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Non-typhoidal Salmonella spp. (hereafter referred to as Salmonella) on beef and pork is an important cause of foodborne illness and death globally. A systematic review of the effectiveness of interventions to reduce Salmonella prevalence or concentration in beef and pork was undertaken. A broad search was conducted in Scopus and CAB abstracts. Each citation was appraised using screening tools tested a priori. Level 1 relevance screening excluded irrelevant citations; level 2 confirmed relevance and categorized studies. Data were then extracted, and intervention categories were descriptively summarized. Meta-analysis was performed to provide a summary estimate of treatment effect where two or more studies investigated the same intervention in comparable populations. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to assess the confidence in the estimated measures of intervention effect for data subgroups.

Pork is one of the major food sources of human salmonellosis worldwide, and beef products have been implicated in numerous foodborne outbreaks. Thus, effective interventions to reduce Salmonella contamination during beef and pork processing are of interest to both regulators and the meat industry. We conducted a rapid systematic review and meta-analysis of literature investigating the efficacy of slaughter and processing interventions to control Salmonella in beef and pork. Review steps included a comprehensive search strategy, relevance screening of abstracts, relevance confirmation of articles, data extraction, risk-of-bias assessment, meta-analysis (where appropriate), and a weight-of-evidence assessment. A total of 191 relevant experimental studies were identified. The results of two controlled trials indicated that hot water and steam treatments were effective for reducing the prevalence of Salmonella on beef carcasses (relative risk [RR] = 0.11; 95% confidence interval [CI]: 0.02, 0.58), wh...

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 spp. (n=278) were the most commonly investigated LMF and microbial hazard categories, respectively. Salmonella spp. 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 spp. had a consistently low prevalence across all LMF categories (0-3%), while other hazards (e.g. B. cereus) were found at highly variable levels. A variety of interventions were investigated in small challenge trials. Key knowledge gaps included under-reporting of LMF outbreaks, limited reporting of microbial concentration data from 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.

Emerging zoonoses are defined as those newly recognized, or increasing in incidence or geographic range. Hepatitis E virus (HEV), norovirus (NoV), and rotavirus (RV), while well known to be transmitted person-person, have also been hypothesized to be emerging zoonoses. Our objective was to investigate their potential public health risks from animal reservoirs. Given the diversity of evidence sources, a scoping review incorporating a mixed methods synthesis approach was used. A broad search was conducted in five electronic databases. Each citation was appraised independently by two reviewers using screening tools designed and tested a priori. Level 1 relevance screening excluded irrelevant citations; level 2 confirmed relevance and categorized. At level 3 screening, data were extracted to support a risk profile. A stakeholder group provided input on study tools and knowledge translation and transfer. Level 1 screening captured 2471 citations, with 1270 advancing to level 2 screening, and 1094 to level 3. We defined criteria for case attribution to zoonosis for each virus. Using these criteria, we identified a small number of zoonotic cases (HEV n=3, NoV=0, RV=40 (zoonoses=3; human-animal re-assortants=37)) categorized as 'likely'. The available evidence suggests the following potential HEV human exposure sources: swine, other domestic animals, wildlife, surface waters, and asymptomatic human shedders. Possible at-risk groups include the immunocompromised and the elderly. Reports of NoV intergenogroup recombinants suggest potential for human-animal recombination. Greatest public health impact for RV zoonoses may be the potential effect of human-animal reassortants on vaccination efficacy.

Our study objective was to describe the Canadian Hepatitis E virus (HEV) sequences currently cataloged in GenBank from three populations: commercially raised pigs, retail pork, and locally acquired Hepatitis E cases, and to interpret the molecular evidence they provide. We searched the GenBank for any/all Canadian HEV sequences from these populations, and identified highly similar matches using the Basic Local Alignment Search Tool (BLAST) algorithm, studying sequences of the partial ORF2 gene. We validated the findings made using Multiple Sequence Comparison by Log-Expectation (MUSCLE) and Clustal 2 programs for multiple sequence alignments, as inputs to estimate dendrograms using both neighbour-joining and Unweighted Pair Group Method with Arithmetic Mean (UPGMA) methods. The GenBank search yielded 47 sequences collected from pigs: 32 sequences from two to four month old commercial pigs in Quebec, one from three to four month old pigs at a research station in Ontario, one from two month old pigs in a commercial Saskatchewan herd, and 13 collected from finisher pigs in a national survey. Additionally, 14 sequences were collected from a national survey of Canadian retail pork livers, and seven sequences from two Canadian pediatric patients with locally acquired Hepatitis E, both from the province of Quebec. All sequences belonged to genotype 3. Eight of the 14 sequences from retail pork livers had human-derived sequences in their top ten BLAST matches; six did not. Those eight sequences having close human BLAST matches clustered within a dendrogram, as did those with no close human BLAST matches. Human sequences with close matches to the eight retail sequences included both of the Quebec Hepatitis E cases, as well as sequences from Japanese Hepatitis E cases, and Japanese blood donors. Seven of the eight HEV sequences from retail liver with close human BLAST matches originated in Quebec. Kulldorff's spatial scan statistic showed a significant (P

