral dose. The Monte Carlo uncertainty analyses of estimates for risk of infection due to enteroviruses showed that enteroviruses concentration was the most important parameter influencing risk estimates, indicating the need for reducing associated uncertainty. More work is required to develop cell-line-based infectivity parameters for different virus concentration levels and sample matrix types using a cut-off-based approach.     

A Decision Support Tool to Compare Waterborne and Foodborne Infection and/or Illness Risks Associated with Climate Change

Climate change may impact waterborne and foodborne infectious disease, but to what extent is uncertain. Estimating climate‐change‐associated relative infection risks from exposure to viruses, bacteria, or parasites in water or food is critical for guiding adaptation measures. We present a computational tool for strategic decision making that describes the behavior of pathogens using location‐specific input data under current and projected climate conditions. Pathogen‐pathway combinations are available for exposure to norovirus, Campylobacter, Cryptosporidium, and noncholera Vibrio species via drinking water, bathing water, oysters, or chicken fillets. Infection risk outcomes generated by the tool under current climate conditions correspond with those published in the literature. The tool demonstrates that increasing temperatures lead to increasing risks for infection with Campylobacter from consuming raw/undercooked chicken fillet and for Vibrio from water exposure. Increasing frequencies of drought generally lead to an elevated infection risk of exposure to persistent pathogens such as norovirus and Cryptosporidium, but decreasing risk of exposure to rapidly inactivating pathogens, like Campylobacter. The opposite is the case with increasing annual precipitation; an upsurge of heavy rainfall events leads to more peaks in infection risks in all cases. The interdisciplinary tool presented here can be used to guide climate change adaptation strategies focused on infectious diseases.     

A Risk Analysis for Airborne Pathogens with Low Infectious Doses: Application to Respirator Selection Against Coccidioides immitis Spores

Probability models incorporating a deterministic versus stochastic infectious dose are described for estimating infection risk due to airborne pathogens that infect at low doses. Such pathogens can be occupational hazards or candidate agents for bioterrorism. Inputs include parameters for the infectious dose model, distribution parameters for ambient pathogen concentrations, the breathing rate, the duration of an exposure period, the anticipated number of exposure periods, and, if a respirator device is used, distribution parameters for respirator penetration values. Application of the models is illustrated with a hypothetical scenario involving exposure to Coccidioides immitis, a fungus present in soil in areas of the southwestern United States Inhaling C. immitis spores causes a respiratory tract infection and is a recognized occupational hazard in jobs involving soil dust exposure in endemic areas An uncertainty analysis is applied to risk estimation in the context of selecting respiratory protection with a desired degree of efficacy.     

Impact of Acquired Immunity and Dose‐Dependent Probability of Illness on Quantitative Microbial Risk Assessment

Dose‐response models in microbial risk assessment consider two steps in the process ultimately leading to illness: from exposure to (asymptomatic) infection, and from infection to (symptomatic) illness. Most data and theoretical approaches are available for the exposure‐infection step; the infection‐illness step has received less attention. Furthermore, current microbial risk assessment models do not account for acquired immunity. These limitations may lead to biased risk estimates. We consider effects of both dose dependency of the conditional probability of illness given infection, and acquired immunity to risk estimates, and demonstrate their effects in a case study on exposure to Campylobacter jejuni. To account for acquired immunity in risk estimates, an inflation factor is proposed. The inflation factor depends on the relative rates of loss of protection over exposure. The conditional probability of illness given infection is based on a previously published model, accounting for the within‐host dynamics of illness. We find that at low (average) doses, the infection‐illness model has the greatest impact on risk estimates, whereas at higher (average) doses and/or increased exposure frequencies, the acquired immunity model has the greatest impact. The proposed models are strongly nonlinear, and reducing exposure is not expected to lead to a proportional decrease in risk and, under certain conditions, may even lead to an increase in risk. The impact of different dose‐response models on risk estimates is particularly pronounced when introducing heterogeneity in the population exposure distribution.     

