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  1. Article ; Online: Physical Treatments to Control Clostridium botulinum Hazards in Food

    Munir, Muhammad Tanveer / Mtimet, Narjes / Guillier, Laurent / Meurens, François / Fravalo, Phillipe / Federighi, Michel / Kooh, Pauline

    Foods. 2023 Apr. 07, v. 12, no. 8

    2023  

    Abstract: Clostridium botulinum produces Botulinum neurotoxins (BoNTs), causing a rare but potentially deadly type of food poisoning called foodborne botulism. This review aims to provide information on the bacterium, spores, toxins, and botulisms, and describe ... ...

    Abstract Clostridium botulinum produces Botulinum neurotoxins (BoNTs), causing a rare but potentially deadly type of food poisoning called foodborne botulism. This review aims to provide information on the bacterium, spores, toxins, and botulisms, and describe the use of physical treatments (e.g., heating, pressure, irradiation, and other emerging technologies) to control this biological hazard in food. As the spores of this bacterium can resist various harsh environmental conditions, such as high temperatures, the thermal inactivation of 12-log of C. botulinum type A spores remains the standard for the commercial sterilization of food products. However, recent advancements in non-thermal physical treatments present an alternative to thermal sterilization with some limitations. Low- (<2 kGy) and medium (3–5 kGy)-dose ionizing irradiations are effective for a log reduction of vegetative cells and spores, respectively; however, very high doses (>10 kGy) are required to inactivate BoNTs. High-pressure processing (HPP), even at 1.5 GPa, does not inactivate the spores and requires heat combination to achieve its goal. Other emerging technologies have also shown some promise against vegetative cells and spores; however, their application to C. botulinum is very limited. Various factors related to bacteria (e.g., vegetative stage, growth conditions, injury status, type of bacteria, etc.) food matrix (e.g., compositions, state, pH, temperature, aw, etc.), and the method (e.g., power, energy, frequency, distance from the source to target, etc.) influence the efficacy of these treatments against C. botulinum. Moreover, the mode of action of different physical technologies is different, which provides an opportunity to combine different physical treatment methods in order to achieve additive and/or synergistic effects. This review is intended to guide the decision-makers, researchers, and educators in using physical treatments to control C. botulinum hazards.
    Keywords Clostridium botulinum ; bacteria ; biological hazards ; botulinum toxin ; botulism ; decision making ; energy ; food matrix ; heat ; heat inactivation ; irradiation ; mechanism of action ; pH ; temperature ; vegetative growth
    Language English
    Dates of publication 2023-0407
    Publishing place Multidisciplinary Digital Publishing Institute
    Document type Article ; Online
    ZDB-ID 2704223-6
    ISSN 2304-8158
    ISSN 2304-8158
    DOI 10.3390/foods12081580
    Database NAL-Catalogue (AGRICOLA)

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  2. Article: Physical Treatments to Control

    Munir, Muhammad Tanveer / Mtimet, Narjes / Guillier, Laurent / Meurens, François / Fravalo, Phillipe / Federighi, Michel / Kooh, Pauline

    Foods (Basel, Switzerland)

    2023  Volume 12, Issue 8

    Abstract: Clostridium ... ...

    Abstract Clostridium botulinum
    Language English
    Publishing date 2023-04-07
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2704223-6
    ISSN 2304-8158
    ISSN 2304-8158
    DOI 10.3390/foods12081580
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Risk factors for sporadic norovirus infection: A systematic review and meta-analysis

    Thébault, Anne / David, Julie / Kooh, Pauline / Cadavez, Vasco / Gonzales-Barron, Ursula / Pavio, Nicole

    Microbial risk analysis. 2021 Apr., v. 17

    2021  

    Abstract: Norovirus is responsible for 20% of acute gastroenteritis worldwide. The fecal-oral route of transmission is known, but we proposed a first attempt to identify the relative importance of different sources and vehicles for sporadic cases using meta- ... ...