Over the past 15 years, hepatitis E virus (HEV), norovirus (NoV), and rotavirus (RV) have been hypothesized to be potentially zoonotic; swine and pork have been suggested as possible human infection sources for all 3 viruses. Our objective was to estimate HEV, NoV, and RV prevalence and load on Canadian retail pork chops and livers. Using the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) sampling platform, pork livers (n = 283) and chops (n = 599) were collected, processed, and assayed for the 3 viruses by four collaborating federal laboratories using validated real time reverse transcriptase polymerase chain reactions (qRT-PCR). Follow-up qRT-PCR estimating viral load in genomic copies/g was followed by nested classical RT-PCR and isolate sequencing of a partial segment of the ORF2 gene. Local alignments were performed using MUSCLE (Multiple Sequence Comparison by Log-Expectation); a phylogenetic tree was created. Twenty-five livers and 6 chops were classified ‘positive’ (thresholds for viral RNA detected in both replicates of the assay) or ‘suspect’ (thresholds detected in one of two replicates) for HEV. Follow-up qRT-PCR detected HEV on 16 livers, 0 chops, and nested classical RT-PCR, on 14 livers and 0 chops. Initial qRT-PCR classified 12 chops ‘suspect’ for NoV. Follow-up qRT-PCR detected viral RNA on only one sample with thresholds greater than 40 in both replicates. No amplicon was yielded, and therefore no isolate was sequenced from this sample. Partial ORF2 genes from 14 HEV isolates were sequenced, and compared via sequence identity and phylogenetic analysis with selected human case isolates listed in NCBI-GenBank. Overall, HEV prevalence on retail pork was comparable with other published reports.

Background The scoping review has become an increasingly popular approach for synthesizing research evidence. It is a relatively new approach for which a universal study definition or definitive procedure has not been established. The purpose of this scoping review was to provide an overview of scoping reviews in the literature. Methods A scoping review was conducted using the Arksey and O'Malley framework. A search was conducted in four bibliographic databases and the gray literature to identify scoping review studies. Review selection and characterization were performed by two independent reviewers using pretested forms. Results The search identified 344 scoping reviews published from 1999 to October 2012. The reviews varied in terms of purpose, methodology, and detail of reporting. Nearly three-quarter of reviews (74.1%) addressed a health topic. Study completion times varied from 2 weeks to 20 months, and 51% utilized a published methodological framework. Quality assessment of included studies was infrequently performed (22.38%). Conclusions Scoping reviews are a relatively new but increasingly common approach for mapping broad topics. Because of variability in their conduct, there is a need for their methodological standardization to ensure the utility and strength of evidence. © 2014 The Authors. Research Synthesis Methods published by John Wiley & Sons, Ltd.

