title: Paediatric HUS Cases Related to the Consumption of Raw Milk Sold by Vending Machines in Italy: Quantitative Risk Assessment Based on Escherichia coli O157 Official Controls over 7 years.
abstract: A quantitative risk assessment (RA) was developed to estimate haemolytic-uremic syndrome (HUS) cases in paediatric population associated with the consumption of raw milk sold in vending machines in Italy. The historical national evolution of raw milk consumption phenomenon since 2008, when consumer interest started to grow, and after 7 years of marketing adjustment, is outlined. Exposure assessment was based on the official Shiga toxin-producing Escherichia coli O157:H7 (STEC) microbiological records of raw milk samples from vending machines monitored by the regional Veterinary Authorities from 2008 to 2014, microbial growth during storage, 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. In case of boiling milk before consumption, we assumed that the risk of HUS is fixed at zero. The model estimates clearly show that the public health significance of HUS cases due to raw milk STEC contamination depends on the current variability surrounding the risk profile of the food and the consumer behaviour has more impact than milk storage scenario. The estimated HUS cases predicted by our model are roughly in line with the effective STEC O157-associated HUS cases notified in Italy only when the proportion of consumers not boiling milk before consumption is assumed to be 1%. Raw milk consumption remains a source of E. coli O157:H7 for humans, but its overall relevance is likely to have subsided and significant caution should be exerted for temporal, geographical and consumers behaviour analysis. Health education programmes and regulatory actions are required to educate people, primarily children, on other STEC sources.
authors.affiliation: Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Giacometti
authors.affiliation: Experimental Institute for Zooprophylaxis in Lombardy and Emilia Romagna, Reggo Emilia, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Bonilauri
authors.affiliation: Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Piva
authors.affiliation: Istituto Superiore di Sanità, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Scavia
authors.affiliation: Experimental Institute for Zooprophylaxis in Lazio and Tuscany, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Amatiste
authors.affiliation: Experimental Institute for Zooprophylaxis in Piedmont, Liguria and Valle D'Aosta, Torino, Italy.
authors.forename: D M
authors.initials: DM
authors.lastname: Bianchi
authors.affiliation: Experimental Institute for Zooprophylaxis in Lombardy and Emilia Romagna, Brescia, Italy.
authors.forename: M N
authors.initials: MN
authors.lastname: Losio
authors.affiliation: Experimental Institute for Zooprophylaxis in Lazio and Tuscany, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bilei
authors.affiliation: Experimental Institute for Zooprophylaxis in Sicily, Palermo, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Cascone
authors.affiliation: Experimental Institute for Zooprophylaxis in Venezie, San Donà di Piave, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Comin
authors.affiliation: Experimental Institute for Zooprophylaxis in Lombardy and Emilia Romagna, Brescia, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Daminelli
authors.affiliation: Experimental Institute for Zooprophylaxis in Piedmont, Liguria and Valle D'Aosta, Torino, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Decastelli
authors.affiliation: Experimental Institute for Zooprophylaxis in Lombardy and Emilia Romagna, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Merialdi
authors.affiliation: Experimental Institute for Zooprophylaxis in Venezie, San Donà di Piave, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Mioni
authors.affiliation: Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Peli
authors.affiliation: Experimental Institute for Zooprophylaxis in Umbria and Marche, Pesaro, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Petruzzelli
authors.affiliation: Experimental Institute for Zooprophylaxis in Umbria and Marche, Pesaro, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Tonucci
authors.affiliation: Modena Health Trust, Carpi District, Modena, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Liuzzo
authors.affiliation: Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Serraino
mesh_terms: D000818:Animals; D002648:Child; D019453:Escherichia coli O157 / Q000302:isolation & purification*; D005509:Food Dispensers, Automatic; D005516:Food Microbiology; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008892:Milk / Q000382:microbiology*; D061352:Pasteurization; D066256:Raw Foods; D018570:Risk Assessment; D044366:Transition Temperature
keywords: Paediatric HUS cases; quantitative risk assessment; raw milk consumption