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Volume 27, Number 1—January 2021

Attribution of Illnesses Transmitted by Food and Water to Comprehensive Transmission Pathways Using Structured Expert Judgment, United States

Elizabeth BeshearseComments to Author , Beau B. Bruce, Gabriela F. Nane, Roger M. Cooke, Willy Aspinall, Tine Hald, Stacy M. Crim, Patricia M. Griffin, Kathleen E. Fullerton, Sarah A. Collier, Katharine M. Benedict, Michael J. Beach, Aron J. Hall, and Arie H. Havelaar
Author affiliations: University of Florida, Gainesville, Florida, USA (E. Beshearse, A.H. Havelaar); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (B.B. Bruce, S.M. Crim, P.M. Griffin, K.E. Fullerton, S.A. Collier, K.M. Benedict, M.J. Beach, A.J. Hall); Delft University of Technology, Delft, the Netherlands (G.F. Nane); Resources for the Future, Washington, DC, USA (R. Cooke); Aspinall & Associates, Tisbury, UK (W. Aspinall); University of Bristol, Bristol, UK (W. Aspinall); Technical University of Denmark, Lyngby, Denmark (T. Hald)

Main Article

Table 2

Major transmission pathway definitions, structured expert judgment, United States, 2017

Major transmission pathways Description
Transmission occurs through eating food. Contamination can originate anywhere in the food production chain from primary production, to retail, and then to the home or restaurant. This pathway applies to all nonwater beverages and items ingested by humans as food (e.g., including raw milk and excluding items consumed for medicinal purposes).
Transmission occurs through the consumption of or direct contact with water or inhalation of aerosols originating from water. This includes drinking water, bottled water, recreational water (treated and untreated), and other water sources, such as water within buildings, used in medical devices, or for industry/manufacturing.
Transmission occurs by direct contact with infected persons or their bodily fluids, or by contact with the local environment where an exposed person is simultaneously present with an infected person or visible excreta.
Animal contact
Transmission occurs through direct contact with an animal, its bodily fluids (excluding raw milk or other fluids consumed as food), fur, hair, feathers, scales, or skin, or by contact with the local environment where an infected animal, its visible excreta, fur, hair, feathers, scales, or skin was simultaneously present with the exposed person (e.g., barns, petting zoos, and pet stores). This pathway includes domestic animals, farm animals, wildlife, and pets.
Environmental Transmission occurs through exposure to naturally occurring agents (e.g., free-living ameba or radon) or contact with contaminated air, mud, soil, or other outdoor or indoor surfaces or objects not attributable to foodborne, waterborne, person-to-person, or animal contact transmission, as defined for this project.

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Page created: October 14, 2020
Page updated: January 27, 2021
Page reviewed: January 27, 2021
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.