Knowledge synthesis refers to the integration of findings from individual research studies on a given topic or question into the global knowledge base. The application of knowledge synthesis methods, particularly systematic reviews and meta-analysis, has increased considerably in the agri-food public health sector over the past decade and this trend is expected to continue. The objectives of our review were: (1) to describe the most promising knowledge synthesis methods and their applicability in agri-food public health, and (2) to summarize the recent advancements, challenges, and opportunities in the use of systematic review and meta-analysis methods in this sector. We performed a structured review of knowledge synthesis literature from various disciplines to address the first objective, and used comprehensive insights and experiences in applying these methods in the agri-food public health sector to inform the second objective. We describe five knowledge synthesis methods that can be used to address various agri-food public health questions or topics under different conditions and contexts. Scoping reviews describe the main characteristics and knowledge gaps in a broad research field and can be used to evaluate opportunities for prioritizing focused questions for related systematic reviews. Structured rapid reviews are streamlined systematic reviews conducted within a short timeframe to inform urgent decision-making. Mixed-method and qualitative reviews synthesize diverse sources of contextual knowledge (e.g. socio-cognitive, economic, and feasibility considerations). Systematic reviews are a structured and transparent method used to summarize and synthesize literature on a clearly-defined question, and meta-analysis is the statistical combination of data from multiple individual studies. We briefly describe and discuss key advancements in the use of systematic reviews and meta-analysis, including: risk-of-bias assessments; an overall quality-of-evidence approach; engagement of stakeholders; Bayesian, multivariate, and network meta-analysis; and synthesis of diagnostic test accuracy studies. We also highlight several challenges and opportunities in the conduct of systematic reviews (e.g. inclusion of grey literature, minimizing language bias, and optimizing search strategies) and meta-analysis (e.g. inclusion of observational studies and approaches to address the insufficient reporting of data and significant heterogeneity). Many of these developments have yet to be comprehensively applied and evaluated in an agri-food public health context, and more research is needed in this area. There is a need to strengthen knowledge synthesis capacity and infrastructure at the regional, national, and international levels in this sector to ensure that the best available knowledge is used to inform future decision-making about agri-food public health issues.

Mycobacterium avium ssp. paratuberculosis is the etiologic agent of Johne's disease in ruminants and is hypothesized to be an infectious cause of Crohn's disease, as well as some other human diseases. Due to key knowledge gaps, the potential public health impact of M. paratuberculosis is unknown. This scoping review aims to identify and characterised the evidence on potential sources and vehicles of M. paratuberculosis exposure for humans to better understand how exposure is likely to occur. Evidence from 255 primary research papers is summarized; most examined the prevalence or concentration of M. paratuberculosis in animals (farmed domestic, pets and wildlife) (n=148), food for human consumption (62) (milk, dairy, meat, infant formula) or water (drinking and recreational) and the environment (farm, pasture and areas affected by runoff water) (20). The majority of this research has been published since 2000 (Figure- abstract). Nine case-control studies examining risk factors for Crohn's disease highlighted significant associations with the consumption of processed meats and cheese, while direct contact with ruminants, high risk occupations (farmer, veterinarian), milk consumption and water source were factors not associated with the disease and/or M. paratuberculosis exposure status. Molecular epidemiology studies demonstrated strain-sharing between species. Produce and seafood were the only previously suggested sources of human exposure for which there was no supporting evidence identified in this scoping review. The results of this review indicate that ruminant populations from around the globe are infected with M. paratuberculosis and many non-ruminant species have also been found to carry or be infected with M. paratuberculosis. Several potential sources for human exposure to M. paratuberculosis were identified; however there remain important gaps in quantitative information on the prevalence and concentration of M. paratuberculosis in contaminated sources of exposure. This information is critical to understanding the risk of exposure, opportunities for risk mitigation interventions and modelling exposures to distill the importance of various sources of human exposure to M. paratuberculosis including direct contact with animals and the environment as well as consumption of contaminated foods and water. Results of this study may be used to prioritize future research and to support evidence-informed decision-making on the M. paratuberculosis issue.

