title: Considering uncertainty in comparing the burden of illness due to foodborne microbial pathogens.
abstract: The uncertainty attendant to burden-of-illness estimates should be taken into account in comparing the public health impact of different foodborne pathogens. In this paper, decision analysis concepts are applied to the comparisons of pathogen-specific burden-of-illness estimates. In situations wherein the magnitude of uncertainty varies, the rank order of pathogen-specific burden-of-illness estimates is sensitive to the decisional criteria applied. To illustrate the magnitude of attendant uncertainty in pathogen-specific foodborne-illness estimates, probabilistic risk assessment methods are used to characterize the uncertainty regarding the burden of illness due to Escherichia coli O157:H7. The magnitude of uncertainty about the burden of food-related illness due to E. coli O157:H7 is substantial, ranging from less than 50,000 to more than 120,000 cases/year. This example underscores the importance of considering the uncertainty attendant to burden-of-illness estimates in comparing the public health impacts of different pathogens. Although some would argue that the expected value of the number of illnesses provides the "best estimate" for decision-making, this merely reflects a decision-making rule of convention and not a scientific truism.
authors.affiliation: Office of Risk Assessment and Cost Benefit Analysis, US Department of Agriculture, Washington, DC 20250, USA. mpowell@oce.usda.gov
authors.forename: M
authors.initials: M
authors.lastname: Powell
authors.forename: E
authors.initials: E
authors.lastname: Ebel
authors.forename: W
authors.initials: W
authors.lastname: Schlosser
mesh_terms: D003663:Decision Trees; D004196:Disease Outbreaks; D019453:Escherichia coli O157 / Q000472:pathogenicity*; D005516:Food Microbiology; D005517:Foodborne Diseases / Q000453:epidemiology*; D006801:Humans; D011634:Public Health; D018570:Risk Assessment