A Probabilistic Transmission Dynamic Model to Assess Indoor Airborne Infection Risks

The purpose of this article is to quantify the public health risk associated with inhalation of indoor airborne infection based on a probabilistic transmission dynamic modeling approach. We used the Wells-Riley mathematical model to estimate (1) the CO2 exposure concentrations in indoor environments where cases of inhalation airborne infection occurred based on reported epidemiological data and epidemic curves for influenza and severe acute respiratory syndrome (SARS), (2) the basic reproductive number, R0 (i.e., expected number of secondary cases on the introduction of a single infected individual in a completely susceptible population) and its variability in a shared indoor airspace, and (3) the risk for infection in various scenarios of exposure in a susceptible population for a range of R0. We also employ a standard susceptible-infectious-recovered (SIR) structure to relate Wells-Riley model derived R0 to a transmission parameter to implicate the relationships between indoor carbon dioxide concentration and contact rate. We estimate that a single case of SARS will infect 2.6 secondary cases on average in a population from nosocomial transmission, whereas less than 1 secondary infection was generated per case among school children. We also obtained an estimate of the basic reproductive number for influenza in a commercial airliner: the median value is 10.4. We suggest that improving the building air cleaning rate to lower the critical rebreathed fraction of indoor air can decrease transmission rate. Here, we show that virulence of the organism factors, infectious quantum generation rates (quanta/s by an infected person), and host factors determine the risk for inhalation of indoor airborne infection.     

A Conceptual Framework to Assess the Risks of Human Disease Following Exposure to Pathogens

Currently, risk assessments of the potential human health effects associated with exposure to pathogens are utilizing the conceptual framework that was developed to assess risks associated with chemical exposures. However, the applicability of the chemical framework is problematic due to many issues that are unique to assessing risks associated with pathogens. These include, but are not limited to, an assessment of pathogen/host interactions, consideration of secondary spread, consideration of short- and long-term immunity, and an assessment of conditions that allow the microorganism to propagate. To address this concern, a working group was convened to develop a conceptual framework to assess the risks of human disease associated with exposure to pathogenic microorganisms. The framework that was developed consists of three phases: problem formulation, analysis (which includes characterization of exposure and human health effects), and risk characterization. The framework emphasizes the dynamic and iterative nature of the risk assessment process, and allows wide latitude for planning and conducting risk assessments in diverse situations, each based on the common principles discussed in the framework.     

A Tiered Approach for Risk‐Benefit Assessment of Foods

Risk‐benefit analyses are introduced as a new paradigm for old problems. However, in many cases it is not always necessary to perform a full comprehensive and expensive quantitative risk‐benefit assessment to solve the problem, nor is it always possible, given the lack of required date. The choice to continue from a more qualitative to a full quantitative risk‐benefit assessment can be made using a tiered approach. In this article, this tiered approach for risk‐benefit assessment will be addressed using a decision tree. The tiered approach described uses the same four steps as the risk assessment paradigm: hazard and benefit identification, hazard and benefit characterization, exposure assessment, and risk‐benefit characterization, albeit in a different order. For the purpose of this approach, the exposure assessment has been moved upward and the dose‐response modeling (part of hazard and benefit characterization) is moved to a later stage. The decision tree includes several stop moments, depending on the situation where the gathered information is sufficient to answer the initial risk‐benefit question. The approach has been tested for two food ingredients. The decision tree presented in this article is useful to assist on a case‐by‐case basis a risk‐benefit assessor and policymaker in making informed choices when to stop or continue with a risk‐benefit assessment.     

Estimation of Tuberculosis Risk on a Commercial Airliner

This article estimates the risk of tuberculosis (TB) transmission on a typical commercial airliner using a simple one box model (OBM) and a sequential box model (SBM). We used input data derived from an actual TB exposure on an airliner, and we assumed a hypothetical scenario that a highly infectious TB source case (i.e., 108 infectious quanta per hour) travels as a passenger on an 8.7-hour flight. We estimate an average risk of TB transmission on the order of 1 chance in 1,000 for all passengers using the OBM. Applying the more realistic SBM, we show that the risk and incidence decrease sharply in a stepwise fashion in cabins downstream from the cabin containing the source case assuming some potential for airflow from more contaminated to less contaminated cabins. We further characterized spatial variability in the risk within the cabin by modeling a previously reported TB outbreak in an airplane to demonstrate that the TB cases occur most likely within close proximity of the source TB patient.     

