Bayesian temporal source attribution of foodborne zoonoses: Campylobacter in Finland and Norway.

Statistical source attribution approaches of food-related zoonoses can generally be based on reported diagnosed human cases and surveillance results from different food sources or reservoirs of bacteria. The attribution model, or probabilistic classifier, can thus be based on the (sub)typing information enabling comparison between human infections and samples derived from source surveillance. Having time series of both data allows analyzing temporal patterns over time providing a repeated natural experiment. A Bayesian approach combining both sources of information over a long time series is presented in the case of Campylobacter in Finland and Norway. The full model is transparently presented and derived from the Bayes theorem. Previous statistical source attribution approaches are here advanced (1) by explicit modeling of the cases not associated with any of the sources under surveillance over time, (2) by modeling uncertain prevalence in a food source by bacteria type over time, and (3) by implementing formal model fit assessment using posterior predictive discrepancy functions. Large proportion of all campylobacteriosis can be attributed to broiler, but considerable uncertainty remains over time. The source attribution is inherently incomplete if only the sources under surveillance are included in the model. All statistical source attribution approaches should include a model fit assessment for judgment of model performance with respect to relevant quantities of interest. It is especially relevant when the model aims at a synthesis of several incomplete information sources under significant uncertainty of explanatory variables.