R ANKING OF L OW OW M OI URE F OOD OODS IN S UPPOR NG OF OISTUR OR OF M ICROB OGICAL R ISK ISK M ANAGE OF OBIOL OLOG GEME MENT Repor ort o of an an FAO/WHO c con onsu sultation p proc ocess ss
O BJECTIVES To undertake a scoping systematic review and analysis of the available knowledge on foodborne illness linked to LMF, microbial contamination of LMF and interventions available for the control of LMF. To develop and apply a multi-criteria decision analysis approach to rank LMF of greatest concern from a global microbiological food safety perspective. To provide a comprehensive report on the available information and ranking results for use by Codex and member countries.
R ANKING OF LMF Flow cha chart of f the he steps eps i inv nvolved in n the he da data co collection a and r nd rank nking exe xerc rcis ise
S COPE OF THE WORK Catego egory Food ods include ded Cereals an and Grai ains whole and milled grains , rice and rice products, cereals and cereal products Confections s an and sn snac acks cocoa and chocolate products, other confections/confectionery, snacks, yeast Dried fruits an and dried fruits, dried vegetables, dried/dehydrated mushrooms veg eget etables dried seaweed Dried p ed protei ein p produ ducts dried dairy products, dried egg products, dried meat other than sausages/salamis/jerky (e.g. meat powders, gelatine, fish) Honey an and preserves honey, jams, syrups (e.g. corn syrup) Nuts an and nut p products tree nuts, peanuts and peanut products, mixed and unspecified nuts Seeds f for or co consumption on sesame seeds, tahini, halva/helva, other and unspecified seeds Spi Spices, dr dried h her erbs and d fruit/seed-based, root-based, leaf-based, bark/flower-based te teas as mixed/unspecified, tea (e.g. herbal, black teas) Specia ializ lized nutritio ional l lipid based nutrient supplements, dried/powdered nutrient supplements product cts
S COPE - N OTE Dried protein products excluded cured, fermented meat and fish products Retained dried fish / seafood fish flour/meal in review Only products with consistent Aw of <0.85 Excluded powdered infant formula Spices, dried herbs and teas Included tea based on feedback of 45th CCFH Honey and preserves – eventually excluded Lipid based RUF for malnourished populations – excluded from ranking but considered relevant to general code of hygienic practice
M ICROORGANISMS Bacillus cereus , Clostridium botulinum, Clostridium perfringens , Cronobacter spp., pathogenic Escherichia coli Listeria monocytogenes Salmonella spp., Staphylococcus aureus EB an generic E.coli
K NOWLEDGE SYNTHESIS ( RESULTS ) Summary of the burden o of illne ness r related to LMF outbreaks a attribut uted to o se select m microbial h haz azar ards % ( (count unt) Outbr Ou breaks Cases es Hospit italiz lizatio ions Deaths hs Salmonella spp. 44.9% (96) 43.8%(12415) 88.6% (895) 73.7% (14) E. coli 2.3% (5) 1.2% (354) 3.3% (33) 5.3% (1) B. cereus 25.7% (55) 3.7% (1057) 1.4% (14) 0% (0) C. botulinum 15.0% (32) 0.3% (84) 6.0% (61) 21.1% (4) C. perfringens 4.7% (10) 1.5% (432) 0% (0) 0% (0) S. aureus 7.5% (16) 49.4% (14006) 0.7% (7) 0% (0) L. monocytogenes 0% (0) 0% (0) 0% (0) 0% (0) Cronobacter spp. 0% (0) 0% (0) 0% (0) 0% (0) Enterobacteriaceae 0% (0) 0% (0) 0% (0) 0% (0)
N UMBER OF LMF OUTBREAKS IN EACH CATEGORY , GROUPED BY SIZE AND MICROBIAL HAZARD
Knowl wledge synthesi sy sis s ults ) (resul Average prevalence nce o of Salmone nella spp. pp. acros ac oss s al all L LMF product uct categor ories
R ANKING C RITERIA Extent of food borne illness – outbreak data International trade – FAOSTAT Consumption Daily consumption (Individual food consumption data) % vulnerable consumers (as above) potential for consumer to increase risk (Expert opinion) Production Prevalence of pathogen (systematic review) Proportion not subject to kill step risk (Expert opinion) Potential for post process contamination risk (Expert opinion)