Five on-farm practices for reduction of Salmonella shedding or sero-prevalence in grow-finish swine were selected through scoping study and expert consultation. Specific examples were selected based on supporting evidence from at least one controlled trial (CT), and availability to Canadian swine producers. Efficacy was evaluated using systematic review and meta-analysis (SR-MA) methodology. A modified Grading of Recommendations, Assessment, and Evaluation (GRADE) approach was applied to assess the quality of evidence for each intervention, and a 'summary of findings' table was developed to present findings 'at-a-glance'. MA of the small dataset of CTs investigating feeding meal, and measuring serology, yielded a significant summary estimate of efficacy (odds ratio (OR)=0.21; 95% confidence intervals (CI): 0.14, 0.31) with non-significant heterogeneity (P0.10). MA of the dataset investigating inclusion of organic acids in the ration, measuring serology, yielded a significant summary estimate with significant heterogeneity across studies (P0.001, I(2)=91%) precluding presentation of a single summary estimate; a range of results were reported (OR Range: 28 (1.6, 498); 0.07 (CI: 0.042, 0.33)). Pen disinfection between batches of finishers was studied in one large CT measuring both fecal culture (OR 0.84 (0.68, 1.1)) and serology (OR 0.48 (0.40, 0.58)) outcomes. The dataset investigating Salmonella spp. vaccination contained inconsistent findings (OR Range: 4.5 (1.3, 15); 0.07 (0.008, 0.68)), with significant heterogeneity across studies (P=0.005, I(2)=82), assessed measuring fecal culture. MA of the dataset investigating inclusion of in-feed tetracyclines yielded a significant OR indicating a potential harmful effect, measuring fecal culture, (OR Range: 14 (1.9, 108); 1.0 (0.43, 2.5)) with significant heterogeneity (P=0.003, I(2)=82%) across studies, suggesting some potential for withdrawal of in-feed tetracyclines to reduce Salmonella shedding. Therefore our ranking of intervention efficacy is: feeding mealinclusion of acids in ration, feeder pen disinfection or Salmonella spp. vaccinationin-feed tetrayclines. Study design characteristics increasing risk of bias, including failure to justify sample size (19 of 31 studies) and failure to report random or systematic sampling (13 of 31 studies), resulted in modified GRADE evidence rankings of 'low' for these interventions. This suggests that further research is likely to affect our findings. Field CTs investigating herd-level interventions with measurements at the herd- and individual-levels are recommended. Overall, SR-MA was a useful approach for ranking efficacy, and GRADE offered a transparent method for ranking quality of evidence, although both were limited by the small number of comparable studies available.

Results from primary processing intervention strategies for Escherichia coli reduction on beef carcasses are often inconsistent or contradictory. Our objective was to identify, critically evaluate and synthesize published intervention research reporting treatment efficacy at the abattoir on E. coli contamination of beef carcasses using systematic review (SR)–meta-analysis (MA) methodology to recommend effective practices and determine knowledge gaps. Four electronic bibliographic databases were searched for intervention studies in English. Two independent reviewers performed all SR steps. Risk of bias was assessed and separate random-effects MAs conducted on datasets. A stochastic simulation model using MA effect estimates evaluated combined effects of potable water carcass wash, steam or hot water pasteurization and a 24 h dry chill. The SR-MA included 36 citations (202 trials). Although 44 interventions were identified at nine stages of processing, MA was precluded for most due to small study numbers, high risk of bias and heterogeneity. Reduced odds of generic E. coli carcass contamination demonstrated by MA: final carcass washing (OR 0.56, CI: 0.41–0.77), pasteurization (OR 0.09, CI: 0.06–0.14) and 24 h dry chilling (OR 0.17, CI: 0.11–0.24). Combining effects of potable water carcass wash, steam or hot water pasteurization and a 24 h dry chill, assuming no additional contamination and all variables constant, resulted in a reduced prevalence of 1.22% (CI 0.17, 3.57). The predicted risk difference in carcass contamination was 14, 42 and 35 per 100 carcasses upon application of final wash, carcass pasteurization and 24 h dry chill, respectively. Existing research indicates that final wash, hot water or steam pasteurization, and dry chilling are beneficial for reducing the contamination of beef carcasses with generic E. coli and potentially pathogenic strains.

Eating inappropriately prepared poultry meat is a major cause of foodborne salmonellosis. Our objectives were to determine the efficacy of feed and water additives (other than competitive exclusion and antimicrobials) on reducing Salmonella prevalence or concentration in broiler chickens using systematic review-meta-analysis and to explore sources of heterogeneity found in the meta-analysis through meta-regression. Six electronic databases were searched (Current Contents (1999-2009), Agricola (1924-2009), MEDLINE (1860-2009), Scopus (1960-2009), Centre for Agricultural Bioscience (CAB) (1913-2009), and CAB Global Health (1971-2009)), five topic experts were contacted, and the bibliographies of review articles and a topic-relevant textbook were manually searched to identify all relevant research. Study inclusion criteria comprised: English-language primary research investigating the effects of feed and water additives on the Salmonella prevalence or concentration in broiler chickens. Data extraction and study methodological assessment were conducted by two reviewers independently using pretested forms. Seventy challenge studies (n=910 unique treatment-control comparisons), seven controlled studies (n=154), and one quasi-experiment (n=1) met the inclusion criteria. Compared to an assumed control group prevalence of 44 of 1000 broilers, random-effects meta-analysis indicated that the Salmonella cecal colonization in groups with prebiotics (fructooligosaccharide, lactose, whey, dried milk, lactulose, lactosucrose, sucrose, maltose, mannanoligosaccharide) added to feed or water was 15 out of 1000 broilers; with lactose added to feed or water it was 10 out of 1000 broilers; with experimental chlorate product (ECP) added to feed or water it was 21 out of 1000. For ECP the concentration of Salmonella in the ceca was decreased by 0.61 log(10)cfu/g in the treated group compared to the control group. Significant heterogeneity (Cochran's Q-statistic p≤0.10) was observed among studies examining all organic acids (controlled or challenge experiments), butyric acid, formic acid, a formic/propionic acid mixture, fermented liquid feed, and D-mannose. Meta-regressions were conducted to examine the source of heterogeneity among studies. For prevalence outcomes, 36% and 60% of the total variance was within and between studies, respectively. For concentration outcomes, 39% and 33% of the total variance was within and between studies, respectively. Inadequate blinding and randomization was common, and no studies undergoing meta-analysis or meta-regression were conducted on a commercial farm. The strength of evidence of the effect of these additives was very low. Studies conducted under commercial conditions are needed to understand the potential benefit of these interventions for the poultry industry and to improve the strength of evidence of the effectiveness of these additives.