Multiobjective Decision-Tree Analysis1

Single-objective-based decision-tree analysis has been extensively and successfully used in numerous decision-making problems since its formal introduction by Howard Raiffa more than two decades ago. This paper extends the traditional methodology to incorporate multiple noncommensurate objective functions and use of the conditional expected value of the risk of extreme and catastrophic events. The proposed methodology considers the cases where (a) a finite number of actions are available at each decision node and (b) discrete or continuous states of nature can be presented at each chance node. The proposed extension of decision-tree analysis is introduced through an example problem that leads the reader step-by-step into the methodological procedure. The example problem builds on flood warning systems. Two noncommensurate objectives—the loss of lives and the loss of property (including monetary costs of the flood warning system)–are incorporated into the decision tree. In addition, two risk measures—the common expected value and the conditional expected value of extreme and catastrophic events—are quantified and are also incorporated into the decision-making process. Theoretical difficulties associated with the stage-wise calculation of conditional expected values are identified and certain simplifying assumptions are made for computational tractibility. In particular, it is revealed that decisions concerning experimentation have a very interesting impact on the noninferior solution set of options—a phenomenon that has no equivalence in the single-objective case.     

Risk-Adjusted Mission Value: Trading Off Mission Risk for Mission Value

This article develops a decision-theoretic methodology for the risk-adjusted mission value (RAMV) for selecting between alternative missions in the presence of uncertainty in the outcomes of the missions. This methodology permits trading off mission risk for mission value, something that probabilistic risk analysis cannot do unless it explicitly incorporates both mission value and risk aversion of the project management. The methodology, in its complete implementation, is consistent with the decision theory known as expected utility theory, although it differs from conventional decision theory in that the probabilities and all but one of the utilities are not those of the decision maker. The article also introduces a new interpretation of risk aversion. The methodology is consistent with the elementary management concept concerning division of labor. An example is presented for selecting between discrete alternatives-four landing sites on Mars. A second example is presented for selecting among a set of continuous alternatives-a comet flyby distance. The methodology is developed within the context of scientific missions, but the methodology is equally applicable to any situation requiring outcome value judgments, probability judgments, and risk aversion judgments by different constituencies.     

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.     

Mlonte Carlo Techniques for Quantitative Uncertainty Analysis in Public Health Risk Assessments

Most public health risk assessments assume and combine a series of average, conservative, and worst-case values to derive a conservative point estimate of risk. This procedure has major limitations. This paper demonstrates a new methodology for extended uncertainty analyses in public health risk assessments using Monte Carlo techniques. The extended method begins as do some conventional methods--with the preparation of a spreadsheet to estimate exposure and risk. This method, however, continues by modeling key inputs as random variables described by probability density functions (PDFs). Overall, the technique provides a quantitative way to estimate the probability distributions for exposure and health risks within the validity of the model used. As an example, this paper presents a simplified case study for children playing in soils contaminated with benzene and benzo(a)pyrene (BaP).     

Risk management: a competitive advantage in the purchasing function

This paper aims to explore the purchasing function on behalf of the provider, when the purchasing takes the form of a request for proposals (RfP) from the client. A methodology for handling the bidding process is presented, illustrated by a case study from the IT sector. The proposed methodology places risk as a factor for the selection of the best and final offer of the provider in addition to the traditional decision factors: delivery time, product cost and performance. The method is supported by a structured corporate memory and a decision support system based on the analytical hierarchy process.     