    Abstract Norovirus is responsible for 20% of acute gastroenteritis worldwide. The fecal-oral route of transmission is known, but we proposed a first attempt to identify the relative importance of different sources and vehicles for sporadic cases using meta-analysis models. Case-control and cohort/cross-sectional studies were systematically reviewed and analyzed to assess the main risk factors associated with sporadic norovirus infections. Suitable scientific articles were identified through systematic literature search and subjected to a methodological quality assessment. Mixed-effects meta-analyses models were adjusted by population type to appropriate risk factor categories. The quality assessment stage led to include 14 primary studies conducted between 1993 and 2014. From these, eight studies investigated exposures in children/infants, and eight concerned the mixed population.The meta-analysis confirmed the oro-fecal route for norovirus infections, with the person-to-person transmission (pooled OR=3.002; 95% CI: [2.502-3.062] in mixed population), and the lack of personal hygiene (pooled OR=2.329; 95% CI: [1.049-5.169]). The meta-analysis also enlightened the role of indirect transmission through the environment with pathways like untreated drinking water (mixed population), with a pooled OR=2.680 (95% CI: [1.081-6.643]) and farm environment (children population). Indirect transmission also involved the food pathway, which was finally found significant with consumption of seafood (mixed population) (pooled OR=2.270; 95% CI: [1.299-3.968]) and composite food (eating outside/uncooked mixed and young population) (pooled OR=4.541; 95% CI: [3.461-5.958]).These results are coherent with the findings from studies on outbreaks. However, a too broad definition of exposure factors limited the interpretation of results, as occurred with the seafood pathways that combined fish and shellfish. Other factors such as consumption of Food-handled products or the type of drinking water deserveE to be better investigated. Furthermore, better harmonization in case definition and appropriate case-control or cross-sectional studies would allow better addressing sporadic cases risk factors, especially for susceptible populations, such as children, elderly or immunosuppressed persons.
    Keywords Norovirus ; elderly ; farms ; fish ; gastroenteritis ; good hygiene practices ; meta-analysis ; microbiological risk assessment ; risk factors ; seafoods ; shellfish ; systematic review
    Language English
    Dates of publication 2021-04
    Publishing place Elsevier B.V.
    Document type Article
    Note NAL-AP-2-clean
    ISSN 2352-3522
    DOI 10.1016/j.mran.2020.100135
    Database NAL-Catalogue (AGRICOLA)

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  4. Article: Risk factors for sporadic giardiasis: a systematic review and meta-analysis

    Thébault, Anne / Favennec, Loic / Kooh, Pauline / Cadavez, Vasco / Gonzales-Barron, Ursula / Villena, Isabelle

    Microbial risk analysis. 2021 Apr., v. 17

    2021  

    Abstract: Giardia duodenalis is an important source of gastroenteritis worldwide. Endemic cases have been described in developing and industrialized countries. We analyzed risk factors for sporadic giardiasis by a systematic review and a meta-analysis of the ... ...

    Abstract Giardia duodenalis is an important source of gastroenteritis worldwide. Endemic cases have been described in developing and industrialized countries. We analyzed risk factors for sporadic giardiasis by a systematic review and a meta-analysis of the literature. From 72 studies, contact with an infected person, lack of personal hygiene, and attending a child daycare center were identified as risk factors in children and adults.Feco-oral transmission was significantly associated with exposure to human sewage/waste water, untreated drinking water and recreational waters. Travel abroad was a risk factor in industrialized countries. No handwashing before eating or preparing food, eating unwashed vegetables, or composite food were significant risk factors. Breastfeeding was a protective factor in developing countries. Interestingly, contact with pets was found as a significant risk factor in children in this meta-analysis. This could be explored in future studies with the comparison of the Giardia assemblage isolated from humans and pets. In the future, it would be interesting to investigate more precisely the type of water, vegetable, and whenever possible the method of preparation/treatment. Environmental and epidemiological investigations of specific risk factors by assemblages and types of Giardia spp. should be further studied. Finally, host factors in relationship with the severity and sequelae of giardiasis deserve future research.
    Keywords Giardia lamblia ; breast feeding ; children ; complications (disease) ; day care centers ; gastroenteritis ; giardiasis ; good hygiene practices ; hand washing ; humans ; industrialization ; meta-analysis ; microbiological risk assessment ; risk factors ; sewage ; systematic review ; travel ; vegetables ; wastewater
    Language English
    Dates of publication 2021-04
    Publishing place Elsevier B.V.
    Document type Article
    Note NAL-AP-2-clean
    ISSN 2352-3522
    DOI 10.1016/j.mran.2020.100158
    Database NAL-Catalogue (AGRICOLA)

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  5. Article: Risk factors for sporadic toxoplasmosis: A systematic review and meta-analysis

    Thebault, Anne / Kooh, Pauline / Cadavez, Vasco / Gonzales-Barron, Ursula / Villena, Isabelle

    Microbial risk analysis. 2021 Apr., v. 17

    2021  

    Abstract: Toxoplasmosis is considered as the most prevalent parasitic zoonotic infection worldwide. The parasitic cycle is mostly known, but the relative contribution of different sources and pathways of transmission was not previously studied by a meta-analysis. ... ...