Context Broiler chicken carcass spray and dip treatments are just two of many different interventions investigated to address the need to reduce Salmonella prevalence and concentration on broiler chicken carcasses during processing. However the results of published research are inconsistent and sometimes contradictory creating a need to formally evaluate, synthesize and summarize available research to avoid recommending ineffective treatments and identify key knowledge gaps for future work. Objective Evaluate intervention research that measured the efficacy of various spray and dip treatments, applied on broiler chicken carcasses during primary processing, as Salmonella prevalence or concentration on broiler carcasses, using systematic review–meta-analysis (SR–MA). Data sources A comprehensive electronic search was implemented in six databases and verified through a manual search of topic-related reference lists, related reviews or book chapters, and through consultations with selected topic experts. Study inclusion Control and challenge trials, cohort and before-and-after intervention research published in English that investigated the efficacy of any spray or dip treatments, applied to broiler chicken carcasses or carcass parts during processing, on Salmonella prevalence or concentration measured at the same level under laboratory, pilot plant and commercial conditions. Risk of bias assessment and data extraction Relevant research was evaluated for methodological soundness and completeness of reporting. The main characteristics of each study included in the review were extracted. Data analysis Random-effects MA of trisodium phosphate and lactic acid dip treatments (n = 12 and n = 32 trials with prevalence outcomes, respectively) resulted in homogeneous (p-value = 0.469; I2 = 0.0% and p-value = 0.284; I2 = 11.4%, respectively) summary effect estimates (OR = 1.16; 95% CI: 0.59–2.26 and OR = 0.05; 95% CI: 0.03–0.10, respectively). Visual evaluation of MA forest plots indicated overall reduction trends for six spray treatments reporting concentration outcomes: trisodium phosphate (n = 48 trials), acidic electrolyzed oxidizing water (n = 2), cetylpyridinium chloride (n = 43), lactic acid (n = 24), sodium bisulfate (n = 11) and potable water (n = 36). Moderate to considerable heterogeneity (p-value ≤ 0.1 and I2 > 25%) was observed for these treatments. Methodological soundness of included studies was poor and a lack of studies conducted under commercial conditions was observed. Conclusions Existing research on the efficacy of broiler carcass dips or sprays on Salmonella prevalence or concentration is limited and heterogeneous, precluding the full benefits of robust meta-analyses. Larger randomized controlled trials conducted under commercial conditions are needed.

