Quantitative risk assessment of thermophilic Campylobacter spp. and cross-contamination during handling of raw broiler chickens evaluating strategies at the producer level to reduce human campylobacteriosis in Sweden.
Campylobacter is a major bacterial cause of infectious diarrheal illness in Sweden and in many other countries. Handling and consumption of chicken has been identified as important risk factors. The purpose of the present study was to use data from a national baseline study of thermophilic Campylobacter spp. in raw Swedish broiler chickens in order to evaluate some risk management strategies and the frequency of consumer mishandling, i.e., handling leading to possible cross-contamination. A probabilistic model describing variability but not uncertainty was developed in Excel and @Risk. The output of the model was the probability of illness per handling if the chicken was mishandled. Uncertainty was evaluated by performing repeated simulations and substituting model parameters, distributions and software (Analytica). The effect of uncertainty was within a factor of 3.2 compared to the baseline scenario. For Campylobacter spp. prevalence but not concentration, there was a one-to-one relation with risk. The effect of a 100-fold reduction in the levels of Campylobacter spp. on raw chicken reduced the risk by a factor of 12 (fresh chicken) to 30 (frozen chicken). Highly-contaminated carcasses contributed most to risk and it was estimated that by limiting the contamination to less than 4 log CFU per carcass, the risk would be reduced to less than 17% of the baseline scenario. Diverting all positive flocks to freezing was estimated to result in 43% as many cases as the baseline. The second best diversion option (54% of baseline cases) was to direct all chickens from the two worst groups of producers, in terms of percentages of positive flocks delivered, to freezing. The improvement of using diverting was estimated to correspond to between 5 to 767 fewer reported cases for the different strategies depending on the assumptions of the proportion of reported cases (1 to 50%) caused by Campylobacter spp. from Swedish chicken. The estimated proportion of consumer mishandlings sufficient to explain 1 to 50% of the reported campylobacteriosis cases was 0.005-0.25%, or taking estimated underreporting into consideration, was 0.05-2.6%. The strategy of using a diversion treatment, e.g., freezing, based on the past performance of producers was promising, but needs to be evaluated further. Although challenging, consumer education has a great potential given the direct relation between behaviour and risk. However, any improvements following implementation of these strategies may be hard to detect if less than 50% of reported cases are exposed via chicken and the cross-contamination route.