    Abstract Toxoplasmosis is considered as the most prevalent parasitic zoonotic infection worldwide. The parasitic cycle is mostly known, but the relative contribution of different sources and pathways of transmission was not previously studied by a meta-analysis. A systematic review and a meta-analysis of case-control, cohort, and cross-sectional studies were performed to determine the main risk factors associated with sporadic Toxoplasma infection. Suitable scientific articles were identified through a systematic literature search and subjected to a methodological quality assessment. Mixed-effects meta-analysis models were adjusted by population type – children, mixed population, and pregnant women – to appropriate data partitions. 187 primary studies passed the quality assessment stage, investigating risk factors for sporadic infection with Toxoplasma gondii conducted between 1983 and 2016. Cases were defined by serology.The meta-analysis of Toxoplasma sporadic infections revealed the significance of transmission by environmental factors such as contact with soil and contact with animals, in particular cats. The consumption of raw or undercooked meat and unwashed vegetables significantly increased the odds of acquiring the disease. Shellfish and raw milk were identified as significant sources of toxoplasmosis. Almost all meat categories were identified as risk factors: pork, poultry, beef, processed meat, lamb, and game meat. Contaminated drinking water may play a role in the acquisition of infection. Moreover, the lack of hygiene in preparing food was identified as a risk factor. A significant risk factor for pregnant women is traveling abroad. Lastly, blood transfusion (in pregnant women) and immunocompromised conditions were found associated with positive serology. The broad definition of exposures and the use of serology for the case definition are the main limitations for the interpretation of the results of this meta-analysis. The transmission pathways require further investigations using longitudinal studies and subtyping approaches.
    Keywords Toxoplasma gondii ; beef ; blood transfusion ; game meat ; hygiene ; meta-analysis ; microbiological risk assessment ; pork ; poultry ; raw milk ; risk factors ; serology ; shellfish ; soil ; systematic review ; toxoplasmosis ; zoonoses
    Language English
    Dates of publication 2021-04
    Publishing place Elsevier B.V.
    Document type Article
    Note NAL-AP-2-clean
    ISSN 2352-3522
    DOI 10.1016/j.mran.2020.100133
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  6. Article: Risk factors for sporadic hepatitis E infection: a systematic review and meta-analysis

    Pavio, Nicole / Kooh, Pauline / Cadavez, Vasco / Gonzales-Barron, Ursula / Thébault, Anne

    Microbial risk analysis. 2021 Apr., v. 17

    2021  

    Abstract: Hepatitis E virus (HEV) is one of the main causes of viral hepatitis infection worldwide. Sources of contamination can vary greatly according to geographical regions and HEV genotypes. HEV is endemic and responsible for large waterborne epidemics ... ...