Risk Mapping of Groundwater‐Drawdown‐Induced Land Subsidence in Heterogeneous Soils on Large Areas

Groundwater leakage into subsurface constructions can cause reduction of pore pressure and subsidence in clay deposits, even at large distances from the location of the construction. The potential cost of damage is substantial, particularly in urban areas. The large‐scale process also implies heterogeneous soil conditions that cannot be described in complete detail, which causes a need for estimating uncertainty of subsidence with probabilistic methods. In this study, the risk for subsidence is estimated by coupling two probabilistic models, a geostatistics‐based soil stratification model with a subsidence model. Statistical analyses of stratification and soil properties are inputs into the models. The results include spatially explicit probabilistic estimates of subsidence magnitude and sensitivities of included model parameters. From these, areas with significant risk for subsidence are distinguished from low‐risk areas. The efficiency and usefulness of this modeling approach as a tool for communication to stakeholders, decision support for prioritization of risk‐reducing measures, and identification of the need for further investigations and monitoring are demonstrated with a case study of a planned tunnel in Stockholm.     

A Risk Assessment Scheme of Infection Transmission Indoors Incorporating the Impact of Resuspension

A new risk assessment scheme was developed to quantify the impact of resuspension to infection transmission indoors. Airborne and surface pathogenic particle concentration models including the effect of two major resuspension scenarios (airflow‐induced particle resuspension [AIPR] and walking‐induced particle resuspension [WIPR]) were derived based on two‐compartment mass balance models and validated against experimental data found in the literature. The inhalation exposure to pathogenic particles was estimated using the derived airborne concentration model, and subsequently incorporated into a dose‐response model to assess the infection risk. Using the proposed risk assessment scheme, the influences of resuspension towards indoor infection transmission were examined by two hypothetical case studies. In the case of AIPR, the infection risk increased from 0 to 0.54 during 0–0.5 hours and from 0.54 to 0.57 during 0.5–4 hours. In the case of WIPR, the infection risk increased from 0 to 0.87 during 0–0.5 hours and from 0.87 to 1 during 0.5–4 hours. Sensitivity analysis was conducted based on the design‐of‐experiments method and showed that the factors that are related to the inspiratory rate of viable pathogens and pathogen virulence have the most significant effect on the infection probability under the occurrence of AIPR and WIPR. The risk assessment scheme could serve as an effective tool for the risk assessment of infection transmission indoors.     

Subsea Release of Oil from a Riser: An Ecological Risk Assessment

This study illustrates a newly developed methodology, as a part of the U.S. EPA ecological risk assessment (ERA) framework, to predict exposure concentrations in a marine environment due to underwater release of oil and gas. It combines the hydrodynamics of underwater blowout, weathering algorithms, and multimedia fate and transport to measure the exposure concentration. Naphthalene and methane are used as surrogate compounds for oil and gas, respectively. Uncertainties are accounted for in multimedia input parameters in the analysis. The 95th percentile of the exposure concentration (EC_95%) is taken as the representative exposure concentration for the risk estimation. A bootstrapping method is utilized to characterize EC_95% and associated uncertainty. The toxicity data of 19 species available in the literature are used to calculate the 5th percentile of the predicted no observed effect concentration (PNEC_5%) by employing the bootstrapping method. The risk is characterized by transforming the risk quotient (RQ), which is the ratio of EC_95% to PNEC_5%, into a cumulative risk distribution. This article describes a probabilistic basis for the ERA, which is essential from risk management and decision‐making viewpoints. Two case studies of underwater oil and gas mixture release, and oil release with no gaseous mixture are used to show the systematic implementation of the methodology, elements of ERA, and the probabilistic method in assessing and characterizing the risk.     

Combining decision tree and MAUT for selecting a country for a global manufacturing facility

The paper presents a multi-phase approach for selecting a country in which to locate a global manufacturing facility. An influence diagram is used to frame the decision. A decision tree then analyzes uncertainties regarding cost and generates a risk profile. The risk profile becomes one of the measures in an MAUT model that incorporate a wide range of factors. This sequential approach of using the output from a decision tree as input to MAUT is demonstrated with an example involving an auto supplier locating a new plant in one of five countries. Three decision makers were interviewed to determine the weights and the shape of the individual utility curves. The paper identifies, clearly defines, and incorporates a variety of measures for which national data are readily available. This list is broader and less subjective when compared to other examples reported in the literature.     

