title: Application of a Rapid Knowledge Synthesis and Transfer Approach To Assess the Microbial Safety of Low-Moisture Foods.
abstract: Low-moisture foods (LMF) are increasingly implicated in outbreaks of foodborne illness, resulting in a significant public health burden. To inform the development of a new Codex Alimentarius code of hygienic practice for LMF, we applied a rapid knowledge synthesis and transfer approach to review global research on the burden of illness, prevalence, and interventions to control nine selected microbial hazards in eight categories of LMF. Knowledge synthesis methods included an integrated scoping review (search strategy, relevance screening and confirmation, and evidence mapping), systematic review (detailed data extraction), and meta-analysis of prevalence data. Knowledge transfer of the results was achieved through multiple reporting formats, including evidence summary cards. We identified 214 unique outbreaks and 204 prevalence and 126 intervention studies. Cereals and grains (n = 142) and Salmonella (n = 278) were the most commonly investigated LMF and microbial hazard categories, respectively. Salmonella was implicated in the most outbreaks (n = 96, 45%), several of which were large and widespread, resulting in the most hospitalizations (n = 895, 89%) and deaths (n = 14, 74%). Salmonella had a consistently low prevalence across all LMF categories (0 to 3%), but the prevalence of other hazards (e.g., Bacillus cereus) was highly variable. A variety of interventions were investigated in small challenge trials. Key knowledge gaps included underreporting of LMF outbreaks, limited reporting of microbial levels in prevalence studies, and a lack of intervention efficacy research under commercial conditions. Summary cards were a useful knowledge transfer format to inform complementary risk ranking activities. This review builds upon previous work in this area by synthesizing a broad range of evidence using a structured, transparent, and integrated approach to provide timely evidence informed inputs into international guidelines.
authors.affiliation: Public Health Risk Sciences Division, Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, Ontario, Canada N1G 5B2; Food Safety and Quality Unit, Food and Agriculture Organization, Viale delle Terme di Caracalla, Roma 00153, Italy. ian.young@fao.org.
authors.forename: Ian
authors.initials: I
authors.lastname: Young
authors.affiliation: Public Health Risk Sciences Division, Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, Ontario, Canada N1G 5B2.
authors.forename: Lisa
authors.initials: L
authors.lastname: Waddell
authors.affiliation: Food Safety and Quality Unit, Food and Agriculture Organization, Viale delle Terme di Caracalla, Roma 00153, Italy.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cahill
authors.affiliation: Department of Food Safety and Zoonoses, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
authors.forename: Mina
authors.initials: M
authors.lastname: Kojima
authors.affiliation: Food Safety and Quality Unit, Food and Agriculture Organization, Viale delle Terme di Caracalla, Roma 00153, Italy.
authors.forename: Renata
authors.initials: R
authors.lastname: Clarke
authors.affiliation: Food Safety and Quality Unit, Food and Agriculture Organization, Viale delle Terme di Caracalla, Roma 00153, Italy.
authors.forename: Andrijana
authors.initials: A
authors.lastname: Rajić
mesh_terms: D000465:Algorithms; D001407:Bacillus; D001424:Bacterial Infections / Q000175:diagnosis* / Q000209:etiology*; D003625:Data Collection; D004196:Disease Outbreaks; D005506:Food Contamination; D005516:Food Microbiology; D005517:Foodborne Diseases / Q000175:diagnosis* / Q000209:etiology*; D006760:Hospitalization; D006801:Humans; D015995:Prevalence; D016016:Proportional Hazards Models; D011634:Public Health; D012306:Risk; D012475:Salmonella / Q000254:growth & development*; D057170:Translational Research, Biomedical