    Abstract Hepatitis E virus (HEV) is one of the main causes of viral hepatitis infection worldwide. Sources of contamination can vary greatly according to geographical regions and HEV genotypes. HEV is endemic and responsible for large waterborne epidemics involving human HEV-1 or HEV-2 genotypes in regions with limited sanitation, in contrast to industrialized countries, where HEV is mainly a foodborne zoonosis involving HEV-3 and HEV-4 zoonotic genotypes. Limited data on HEV source attribution are available, and all possible sources and transmission pathways of HEV are not fully identified.A systematic review and a meta-analysis of case-control and cohort studies (including transversal studies) were performed to determine the main risk factors associated with sporadic hepatitis E infection. Suitable scientific articles were identified through a systematic literature search and subjected to a methodological quality assessment. From each study, odds-ratio (OR) measures were extracted/calculated, as well as study characteristics such as population type, design, and risk factor hierarchy. Mixed-effects meta-analyses models were adjusted by population type to appropriate data partitions.Seventy-seven cohort and case-control studies conducted between 1986 and 2016 and investigating risk factors in mixed population, susceptible population, and pregnant women, were included in this meta-analysis. Hepatitis E cases were defined with serological exams and differentiated whenever the serological exam is associated or not with symptoms.This meta-analysis identified the parenteral pathway (blood transfusion, tattooing or IV injection, dialysis or hemodialysis), and routes of infection related to contaminated water, animal contact (occupational exposure) and consumption of foods as relevant risk factors for hepatitis E infection.With regards to the role of food, as suspected and sometimes proven in several studies, pig meat, pork sausages, and game meat are identified as significant risk factors for HEV, in particular undercooked pig meat, or meat preparations containing pig liver. In addition, consumption of shellfish (oysters and mussels), in which HEV can accumulate when water is environmentally contaminated (from animal or human origin), is also associated with the detection of anti-HEV antibodies.The results of this meta-analysis show that symptomatic and infected cases share the most explainable risk factors, and are in agreement with recent studies conducted in Europe. This meta-analysis reveals that some sources such as consumption of insufficiently treated water, shellfish, or vegetables are under-investigated. Future case-control studies should include population at risk but under-investigated, such as transplant recipients, pregnant women and children, and investigate other potential sources of HEV.
    Keywords Orthohepevirus A ; at-risk population ; blood transfusion ; dialysis ; game meat ; hemodialysis ; hepatitis E ; humans ; industrialization ; liver ; meta-analysis ; microbiological risk assessment ; occupational exposure ; odds ratio ; pork ; risk factors ; sanitation ; shellfish ; source attribution ; swine ; systematic review ; water pollution ; zoonoses ; Europe
    Language English
    Dates of publication 2021-04
    Publishing place Elsevier B.V.
    Document type Article
    Note NAL-AP-2-clean
    ISSN 2352-3522
    DOI 10.1016/j.mran.2020.100129
    Database NAL-Catalogue (AGRICOLA)

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  7. Article ; Online: An agent-based model to simulate SARS-CoV-2 contamination of surfaces and meat cuts in processing plants

    Luong, Ngoc-Du Martin / Guillier, Laurent / Federighi, Michel / Guillois, Yvonnick / Kooh, Pauline / Maillard, Anne-Laure / Pivette, Mathilde / Boue, Géraldine / Martin-Latil, Sandra / Chaix, Estelle / Duret, Steven

    International Journal of Food Microbiology. 2023 July 13, p.110321-

    2023  , Page(s) 110321–

    Abstract: At the beginning of the COVID-19 pandemic, several contamination clusters were reported in food-processing plants in France and several countries worldwide. Therefore, a need arose to better understand viral transmission in such occupational environments ...

    Abstract At the beginning of the COVID-19 pandemic, several contamination clusters were reported in food-processing plants in France and several countries worldwide. Therefore, a need arose to better understand viral transmission in such occupational environments from multiple perspectives: the protection of workers in hotspots of viral circulation; the prevention of supply disruption due to the closure of plants; and the prevention of cluster expansion due to exports of food products contaminated by the virus to other locations. This paper outlines a simulation-based approach (using agent-based models) to study the effects of measures taken to prevent the contamination of workers, surfaces, and food products. The model includes user-defined parameters to integrate characteristics relating to SARS-CoV-2 (variant of concern to be considered, symptom onset…), food-processing plants (dimensions, ventilation…), and other sociodemographic transmission factors based on laboratory experiments as well as industrial and epidemiological investigations. Simulations were performed for a typical meat-processing plant in different scenarios for illustration purposes. The results suggested that increasing the mask-wearing ratio led to great reductions in the probability of observing clusters of >25 infections. In the case of clusters, masks being worn by all workers limited the presence of contamination (defined as levels of at least 5 log₁₀ viral RNA copies) on meat cuts at <0.05 % and maintained the production capacity of the plant at optimal levels. Increasing the average distance between two workers from <1 m to >2 m decreased the cluster-occurrence probability by up to 15 % as well as contamination of food products during cluster situations. The developed approach can open up several perspectives in terms of potential communication-support tools for the agri-food sector and further reuses or adaptations for other hazards and occupational environments.
    Keywords COVID-19 infection ; RNA ; Severe acute respiratory syndrome coronavirus 2 ; food contamination ; food industry ; food microbiology ; food processing ; meat ; meat processing plants ; probability ; simulation models ; virus transmission ; viruses ; France ; Coronavirus ; Viral transmission ; Occupational environment ; Preventive measure ; ABM
    Language English
    Dates of publication 2023-0713
    Publishing place Elsevier B.V.
    Document type Article ; Online
    Note Pre-press version
    ZDB-ID 87122-9
    ISSN 1879-3460 ; 0168-1605
    ISSN (online) 1879-3460
    ISSN 0168-1605
    DOI 10.1016/j.ijfoodmicro.2023.110321
    Database NAL-Catalogue (AGRICOLA)

