2 RISK ASSESSMENT OF VIBRIO PARAHAEMOLYTICUS IN RAWOYSTERS2.1 Hazard identification<strong>Vibrio</strong> parahaemolyticus is a mar<strong>in</strong>e micro-<strong>org</strong>anism occurr<strong>in</strong>g <strong>in</strong> estuar<strong>in</strong>e waters throughout theworld. The <strong>org</strong>anism was first identified as a foodborne pathogen <strong>in</strong> Japan <strong>in</strong> the 1950s (Fuj<strong>in</strong>o et al.,1953). By the late 1960s and early 1970s, V. parahaemolyticus was recognized as a cause of diarrhoealdisease worldwide, although most common <strong>in</strong> Asia and the United States. A recent history of <strong>seafood</strong>consumption is quite a consistent aspect of <strong>Vibrio</strong> <strong>in</strong>fection. <strong>Vibrio</strong>s concentrate <strong>in</strong> the gut of filter-feed<strong>in</strong>gmolluscan shellfish such as oysters, clams, and mussels where they multiply and cohere. Althoughthorough cook<strong>in</strong>g destroys these <strong>org</strong>anisms, oysters are often eaten raw and, at least <strong>in</strong> the United States,are the most common food associated with <strong>Vibrio</strong> <strong>in</strong>fection (Hlady, 1997).2.1.1 Human <strong>in</strong>cidenceIn Asia V. parahaemolyticus is a common cause of foodborne disease. In general the outbreaksare small <strong>in</strong> scale, <strong>in</strong>volv<strong>in</strong>g fewer than 10 cases, but occur frequently. Prior to 1994, the <strong>in</strong>cidence ofV. parahaemolyticus <strong>in</strong>fections <strong>in</strong> Japan had been decl<strong>in</strong><strong>in</strong>g, however, <strong>in</strong> 1994-95 there were 1,280 reportsof <strong>in</strong>fection due to the <strong>org</strong>anism (Anonymous, 1999a) and dur<strong>in</strong>g this period, V. parahaemolyticus foodpoison<strong>in</strong>gs outnumbered those of Salmonella food poison<strong>in</strong>g. For both years, the majority of the casesoccurred <strong>in</strong> the summer, with the largest number appear<strong>in</strong>g <strong>in</strong> August. From 1996-1998, there were 496outbreaks, 1,710 <strong>in</strong>cidents and 24,373 cases of V. parahaemolyticus reported. The number ofV. parahaemolyticus food poison<strong>in</strong>g cases doubled <strong>in</strong> 1998 as compared with 1997 and aga<strong>in</strong> exceeded thenumber of Salmonella cases (Anonymous, 1999a). As <strong>in</strong> 1994-1995, outbreaks were more prevalent <strong>in</strong> thesummer with a peak <strong>in</strong> August and with few outbreaks dur<strong>in</strong>g w<strong>in</strong>ter months. Boiled crabs caused onelarge-scale outbreak, <strong>in</strong>volv<strong>in</strong>g 691 cases. The <strong>in</strong>creased <strong>in</strong>cidence dur<strong>in</strong>g 1997-1998 has been attributedto an <strong>in</strong>creased <strong>in</strong>cidence of serovar O3:K6;Between 1986 and 1995 197 outbreaks of foodborne disease were caused by V. parahaemolyticus<strong>in</strong> Taiwan (Pan et al., 1997) while <strong>in</strong> 1997 over 200 outbreaks were reported, <strong>in</strong>clud<strong>in</strong>g an outbreak of 146cases acquired from boxed lunches (Anonymous. 1999b).Dur<strong>in</strong>g 1997 and 1998 there were more than 700 cases of illness due to <strong>Vibrio</strong> parahaemolyticus<strong>in</strong> the United States, the majority of which were associated with the consumption of raw oysters. In two ofthe 1998 outbreaks a serotype of V. parahaemolyticus, O3:K6, previously reported only <strong>in</strong> Asia, emergedas a pr<strong>in</strong>cipal cause of illness for the first time. Subsequent studies on these stra<strong>in</strong>s have revealed theirpandemic spread. It was suggested that warmer than usual water temperatures were responsible for theoutbreaks. In 1999, the United States Food and Drug Adm<strong>in</strong>istration (FDA) <strong>in</strong>itiated a risk assessment tocharacterize the public health impact of consum<strong>in</strong>g raw oysters contam<strong>in</strong>ated with V. parahaemolyticus.The FDA Draft Risk Assessment on the Public Health Impacts of V. parahaemolyticus <strong>in</strong> Raw MolluscanShellfish (FDA-VPRA) was released for public comment <strong>in</strong> 2001 (Anonymous, 2001).In Europe few data exist on the <strong>in</strong>cidence of V. parahaemolyticus <strong>in</strong>fections, one of the reasonsbe<strong>in</strong>g that such <strong>in</strong>fections are not notifiable. However the current knowledge of the <strong>in</strong>cidence <strong>in</strong> Europehas been summarized as presented <strong>in</strong> the recent Op<strong>in</strong>ion of the Scientific Committee on Veter<strong>in</strong>aryMeasures relat<strong>in</strong>g to Public Health on <strong>Vibrio</strong> vulnificus and <strong>Vibrio</strong> parahaemolyticus <strong>in</strong> raw andundercooked <strong>seafood</strong> issued by the European Commission (Table 2.1) (European Commission, 2001).4
