McLauchlin J, Mitchell R T, Smerdon W J, Jewell K
Health Protection Agency, Food Safety Microbiology Laboratory, Division of Gastrointestinal Infections, Central Public Health Laboratory, 61 Colindale Avenue, London NW9 5HT, UK.
Int J Food Microbiol. 2004 Apr 1;92(1):15-33. doi: 10.1016/S0168-1605(03)00326-X.
Considerable effort has been put into the application of quantitative microbiological risk assessment for Listeria monocytogenes, and data are available for England and Wales (probably more so than most other countries) on the adverse health effects, together with incidence data on different age and risk groups for human L. monocytogenes infections. This paper reviews aspects of Listeria and human listeriosis, especially from a public health perspective and provide hazard characterisation data, i.e. the qualitative and/or quantitative evaluation of the adverse health effect associated with the hazard, which is the relationship between exposure levels (dose) and frequency of illness. The majority of cases of human listeriosis are food-borne; however, the disease process is complex with multiple routes of infection. The dose-response relationship is poorly understood, and data from human volunteer studies are not available and would be unethical to produce. Data are available from a range of different animal and in vitro models, although these poorly mimic the natural disease process in route of infection, end point, host and history of prior exposure to the bacterium. Epidemiological data provide some information on infective doses and dose responses, but because of the characteristics of the disease (the hugely variable and potentially very long incubation periods, the low attack rates and the rarity of identification of specific food vehicles), this also provides limited data for calculation of dose responses. There is some, albeit limited, evidence for strain variation, but this is an area of considerable uncertainty despite great advances in the genetic basis of the virulence of this bacterium, and almost all strains seem capable of causing serious disease. A variety of mathematical approaches have been used to model dose responses. The review is written to provide a clinical and epidemiological background to the mathematically oriented, as well as to outline the mathematical approaches to those interested in food-borne infection.
人们已投入大量精力将定量微生物风险评估应用于单核细胞增生李斯特菌，并且在英格兰和威尔士可获取有关不良健康影响的数据（可能比大多数其他国家更多），以及人类单核细胞增生李斯特菌感染在不同年龄和风险群体中的发病率数据。本文回顾了李斯特菌和人类李斯特菌病的各个方面，特别是从公共卫生角度，并提供危害特征描述数据，即对与危害相关的不良健康影响进行定性和/或定量评估，也就是暴露水平（剂量）与疾病发生频率之间的关系。大多数人类李斯特菌病病例是食源性的；然而，疾病过程复杂，存在多种感染途径。剂量反应关系尚不清楚，且无法获取人体志愿者研究的数据，生成此类数据也是不道德的。虽然有一系列不同动物和体外模型的数据，但这些模型在感染途径、终点、宿主以及先前接触该细菌的历史等方面都难以模拟自然疾病过程。流行病学数据提供了一些关于感染剂量和剂量反应的信息，但由于该疾病的特征（潜伏期变化极大且可能非常长、发病率低以及确定特定食物载体的情况罕见），这也为计算剂量反应提供了有限的数据。虽然有一些（尽管有限）证据表明菌株存在差异，但尽管在该细菌毒力的遗传基础方面取得了巨大进展，这仍是一个存在相当大不确定性的领域，而且几乎所有菌株似乎都能够引发严重疾病。已使用多种数学方法来模拟剂量反应。撰写本综述是为了为数学导向的研究提供临床和流行病学背景，同时也为对食源性感染感兴趣的人概述数学方法。