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  8. Article: Risk factors for sporadic hepatitis A infection: A systematic review and meta-analysis

    Thébault, Anne / Roque-Afonso, Anne-Marie / Kooh, Pauline / Cadavez, Vasco / Gonzales-Barron, Ursula / Pavio, Nicole

    Microbial risk analysis. 2021 Apr., v. 17

    2021  

    Abstract: Hepatitis A virus (HAV) is responsible for common acute viral hepatitis worldwide. Improvement in sanitation and use of efficient vaccines have reduced HAV incidence in developed countries. However, naive adult population are most susceptible to severe ... ...

    Abstract Hepatitis A virus (HAV) is responsible for common acute viral hepatitis worldwide. Improvement in sanitation and use of efficient vaccines have reduced HAV incidence in developed countries. However, naive adult population are most susceptible to severe outcomes, and high endemic areas persist in developing regions. The transmission of HAV through the fecal-oral route is established. However, considering evolving consumption habits and global market exchange of food, investigations on risk factors associated with HAV infection are needed. Thus, a systematic review and a meta-analysis of case-control, cohort and transversal studies was performed to determine the main risk factors associated with sporadic HAV infection. Relevant scientific articles were identified through systematic literature search and subjected to a methodological quality assessment. Mixed-effects meta-analyses models were adjusted by population type to appropriate data partitions. HAV infections are defined by serological testing. The quality assessment stage selected 78 studies investigating risk factors for sporadic infections with hepatitis A conducted between 1985 and 2013. This meta-analysis confirmed that HAV infections are mostly related to inter-human transmissions, either due to contact with an ill person, through oral-anal sex practice, or lack of personal hygiene. Travel to endemic countries, occupational exposure such as working in child daycare, and exposure to wastewater were associated with HAV infection. As HAV can persist in the environment, it was not surprising that consumption of untreated drinking water, shellfish consumed raw, and crop products were risk factors. Food contamination could be due to the use of contaminated water (fruits, vegetables) or originate from infected food handlers at every point of the food chain (from picking to serving). Eating or drinking outside were associated with HAV infection. A lack of recent case-control studies was identified, with only three studies eligible between 2011 and 2017. Case-control studies required a more precise definition of risk factors such as type of crop product, and storing/preparation information (e.g. washed, frozen). The frequency of consumption or duration of environmental exposure could also better inform relationship between exposure and risk of infection. In a context of epidemiological change of HAV, international travel and trade of foods, future case-control studies are needed and should focus on populations at risk of severe infections and acute cases.
    Keywords Hepatovirus A ; adults ; children ; food chain ; food contamination ; good hygiene practices ; hepatitis A ; meta-analysis ; microbiological risk assessment ; occupational exposure ; sanitation ; shellfish ; systematic review ; trade ; travel ; wastewater ; water pollution ; world markets
    Language English
    Dates of publication 2021-04
    Publishing place Elsevier B.V.
    Document type Article
    Note NAL-AP-2-clean
    ISSN 2352-3522
    DOI 10.1016/j.mran.2020.100155
    Database NAL-Catalogue (AGRICOLA)

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  9. Article: Risk factors for sporadic listeriosis: A systematic review and meta-analysis

    Leclercq, Alexandre / Kooh, Pauline / Augustin, Jean-Christophe / Guillier, Laurent / Thébault, Anne / Cadavez, Vasco / Gonzales-Barron, Ursula / Sanaa, Moez

    Microbial risk analysis. 2021 Apr., v. 17

    2021  

    Abstract: Listeriosis is a major public health concern associated with high hospitalization and mortality rates. The objective of this work was to summarize evidence on the associations between risk factors and sporadic cases by meta-analysing outcomes from ... ...

