title: Human campylobacteriosis related to the consumption of raw milk sold by vending machines in Italy: Quantitative risk assessment based on official controls over four years.
abstract: A quantitative risk assessment (RA) model was developed to describe the risk of campylobacteriosis linked to consumption of raw milk sold in vending machines in Italy. Exposure assessment was based on the official microbiological records of raw milk samples from vending machines monitored by the regional Veterinary Authorities from 2008 to 2011, microbial growth during storage, destruction experiments, consumption frequency of raw milk, serving size, consumption preference and age of consumers. The differential risk considered milk handled under regulation conditions (4°C throughout all phases) and the worst time-temperature field handling conditions detected. Two separate RA models were developed, one for the consumption of boiled milk and the other for the consumption of raw milk, and two different dose-response (D-R) relationships were considered. The RA model predicted no human campylobacteriosis cases per year either in the best (4°C) storage conditions or in the case of thermal abuse in case of boiling raw milk, whereas in case of raw milk consumption the annual estimated campylobacteriosis cases depend on the dose-response relationships used in the model (D-R I or D-R II), the milk time-temperature storage conditions, consumer behaviour and age of consumers, namely young (with two cut-off values of ≤5 or ≤6 years old for the sensitive population) versus adult consumers. The annual estimated cases for young consumers using D-R II for the sensitive population (≤5 years old) ranged between 1013.7/100,000 population and 8110.3/100,000 population and for adult consumers using D-R I between 79.4/100,000 population and 333.1/100,000 population. Quantification of the risks associated with raw milk consumption is necessary from a public health perspective and the proposed RA model represents a useful and flexible tool to perform future RAs based on local consumer habits to support decision-making on safety policies. Further educational programmes for raw milk consumers or potential raw milk consumers are required to encourage consumers to boil milk to reduce the associated risk of illness.
authors.affiliation: University of Bologna, Department of Veterinary Medical Sciences, Via Tolara di Sopra, 50, Bologna, 40064 Ozzano Emilia, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Giacometti
authors.affiliation: Experimental Institute for Zooprophylaxis in Lombardy and Emilia Romagna, Via Pitagora 2, 42100 Reggio Emilia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bonilauri
authors.affiliation: Experimental Institute for Zooprophylaxis in Lazio and Tuscany, Via Appia Nuova 1411, 00187 Rome, Italy.
authors.forename: Simonetta
authors.initials: S
authors.lastname: Amatiste
authors.affiliation: Experimental Institute for Zooprophylaxis in Lombardy and Emilia Romagna, Strada della Faggiola 1, 29027 Gariga di Podenzano, Italy.
authors.forename: Norma
authors.initials: N
authors.lastname: Arrigoni
authors.affiliation: Experimental Institute for Zooprophylaxis in Piedmont, Liguria and Valle D'Aosta, Via Bologna, 148, 10154 Turin, Italy.
authors.forename: Manila
authors.initials: M
authors.lastname: Bianchi
authors.affiliation: Experimental Institute for Zooprophylaxis in Lombardy and Emilia Romagna, Via Bianchi 7/9, 25124 Brescia, Italy.
authors.forename: Marina Nadia
authors.initials: MN
authors.lastname: Losio
authors.affiliation: Experimental Institute for Zooprophylaxis in Lazio and Tuscany, Via Appia Nuova 1411, 00187 Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bilei
authors.affiliation: Experimental Institute for Zooprophylaxis in Sicily, Via G. Marinuzzi, 3, 90129, Palermo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cascone
authors.affiliation: Experimental Institute for Zooprophylaxis in Veneto, Viale dell'Università, 10, Padua,35020 Legnaro, Italy.
authors.forename: Damiano
authors.initials: D
authors.lastname: Comin
authors.affiliation: Experimental Institute for Zooprophylaxis in Lombardy and Emilia Romagna, Via Bianchi 7/9, 25124 Brescia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Daminelli
authors.affiliation: Experimental Institute for Zooprophylaxis in Piedmont, Liguria and Valle D'Aosta, Via Bologna, 148, 10154 Turin, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Decastelli
authors.affiliation: Experimental Institute for Zooprophylaxis in Lombardy and Emilia Romagna, Via P. Fiorini, 5, 40127 Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Merialdi
authors.affiliation: Experimental Institute for Zooprophylaxis in Veneto, Viale dell'Università, 10, Padua,35020 Legnaro, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Mioni
authors.affiliation: University of Bologna, Department of Veterinary Medical Sciences, Via Tolara di Sopra, 50, Bologna, 40064 Ozzano Emilia, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Peli
authors.affiliation: Experimental Institute for Zooprophylaxis in Umbria and Marche, Via G. Salvemini, 1, 06162, Perugia, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Petruzzelli
authors.affiliation: Experimental Institute for Zooprophylaxis in Umbria and Marche, Via G. Salvemini, 1, 06162, Perugia, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Tonucci
authors.affiliation: University of Bologna, Department of Veterinary Medical Sciences, Via Tolara di Sopra, 50, Bologna, 40064 Ozzano Emilia, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Piva
authors.affiliation: University of Bologna, Department of Veterinary Medical Sciences, Via Tolara di Sopra, 50, Bologna, 40064 Ozzano Emilia, Italy. Electronic address: andrea.serraino@unibo.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Serraino
mesh_terms: D000818:Animals; D002169:Campylobacter Infections / Q000453:epidemiology* / Q000382:microbiology; D016123:Campylobacter jejuni / Q000302:isolation & purification*; D005509:Food Dispensers, Automatic; D005516:Food Microbiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008892:Milk / Q000382:microbiology*; D015995:Prevalence; D066256:Raw Foods / Q000382:microbiology*; D018570:Risk Assessment
keywords: Campylobacter jejuni; Monitoring; Raw milk; Risk assessment