Our objective was to estimate the effectiveness of vaccination and biosecurity on the prevalence of Salmonella spp. in broiler chickens using systematic review and meta-analysis. A comprehensive search of the global primary literature was conducted in: Current Contents (1999–2009), Agricola (1924–2009), MEDLINE (1860–2009), Scopus (1960–2009), CAB (1913–2009), and Centre for Agricultural Bioscience Global Health (1971–2009). The search algorithm was (Salmonell*) AND (chicken* OR chick* OR poultry* OR broiler* OR gallus*). Additional studies were identified by contacting five topic experts and hand-scanning bibliographies of recent review articles and a recently published textbook. Studies were included if they were English language and investigated the effects of vaccination and biosecurity on the prevalence of Salmonella spp. in broiler chickens. All study design types were included. Data extraction and methodological assessment were conducted by two reviewers independently. All meta-analyses were based on random-effects models. For biosecurity, sixteen challenge studies ( n = 137 treatment-control comparisons) and one controlled study ( n = 2) met the inclusion criteria. Significant heterogeneity (Cochran's Q -statistic, p n = 226) and three controlled studies ( n = 10) met the inclusion criteria. Among live Salmonella Typhimurium vaccine challenge studies heterogeneity was not significant ( p = 0.138). Vaccination with a live Salmonella Typhimurium reduced the risk of Salmonella cecal colonization in the treated broiler group by 35 out of 1000 broilers when compared to the control group (OR = 0.21; 95% CI = 0.06–0.77) and this effect was significant ( p = 0.018). One biosecurity study ( n = 2 treatment-control comparisons) and three vaccination studies ( n = 10) were conducted in a commercial setting. The two included studies in the vaccination meta-analysis were both conducted at research facilities. The live Salmonella Typhimurium vaccine showed the most promise in reducing the prevalence of Salmonella in broiler ceca. However, the meta-analysis included few studies, and these studies challenged the birds with different serotypes. We recommend that more large-scale randomized, blinded trials be conducted with a live Salmonella Typhimurium vaccine on commercial farms.

A scoping study was conducted to identify all published prevalence, risk factor, and intervention research investigating 16 microbial hazards in leafy green vegetables and to evaluate the volume, main characteristics, basic aspects of methodological soundness and/or reporting, and the main knowledge gaps and research needs. Our study included a comprehensive literature search, a replicable two-level relevance screening (abstract and article levels), and a two-phase quality assessment and data extraction (article level). All steps were conducted by two independent reviewers following general principles of systematic review methodology. From the initial 7961 citations, 657 articles were relevant, reporting one or more research themes: prevalence (314 studies), risk factor (472) and intervention research (269). These articles were published in 190 different scientific journals, 15% between 1990 and 2000, and the remaining 85% after year 2000. Sixty-five percent of studies was conducted in the USA, Canada, or Europe. Over 70% of all studies investigated lettuce. Collectively, four leafy greens (lettuce, cabbage, spinach, and fresh leafy herbs) and microorganism (Escherichia coli, Salmonella, Listeria and coliforms) combinations accounted for almost 80% of relevant studies. Forty-one percent of the research was conducted at the processing stage of production. Lack of reporting sufficient data and/or replicable laboratory protocols (first phase assessment) resulted in exclusion of 60% of relevant articles. In total, 231 papers were retained following second phase quality evaluation, and only 152 (20% of all relevant articles) met all ranking criteria. A lack of well designed, executed, and reported prevalence studies with sampled populations representative of the target populations and of experimental studies investigating the efficacy of intervention(s) under real-life conditions was observed. A limited number of articles investigating commonly accepted important risk factors, for example worker hygiene and health, equipment sanitation, and wildlife, was identified. We highlight research areas with the data potentially feasible for full systematic review-meta-analysis methodology and areas warranting additional investigation. The resulting information is necessary for the establishment of evidence-informed guidelines for food safety enhancement.

SUMMARYThe objectives of our study were to identify and categorize primary research investigating swine/pork as a source of zoonotic hepatitis E virus (HEV) using the relatively new technique of scoping study, and to investigate the potential association between human exposure to swine/pork and HEV infection quantitatively using systematic review/meta-analysis methodology. From 1890 initially identified abstracts, 327 were considered for the review. Five study design types (cross-sectional, prevalence, genotyping, case-report and experimental transmission studies) were identified. A significant association between occupational exposure to swine and human HEV IgG seropositivity was reported in 10/13 cross-sectional studies. The association reported between pork consumption and HEV IgG seropositivity was inconsistent. The quantification of viral load in swine and retail pork, viral load required for infection in primates, cohort and case-control studies in humans, and formal risk assessment are recommended before specific public-health policy actions are taken.