2.1.2 Foods implicatedV. parahaemolyticus occurs <strong>in</strong> a variety of fish and shellfish <strong>in</strong>clud<strong>in</strong>g clams, shrimp, lobster,crayfish, scallops and crabs as well as oysters. Although oysters are the most common food associatedwith <strong>Vibrio</strong> <strong>in</strong>fection <strong>in</strong> some countries (Hlady, 1997), there have been reports of V. parahaemolyticus<strong>in</strong>fections associated with the other types of <strong>seafood</strong>. One such report was a case-controlled study ofsporadic <strong>Vibrio</strong> <strong>in</strong>fections <strong>in</strong> two coastal areas of the states of Louisiana and Texas <strong>in</strong> the United Statesconducted from 1992-93, <strong>in</strong> which crayfish consumption was reported by 50% (5/10) of the personsaffected with V. parahaemolyticus <strong>in</strong>fection (Bean et al., 1998). Outbreaks of V. parahaemolyticusgastroenteritis aboard two Caribbean cruise ships were reported <strong>in</strong> 1974 and 1975 (Lawrence et al., 1979).The outbreaks were most likely caused by contam<strong>in</strong>ation of cooked <strong>seafood</strong> by seawater from the ships’seawater fire systems. In 1972, an estimated 50% (600/1,200) of persons who attended a shrimp feast <strong>in</strong>Louisiana <strong>in</strong> the United States became ill with V. parahaemolyticus gastroenteritis (Barker et al., 1974).Samples of uncooked shrimp tested positive for the <strong>org</strong>anism. Three outbreaks occurred <strong>in</strong> Maryland <strong>in</strong>the United States <strong>in</strong> 1971 (Dadisman et al., 1972). Steamed crabs were implicated <strong>in</strong> two of the outbreaksafter cross-contam<strong>in</strong>ation with live crabs. The third outbreak was associated with crabmeat that hadbecome contam<strong>in</strong>ated before and dur<strong>in</strong>g cann<strong>in</strong>g. Recently, sampl<strong>in</strong>g studies <strong>in</strong> the Adriatic Seademonstrated the presence of V. parahaemolyticus <strong>in</strong> fish, mussels and clams (Baffone et al., 2000). In arecent study conducted mussels from the North-western coast of Spa<strong>in</strong> V. parahaemolyticus was isolatedfrom 8% of samples (European Commission, 2001). Also Figure 3.1 <strong>in</strong> the section on risk assessment ofV. parahaemolyticus on raw and undercooked f<strong>in</strong>fish summarises the types of <strong>seafood</strong>s implicated <strong>in</strong>V. parahaemolyticus outbreaks <strong>in</strong> Japan.Table 2.1. Available data on the <strong>in</strong>cidence of <strong>Vibrio</strong> parahaemolyticus <strong>in</strong>fections <strong>in</strong> Europe. (EuropeanCommission, 2001)Country Period considered Number of Cases Symptoms Orig<strong>in</strong> of dataDenmark1987-1992 1310Wound <strong>in</strong>fectionEar <strong>in</strong>fectionHornstrup and Gahrn-Hansen, 19931980-2000 2 Gastroenteritis Statens Serum Institut,CopenhagenEngland and Wales 1995-1999 115 PHLS, Col<strong>in</strong>daleFrance1995-1998 61GastroenteritisSepticemiaGeneste et al., 20001997 44 Gastroenteritis 1 Lemo<strong>in</strong>e et al., 1999Northern Ireland 1990-1999 0 CDSC (CommunicableDisease SurveillanceCentre, NI)Scotland 1994-1999 6Spa<strong>in</strong> 1995-1998 19 Gastroenteritis Anonymous, 1996Anonymous, 1998bSweden 1992-1997 350 Gastroenteritis 2 L<strong>in</strong>dquist et al., 2000Norway 1999 4 Unpublished data1One outbreak associated with <strong>seafood</strong> imported from Asia.2 One outbreak associated with consumption of crayfish imported from Ch<strong>in</strong>a.2.2 Exposure assessmentThe purpose of this exposure assessment is to quantify the exposure of consumers to pathogenicV. parahaemolyticus from the consumption of raw oysters.5
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Reilly, L.A. and Hackney, C.R. 1985