Pouillot Régis, Hoelzer Karin, Chen Yuhuan, Dennis Sherri B
Risk Anal. 2015 Jan;35(1):90-108. doi: 10.1111/risa.12235. Epub 2014 Jun 26.
Evaluations of Listeria monocytogenes dose-response relationships are crucially important for risk assessment and risk management, but are complicated by considerable variability across population subgroups and L. monocytogenes strains. Despite difficulties associated with the collection of adequate data from outbreak investigations or sporadic cases, the limitations of currently available animal models, and the inability to conduct human volunteer studies, some of the available data now allow refinements of the well-established exponential L. monocytogenes dose response to more adequately represent extremely susceptible population subgroups and highly virulent L. monocytogenes strains. Here, a model incorporating adjustments for variability in L. monocytogenes strain virulence and host susceptibility was derived for 11 population subgroups with similar underlying comorbidities using data from multiple sources, including human surveillance and food survey data. In light of the unique inherent properties of L. monocytogenes dose response, a lognormal-Poisson dose-response model was chosen, and proved able to reconcile dose-response relationships developed based on surveillance data with outbreak data. This model was compared to a classical beta-Poisson dose-response model, which was insufficiently flexible for modeling the specific case of L. monocytogenes dose-response relationships, especially in outbreak situations. Overall, the modeling results suggest that most listeriosis cases are linked to the ingestion of food contaminated with medium to high concentrations of L. monocytogenes. While additional data are needed to refine the derived model and to better characterize and quantify the variability in L. monocytogenes strain virulence and individual host susceptibility, the framework derived here represents a promising approach to more adequately characterize the risk of listeriosis in highly susceptible population subgroups.
对单核细胞增生李斯特菌剂量反应关系的评估对于风险评估和风险管理至关重要，但因人群亚组和单核细胞增生李斯特菌菌株之间存在相当大的变异性而变得复杂。尽管从暴发调查或散发病例中收集充分数据存在困难，现有动物模型存在局限性，且无法开展人体志愿者研究，但目前一些可用数据现在允许对已确立的单核细胞增生李斯特菌指数剂量反应进行改进，以更充分地代表极易感人群亚组和高毒力单核细胞增生李斯特菌菌株。在此，利用包括人类监测和食品调查数据在内的多个来源的数据，为11个具有相似潜在合并症的人群亚组推导了一个纳入单核细胞增生李斯特菌菌株毒力和宿主易感性变异性调整的模型。鉴于单核细胞增生李斯特菌剂量反应的独特固有特性，选择了对数正态-泊松剂量反应模型，该模型被证明能够使基于监测数据建立的剂量反应关系与暴发数据相协调。将该模型与经典的β-泊松剂量反应模型进行了比较，后者在模拟单核细胞增生李斯特菌剂量反应关系的具体情况时不够灵活，尤其是在暴发情况下。总体而言，建模结果表明，大多数李斯特菌病病例与摄入受中高浓度单核细胞增生李斯特菌污染的食物有关。虽然需要更多数据来完善推导模型，并更好地表征和量化单核细胞增生李斯特菌菌株毒力和个体宿主易感性的变异性，但此处推导的框架代表了一种有前景的方法，可更充分地表征极易感人群亚组中李斯特菌病的风险。