The study objective was to evaluate the accuracy of a real-time polymerase chain reaction (RT-PCR) and a culture protocol used to detect Salmonella in the faeces of grow-finish pigs using a Bayesian approach. The RT-PCR was invA-gene-based assay, while the culture protocol included pre-enrichment in buffered peptone water, selective enrichment in tetrathionate and Rappaport-Vassiliadis broths, and isolation on semi-solid (modified semi-solid RV) or solid (XLT4, Rambach) agar plates. Bayesian analysis was performed using a two-test, two-population model with dependence between culture and RT-PCR and compared to a second model with conditional independence between these two tests. Two hundred and ninety three individual faecal and 294 pooled pen samples from grow-finish pig collected from 10 farms were tested and results were divided into two groups according to herd size (five herds 400 sows). In the dependence model, RT-PCR sensitivity (Se) and specificity (Sp) were estimated to be 90% (95% probability interval 74, 97) and 99% (98, 99), respectively. Culture Se was 92% (75, 99), while culture Sp was considered 100% as all culture-positive samples were confirmed by serotyping. In the conditional independence model, RT-PCR Se and Sp, and culture Se, were 96% (93, 98), 99% (98, 100) and 97% (94, 100), respectively. The dependence model resulted in posterior estimates of Se that were lower and with broader probability intervals than the independence model, indicating that when RT-PCR and culture are evaluated relative to each other, the correlation between these tests is an important source of bias and should be adjusted for during analysis. The RT-PCR evaluated in this study performed almost comparably to culture; given the cost savings associated with using this test and more timely results, the RT-PCR may be a useful alternative to culture for screening large numbers of samples, particularly when Salmonella prevalence is low.

The accuracy of bacterial culture and PCR for Salmonella in swine was examined through systematic review of existing primary research in this field. A replicable search was conducted in 10 electronic databases. All steps of the review were conducted by two reviewers: to identify relevant publications, to assess their methodological soundness and reporting, and to extract raw data or reported test accuracy estimates. Meta-analyses and meta-regression were performed: to evaluate pooled estimates of test sensitivity (Se) and specificity (Sp), to identify variables explaining the variation in reported test estimates, and to evaluate the association between these variables and reported test Se and Sp. Twenty-nine studies were included in the review. Unique test evaluations reported in these 29 studies were categorized according to the type of test comparison: culture versus culture (n = 134 test evaluations) and PCR versus culture (n = 21). We identified significant heterogeneity among evaluations for each test category. For culture, more heterogeneity was caused by differences in individual test protocols (52%) than overall differences between studies (16%). Enrichment temperature, study population, agar and enrichment type were significantly associated with variation in culture Se. Furthermore, interaction between enrichment temperature and enrichment type was detected. For PCR, most of the heterogeneity was caused by overall differences between studies (65-70%); sample type and study size were associated with variation in reported PCR Se and Sp. The overall methodological soundness and/or reporting of primary studies included in this review were poor, with variable use of reference standards, and consistent lack of the use or reporting of blinding, randomization and subject (sample) selection criteria. Consequently, the food safety and veterinary public health research community should formally consider ways for standardizing the conduct and reporting of this type of research.

Summary Literature reviews are important information sources for multiple stakeholders in zoonotic public health with limited time to keep up with the rapid increase in primary research in this field. However, their validity depends on their methodological soundness. The study purpose was to evaluate the methodological soundness of literature reviews in zoonotic public health. Relevant reviews (n = 132) published between January 2000 and August 2006 were identified on three issues: Mycobacterium avium ssp paratuberculosis as a potential cause of Crohn’s disease in humans (30 reviews); antimicrobial use in animals as a risk factor for antimicrobial resistance in human pathogens (36); and the zoonotic potential of transmissible spongiform encephalopathies (66). The zoonotic aspect of the issue was the focus of 59 reviews and a subsection of 73 reviews. Two independent reviewers evaluated reviews using 13 criteria: 10 previously validated in the medical field, and three applicable to aetiology research. No review met more than eight of 13 criteria for methodological soundness; two articles met only one criterion. Two reviews described methods for identifying relevant primary research. In only two and four reviews respectively, authors conducted quantitative syntheses of research evidence or reported summarized measures of effect for the zoonotic risk to humans. Recommendations for future research and economic impact were provided in 64 and 10 reviews respectively. In 14 reviews, conclusions exceeded evidence presented. The various review authors’ position on the evidence for the zoonotic association and the zoonotic risk to public health were inconsistent for all three issues. Reviews addressing potential zoonotic public health issues lack structured and transparent methodology preventing the end user from assessing the review’s validity. These reviews should adhere to structured scientific principles similar to what is used for primary research articles.

