Dose-response Modelling of Staphylococcal Enterotoxins Using Outbreak Data

Staphylococcal food poisoning (SFP) is one of the most common food-borne diseases and results from the ingestion of staphylococcal enterotoxins (SEs). Yet, small amount of data are available for establishing a dose response. The objective of this work was to build a dose response relation based on the systematic investigations carried out during recent years in France. Over the period 2010-2014, more than 60 SFP outbreaks involving SEs, mainly from France, were microbiologically investigated. The enterotoxins were characterized as well as quantified. Attack rates, appearance times and natures of symptoms collected during epidemiological investigations were related to microbiological data. The outbreaks collected focused on enterotoxins SEA, SEB, SEC, and SED. Distribution of appearance times of symptoms and their natures were not influenced by the type of enterotoxins. The US EPA benchmark dose (BMD) methodology was then used to establish dose response. Attack rates of SFP outbreaks were modelled as a function of ingested doses and a BMD have been estimated for SEA.