Burden of disease estimation based on Escherichia coli quantification in ready-to-eat meals served in Portuguese institutional canteens

Shiga toxin-producing E. coli (STEC), enterotoxigenic E. coli (ETEC) and enteropathogenic E. coli (EPEC) are associated with the onset of gastroenteritis with different severities, and STEC has been associated with other sequelae, such as hemolytic uremic syndrome and end stage renal disease. The main goal of this study was to estimate the annual foodborne burden of disease associated with STEC, ETEC and EPEC infection based on E. coli quantification results obtained in the routine analysis of ready-to-eat meals served in institutional canteens from 2018 to 2019. A stochastic Quantitative Microbial Risk Assessment (QMRA) model was used to estimate the expected number of cases per health outcome and Disability Adjusted Life Years (DALYs). Assuming a daily consumption of a whole meal portion (450 g), the estimated burden was of 4.2 x 10-3 DALYs/person/year for STEC infection, 2.82 x 10-4 DALYs/person/year for ETEC infection and 7.91 x 10-6 DALYs/person/year for EPEC infection. Additionally, using the Sobol method, the sensitivity analysis revealed that the factors with higher influence on the final output (DALYs) were the pathotype's prevalence for the STEC model, the number of people exposed to the hazard for the ETEC model and E. coli concentrations for the EPEC model.