Application of a Rapid Knowledge Synthesis and Transfer Approach to Assess the Microbial Safety of Low-Moisture Foods

摘要

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.