    Abstract Listeriosis is a major public health concern associated with high hospitalization and mortality rates. The objective of this work was to summarize evidence on the associations between risk factors and sporadic cases by meta-analysing outcomes from currently published case-control studies. Suitable scientific articles were identified through systematic literature search, and subjected to a methodological quality assessment. From each study, odds-ratio (OR) measures as well as study characteristics such as population type, design, type of model and risk factor hierarchy were extracted. Mixed-effects meta-analysis models were adjusted by population type to appropriate data partitions.Twelve primary studies investigating sporadic listeriosis conducted between 1985 and 2013 passed through a quality assessment stage. These studies provided 226 OR considered for meta-analysis.According to the meta-analysis, the main risk factor for acquiring listeriosis is suffering from an immunocompromising disease. In relation to the food exposures, this meta-analysis confirmed known risk factors such as consumption of RTE dairy, seafood and processed meat and underlined new food vehicles as fruits and vegetables, recently involved in outbreaks. There were not enough data to appraise travel, animal-contact and person-to-person as transmission pathways for listeriosis. These results will allow refining the case-control studies in the aim of improving risk factors characterisation for listeriosis in the susceptible population.
    Keywords at-risk population ; listeriosis ; meta-analysis ; microbiological risk assessment ; models ; mortality ; odds ratio ; processed meat ; public health ; risk factors ; seafoods ; systematic review ; travel
    Language English
    Dates of publication 2021-04
    Publishing place Elsevier B.V.
    Document type Article
    Note NAL-AP-2-clean
    ISSN 2352-3522
    DOI 10.1016/j.mran.2020.100128
    Database NAL-Catalogue (AGRICOLA)

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  10. Article: Risk factors for sporadic campylobacteriosis: A systematic review and meta-analysis

    Fravalo, Philippe / Kooh, Pauline / Mughini-Gras, Lapo / David, Julie / Thébault, Anne / Cadavez, Vasco / Gonzales-Barron, Ursula

    Microbial risk analysis. 2021 Apr., v. 17

    2021  

    Abstract: Campylobacter spp. is an important causative agent of diarrheal illness worldwide. The disease is frequently associated with foodborne transmission, but other routes of exposure are increasingly recognized. A systematic review and meta-analysis of case- ... ...

    Abstract Campylobacter spp. is an important causative agent of diarrheal illness worldwide. The disease is frequently associated with foodborne transmission, but other routes of exposure are increasingly recognized. A systematic review and meta-analysis of case-control studies were performed to determine the main risk factors associated with sporadic campylobacteriosis. Suitable scientific articles published up to March 2017 were identified through a systematic literature search and subject to methodological quality assessment. From each study, odds ratios (OR) as measures of association were extracted or calculated, as well as study characteristics such as study population, design, type of model used and risk factor categorization. Mixed-effects meta-analytical models were adjusted by population type to appropriate data partitions. From 4453 identified references, the quality assessment stage was passed by 71 case-control studies focusing on sporadic campylobacteriosis. The eligible studies were conducted between 1981 and 2012 and provided 1336 ORs for meta-analysis. The meta-analysis identified international travel (pooled OR=4.626), recent use of gastric antacids (pooled OR=2.911), occupational exposure to animals/carcasses (pooled OR=3.022), and food consumption (in particular raw or undercooked eggs, poultry, beef, and dairy) as the main risks factors for sporadic campylobacteriosis in the mixed population. In the child population, the main risk factors concerned environmental/animal transmission routes (e.g. drinking untreated water (pooled OR=3.261), exposure to recreational water (pooled OR=3.156), exposure to farm/rural environment (pooled OR=3.128), contact with farm animals (pooled OR=2.747), person-to-person transmission (pooled OR=2.736) and consumption of raw milk (pooled OR =2.603). The results of this meta-analysis highlight the importance of overlooked routes and vehicles of transmission (environment, animal contact, and other food vehicles) of Campylobacter that should be explored in dedicated studies.
    Keywords Campylobacter ; beef ; campylobacteriosis ; children ; diarrhea ; etiological agents ; farms ; food consumption ; meta-analysis ; microbiological risk assessment ; models ; occupational exposure ; poultry ; raw milk ; risk factors ; rural areas ; systematic review ; travel
    Language English
    Dates of publication 2021-04
    Publishing place Elsevier B.V.
    Document type Article
    Note NAL-AP-2-clean
    ISSN 2352-3522
    DOI 10.1016/j.mran.2020.100118
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