Challenges and opportunities in risk assessment for viruses Marion

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Cecilia Jefferson
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1 Challenges and opportunities in risk assessment for viruses Marion

2 Estimates of foodborne viral disease, US Estimated nr FB cases Per Estimated nr hospitalisations Estimated nr deaths 95% NoV 95% HAV 99% NoV Scallan et al., 2011

3 Viruses and food, sources Category Source Mode of Tx Example Clinical syndrome Fecal viruses human Fecal contamination at source irrigation Food handler Fecal oral Norovirus Sapovirus Astrovirus Rotavirus Enterovirus Hepatitis A virus Hepatitis E virus? Diarrheal disease Hepatitis Neurological disease Fecal viruses animal Fecal contamination at source Irrigation (shellfish, berries) Fecal oral, zoonotic Hepatitis E virus Rotavirus.. Hepatitis Diarrheal disease Systemic infection animal Meat, animal products Zoonotic, including fecal oral Hepatitis E virus TBE Nipah Avian influenza Rift valley fever MERS. Hepatitis Neurological disease Respiratory disease Hemorrhagic fever

4 Issues to address in microbial risk assessment Microbial growth and death Genetic diversity and evolution Potential for secondary transmission Immunity Diversity of health endpoints Heterogenous distribution in environment Detection method sensitivity Population, community, and ecosystem level dynamics Routes of exposure. Infectome, microbiome and exposome Microbial Risk Assessment Guideline: Pathogenic Organisms with Focus on Food and Water. FSIS Publication No. USDA/FSIS/ ; EPA Publication No. EPA/100/J12/001.

5 Family, genus, genogroups, genotypes, variants GGII ~80% Seasonal HCAI Dominant Variant (GII.4) Clarke et al, 2010; Verhoef et al., 2011; Kroneman et al., 2013 GGI ~20% More varied Food

6 Higher associa on with non-gii.4 NoV Day care center Mild illness Higher associa on With GII.4 NoV Hospitals Severe illness Global community Zoonotic events? Long-term Care facility Severe illness - Genetic and antigenic evolution through recombination -Prolonged shedding, -more time for genetic evolution -less immune pressure Transmission via food (non-gii.4) via person-to-person contact (GII.4) -Genetic and antigenic evolution due to immune pressure Evidence for QMRA Animal Kingdom De Graaf et al., submitted

Noroviruses persist in the population through evolution Effects of mutations: Escape mutants (drift) No protective immunity Differences in host cell binding >

7 Noroviruses persist in the population through evolution Effects of mutations: Escape mutants (drift) No protective immunity Differences in host cell binding > New host range Siebenga et al., 2008; Allen et al., 2008; Parra et al., 2012; Tan et al., 2003 Lindesmith et al., 2008; Bok et al., 2009; Siebenga et al. 2010

8 Reassortment Infection of a single cell with more than one strain > progeny virus with mixed genome More likely when humans are exposed to multiple viruses Eg foodborne outbreaks Daycare centres Immunocompromised persons Potential for introduction of novel viruses into the population (mixed genomes) I.p5 GI.p4 GI.p1 GI.pb GI.p2 GI.p7 GI.pd GI.p3 GII.22 GII.p7 GII.p16 GII.p2 GII.6 GII.13 GII.12 GII.10 GII.1 GII.5 GII.2 GII.17 GI.1 GI.6 GI.2 GI.4 GI.3 GI.5 De Graaf et al., submitted GII.P21 GII.P13 GII.Pc GII.Pg GII.P12 GII.3 GII.14

Emergence of recombinant strains may change impact Kenya 20122013, environmental

9 Emergence of recombinant strains may change impact Kenya , environmental China, Japan , outbreaks De Graaf et al., 2015; van Beek et al., submitted

10 Effects of strain diversity of FB disease estimates Great fluctuations in estimated foodborne illness Verhoef et al., 2015

11 North America imports EUROPE imports Japan and Korea imports Central Asia North Africa Middle East East Asia Central America South Asia Sub-Sahara South East Asia South America Genotype IA N= 4143 Genotype IB Genotype IIIA De Sousa et al., in preparation

Sequence based cluster detection, HAV example France: Jan 2010 N =59 cases HAV infections The Netherlands: Jan 2010-2011 N =14 cases HAV infections IB Frozen

12 Sequence based cluster detection, HAV example France: Jan 2010 N =59 cases HAV infections The Netherlands: Jan N =14 cases HAV infections IB Frozen Berries Nordic countries: Oct N = 103 cases HAV infections Semi-Dried tomatoes IB Australia: May 2009 N= 250 cases HAV infections Petrignani et al., 2010, 2014

13 Hurdle: getting robust evidence for foodborne outbreaks

14 Oyster herpes virus Massive die-out Market shift Top producers: China, Japan, Korea

15 Emerging viruses and the food chain Pig Hepatitis E immunocompromised SARS wild animal markets Nipah fruits>pigs>people Avian influenza- food handlers, blood Rift valley fever animal products, slaughter Ebola bush meat MERS coronavirus: dromedary milk, slaughterers immunocompromised..

16 Impact of avian influenza H7N9 emergence

of pathogens - Start date December 1 st 2014 Coordinated by Frank M.

18 COllaborative Management Platform for detection and Analyses of (Re-) emerging and foodborne outbreaks in Europe A global platform for the sequence-based rapid identification of pathogens - Start date December 1 st 2014 Coordinated by Frank M. Aarestrup (Technical University of Denmark) Marion Koopmans (Erasmus Medical Center, the Netherlands)

19 Analytical framework and globally linked data and information sharing platform. RA Models & risk-based strategies for sample and data collection Harmonized standards for sample processing and sequencing Analytical workflows for generating actionable information Data and information platform

20 The future of risk assessment science for viruses? Develop capacity to deal with emerging diseases > agenda setting for research Develop capacity to take stock of evolving data sources

Noronet report, April 2014

Noronet report, April 2014 Janko van Beek, Annelies Kroneman, Harry Vennema, Marion Koopmans A. van Leeuwenhoeklaan 9 3721 MA Bilthoven Postbus 1 3720 BA Bilthoven www.rivm.nl T 030 274 91 11 F 030 274