R ANKING OF LMF R ANKING CRITERIA Crit iteria ia Sub-Crit iteria ia Attr ttribute Source of f info formation /ev /evidence C1: I Internat ational al T Trad ade - Export value in US$ billions/year FAOSTAT Trade data (http://faostat3.fao.org/) C2: B Bur urden o n of f Disease - Total DALYs in outbreak cases from 1990 Systematic/scoping review (Appendix onwards 1) and Published DALY data (Appendix 5) C3: V Vuln lnerabilit ilitie ies due C3.1: A Aver erage ge Average g/day FAO/WHO Chronic Individual Food Consumption Database Summary to F Food C Cons nsump umption Servi ving Statistics (CIFOCOSS) (Appendix 6) C3.2: P Prop ropor ortion on Proportion (0-100%) consumed by vulnerable FAO/WHO Chronic Individual Food groups (toddlers and elderly) Consumption Database Summary Vuln lnerable le Statistics (CIFOCOSS) (Appendix 6) Cons nsume umers C3.3: P Pote tenti tial Proportion (0-100%) of LMF products in a given Expert opinion category with an increased risk as a result of for C Consume umer mishandling/poor practices at any time Mis ishan andlin ling between final retail and consumption (see Appendix 7 for details) C4: V Vuln lnerabilit ilities due C4.1: I Increa eased ed Proportion (0-100%) of LMF products in a given Expert opinion category with an increased risk of contamination to F Food od P Prod oduction on Ri Risk o k of post kill step (see Appendix 7for details) Contam aminat atio ion C4.2: P Prop roportion on Proportion (0-100%) of LMF in a given category Expert opinion without a kill step prior to retail and distribution wit ithout K Kill ill Step (see Appendix 7 for details) C4.3: P Prevalence nce Probability that a LMF is contaminated at a level Systematic/scoping review (Appendix with any pathogens with the potential to cause 1) of Pa Pathogen illness in consumers
R ANKING OF LMF R ESULTS OF SCORES FOR EACH CATEGORY – B URDEN OF DISEASE C2: B Burden of D Dis isease Code Category Name Total DALYs in Normalised Impact outbreak cases (v 2 ) [Dis-Value] from 1990 to 2014 Cat Cat 1 1 Cereals and Grains 72.53 45.9 Cat Cat 2 2 Confections and Snacks 60.26 35.4 Cat 3 Cat 3 Dried Fruits and Vegetables 32.78 12.2 Cat Cat 4 4 Dried Protein Products 136.44 100.0 Cat Cat 5 5 Nuts and Nut Products 118.51 84.8 Cat Cat 6 6 Seeds for Consumption 18.42 0.0 Cat Cat 7 7 Spices, Dried Herb and Tea 80.71 52.8
R ANKING OF LMF R ESULTS OF SCORES FOR EACH CATEGORY – INTERNATIONAL TRADE C1: I Intern rnati tional T Trade Code Category Name Export value [US$ Normalised Impact billions/year] (v 1 ) [Dis-Value] Cat Cat 1 1 Cereals and Grains 118. 118.59 594 100.0 Cat Cat 2 2 Confections and Snacks 58.124 48.5 Cat 3 Cat 3 Dried Fruits and Vegetables 15.211 12.0 Cat Cat 4 4 Dried Protein Products 22.800 18.4 Cat Cat 5 5 Nuts and Nut Products 20.338 16.3 Cat Cat 6 6 Seeds for Consumption 1.150 0.0 Cat Cat 7 7 Spices, Dried Herb and Tea 14.938 11.7
R ANKING OF LMF R ESULTS OF SCORES FOR EACH CATEGORY - CONSUMPTION C3.1: Aver erage S ge Serving C3.2 2 - Vulnerabl ble e C3.3 3 - Consume umer M Mishandling ng Cons nsume umers Cod ode Category Name Average Normalised Proportion Normalised Proportion (0-100%) Normalised g/day Impact (v 3.1 ) (0-100%) Impact (v 3.2 ) of LMF products in a Impact (v 3.3 ) consumed given category with [Dis-Value] [Dis-Value] [Dis-Value] by an increased risk as a vulnerable result of groups: mishandling/poor toddlers and practices at any time elderly between final retail and consumption* Cat at 1 1 Cereals and 185. 85.0 100. 00.0 14.9 10.6 20 75.0 Grains Cat at 2 2 Confections and 67.4 36.1 12.7 0.0 5 0.0 Snacks Cat at 3 3 Dried Fruits and 21.1 10.9 16.0 15.9 5 0.0 Vegetables Cat at 4 4 Dried Protein 1.1 0.0 33.5 33. 100. 00.0 25 25 100. 00.0 Products Cat at 5 5 Nuts and Nut 2.1 0.5 19.8 34.1 5 0.0 Products Cat at 6 6 Seeds for 5.5 2.4 12.7 0.0 5 0.0 Consumption Cat at 7 7 Spices, Dried 4.4 1.8 13.9 5.8 15 50.0 Herb and Tea *scores based on experts' opinion
R ANKING OF LMF R ESULTS OF SCORES FOR EACH CATEGORY - PRODUCTION C4.1 1 - Incre reased R Risk of of C4.2 .2 - Prop ropor ortion on Withou out K Kill Step C4.3 .3 - Prevalence nce o of Patho hogens Contam aminat atio ion Cod ode Category Proportion (0- Normalised Proportion (0-100%) Normalised Presence of Normalised Name 100%) of LMF Impact (v 4.1 ) of LMF products in a Impact (v 4.2 ) contamination Impact (v 4.3 ) products in a given category not (log 10 cfu/g) [Dis-Value] [Dis-Value] [Dis-Value] given category subject to a kill step with an (see definition increased risk of below) prior to retail contamination and distribution* post kill step* Cat at 1 1 Cereals and 14.55 15.2 85 85 100. 00.0 3.94 29.0 Grains Cat at 2 2 Confections 40 40 100. 00.0 20 13.3 2.21 13.1 and Snacks Cat at 3 3 Dried Fruits 10 0.0 70 80.0 4.84 37.3 and Vegetables Cat at 4 4 Dried Protein 20 33.3 10 0.0 2.54 16.2 Products Cat at 5 5 Nuts and Nut 10.5 1.7 50 53.3 0.78 0.0 Products Cat at 6 6 Seeds for 10 0.0 75 86.7 2.07 11.8 Consumption Cat at 7 7 Spices, Dried 10 0.0 75 86.7 11. 11.67 100. 00.0 Herb and Tea
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