In the food safety arena, the decision-making process can be especially difficult. Decision makers are often faced with social and fiscal pressures when attempting to identify an appropriate balance among several choices. Concurrently, policy and decision makers in microbial food safety are under increasing pressure to demonstrate that their policies and decisions are made using transparent and accountable processes. In this article, we present a multi-criteria decision analysis approach that can be used to address the problem of trying to select a food safety intervention while balancing various criteria. Criteria that are important when selecting an intervention were determined, as a result of an expert consultation, to include effectiveness, cost, weight of evidence, and practicality associated with the interventions. The multi-criteria decision analysis approach we present is able to consider these criteria and arrive at a ranking of interventions. It can also provide a clear justification for the ranking as well as demonstrate to stakeholders, through a scenario analysis approach, how to potentially converge toward common ground. While this article focuses on the problem of selecting food safety interventions, the range of applications in the food safety arena is truly diverse and can be a significant tool in assisting decisions that need to be coherent, transparent, and justifiable. Most importantly, it is a significant contributor when there is a need to strike a fine balance between various potentially competing alternatives and/or stakeholder groups.

This review summarizes evidence for associations between Salmonella prevalence in market-weight swine and changes in feeding management practices or feed characteristics. A systematic review of the topic was conducted with the goal of minimizing the impact of bias on the review conclusions. Potential interventions included feed withdrawal from swine prior to slaughter, feed acidification, heat treatment of feed, pelletized feed versus mash, course versus fine grind, and wet versus dry feeds. In the reviewed literature, Salmonella prevalence was measured either by culture or by the presence of antibodies to Salmonella. The evidentiary value of studies was assessed, and studies that failed to meet predetermined standards were excluded. 7694 potentially relevant references were identified by an extensive literature search; however, 2623 references that were not published in English were excluded, because funds for translation were not available. Of the remaining references, only 277 were considered relevant to the review topic by two independent reviewers, and assessed for methodological quality. During quality assessment, 233 references were excluded because they failed to report design features that limit the introduction of bias or were conducted in a non-target population such as gnotobiotic, neonatal, nursery, or recently weaned pigs and sows. Forty-four publications passed the quality assessment conducted by 2 independent reviewers, but only 15 of the 44 publications reported studies that tested hypotheses associated with feeding management practices and feed characteristics and Salmonella prevalence in market-weight swine. The most common study design was cross-sectional (7/15). The included studies failed to provide strong evidence of an association between any of the potential interventions and Salmonella prevalence, due to the potential for confounding, and the failure to document temporal association between the intervention and Salmonella prevalence. The strongest evidence of an association was found for feed form, i.e. the use of non-pelleted may be potential interventions associated with reduced Salmonella prevalence. The uncertainty is primarily based on studies containing moderate to low evidentiary value or insufficient numbers of tested individuals, resulting in a low degree of confidence that results could be extrapolated to the target population. Therefore, the conclusion of the review is that there should be a low level of comfort among qualified scientists that the claimed association between non-pelleted feed and reduced Salmonella prevalence is scientifically valid. There is no strong evidence regarding associations between presence of Salmonella and the other feed characteristics examined.

Our objective was to use formal systematic review methods to evaluate the efficacy of interventions to reduce faecal shedding of Escherichia coli O157 in post-weaned ruminants by increasing animal resistance. The methodology consisted of an extensive search to identify all potentially relevant research, screening of titles and abstracts for relevance to the research question, quality assessment of relevant research, extraction of data from research of sufficient quality, and qualitative summarization of results. The interventions evaluated included probiotics, vaccination, antimicrobials, sodium chlorate, bacteriophages and other feed additives. There was evidence of efficacy for the probiotic combination Lactobacillus acidophilus NP51 (NPC 747) and Propionibacterium freudenreichii and for sodium chlorate in feed or water. The effectiveness of vaccination varied among studies and among vaccine protocols and there was no consistent evidence to suggest that antibiotic use was associated with a decrease in faecal shedding of E. coli O157, or that current industry uses of antimicrobials were associated with increased faecal shedding. There were an insufficient number of studies available to address the effectiveness of bacteriophages and several other feed additives. In general, few of the primary studies evaluated the interventions under commercial housing conditions with a natural disease challenge, there were inconsistencies in the results among study designs and in some cases among studies within study designs, and a relatively large proportion of publications were excluded based on quality assessment criteria. Few studies reported on associations between the proposed intervention and production parameters, such as average daily gain and feed: gain ratio. While the results suggest that some interventions may be efficacious, there are knowledge gaps in our understanding of the efficacy of pre-harvest interventions to increase animal resistance to E. coli O157 that require further targeted research.