Health risk and disease burden of pork-derived nontyphoidal Salmonella in Chinese households: A quantitative microbiological risk assessment

Abstract

Nontyphoidal Salmonella (NTS) represents a significant public health concern. However, the health risks associated with pork consumption in China have not been adequately characterized, particularly within household settings. This study aimed to develop a quantitative microbiological risk assessment (QMRA) model that integrates consumers' food handling practices and multidrug resistance (MDR) profiles of NTS to assess the health risks and disease burden, expressed as disability-adjusted life years (DALYs), associated with pork-derived NTS exposure in Chinese households. With 17.6% of pork consumption posing a foodborne risk, the QMRA models predicted a substantial annual incidence of 3.56 million (95% CI: 3.36-3.76) of pork-derived salmonellosis cases in China. Cross-contamination accounted for 77.2% of total cases, representing a 3.4-fold higher risk compared with undercooking. The total disease burden was estimated at 16,597 DALYs (95% CI: 15,627-17,567), with MDR-NTS strains accounting for 91.8% of the total burden. Scenario analysis showed that reducing initial contamination prevalence yielded the greatest marginal reduction in disease burden, while combined interventions at the production and consumption stages could reduce the burden by up to 80%. This study presents an evidence-based, bottom-up risk assessment framework for NTS associated with household pork consumption in China, highlighting the need for strengthened food safety regulations and more effective consumer-targeted interventions.

Keywords: Disease burden; Food handling practices; Household; Nontyphoidal Salmonella; Pork; Risk assessment.