Decision Making During Nuclear Power Plant Incidents—A New Approach to the Evaluation of Precursor Events

Renewed interest in precursor analysis has shown that the evaluation of near misses is an interdisciplinary effort, fundamental within the life of an organization for reducing operational risks and enabling accident prevention. The practice of precursor analysis has been a part of nuclear power plant regulation in the United States for over 25 years. During this time, the models used in the analysis have evolved from simple risk equations to quite complex probabilistic risk assessments. But, one item that has remained constant over this time is that the focus of the analysis has been on modeling the scenario using the risk model (regardless of the model sophistication) and then using the results of the model to determine the severity of the precursor incident. We believe that evaluating precursors in this fashion could be a shortcoming since decision making during the incident is not formally investigated. Consequently, we present the idea for an evaluation procedure that enables one to integrate current practice with the evaluation of decisions made during the precursor event. The methodology borrows from technologies both in the risk analysis and the decision analysis realms. We demonstrate this new methodology via an evaluation of a U.S. precursor incident. Specifically, the course of the incident is represented by the integration of a probabilistic risk assessment model (i.e., the risk analysis tool) with an influence diagram and the corresponding decision tree (i.e., the decision analysis tools). The results and insights from the application of this new methodology are discussed.     

Ranking the Risks from Multiple Hazards in a Small Community

Natural hazards, human-induced accidents, and malicious acts have caused great losses and disruptions to society. After September 11, 2001, critical infrastructure protection has become a national focus in the United States and is likely to remain one for the foreseeable future. Damage to the infrastructures and assets could be mitigated through predisaster planning and actions. A systematic methodology was developed to assess and rank the risks from these multiple hazards in a community of 20,000 people. It is an interdisciplinary study that includes probabilistic risk assessment (PRA), decision analysis, and expert judgment. Scenarios are constructed to show how the initiating events evolve into undesirable consequences. A value tree, based on multi-attribute utility theory (MAUT), is used to capture the decisionmaker's preferences about the impacts on the infrastructures and other assets. The risks from random failures are ranked according to their expected performance index (PI), which is the product of frequency, probabilities, and consequences of a scenario. Risks from malicious acts are ranked according to their PI as the frequency of attack is not available. A deliberative process is used to capture the factors that could not be addressed in the analysis and to scrutinize the results. This methodology provides a framework for the development of a risk-informed decision strategy. Although this study uses the Massachusetts Institute of Technology campus as a case study of a real project, it is a general methodology that could be used by other similar communities and municipalities.     

Combined Effects of Contaminant Desorption and Toxicity on Risk from PAH Contaminated Sediments

A strong inverse correlation was observed between the polycyclic aromatic hydrocarbon (PAH) mass fraction desorbed, a surrogate measure of bioavailability, and relative carcinogenicity, as quantified by potency equivalency factors (PEFs), for two study sediments from the New York/New Jersey Harbor estuary. Because compounds with the highest toxicity, such as dibenz(a,h)anthracene and benzo(a)pyrene (BAP), also tended to be the least rapidly and least extensively desorbed, the U.S. Environmental Protection Agency (EPA) default guidance may dramatically overestimate risk from exposure to PAH-contaminated soils or sediments. A "relative risk index" (RRI) was developed to account for the combined effects of compound-specific bioavailability and toxic potency in estimating excess cancer risk. Using this approach, estimated excess cancer risk may be diminished by as much as a factor of 159 times versus default EPA guidance. Also, the hierarchy of estimated risk between study sediments and among treatment fractions of study sediments differed using the two approaches, implying that the default approach may inaccurately determine site clean-up priorities. The percentage contribution of each potentially carcinogenic priority PAH to total excess cancer risk was computed under various scenarios. In each case, the contribution of BAP to total excess cancer risk was remarkably invariable, for example, ranging from 48% to 52% in one sediment, and 44% to 54% in the other, over four different exposure durations. These results suggest that BAP may be an excellent indexing compound for gauging relative exposure risk across sediments. Other important contributors to total excess cancer risk were benz(a)anthracene and dibenz(a,h)anthracene. Together, these three compounds comprised nearly 90% of total excess cancer risk from all PAHs in every scenario. This integrated RRI approach may enable regulators to more accurately gauge relative risks and make more informed sediment management decisions.