Dose-response models for selected respiratory infectious agents: Bordetella pertussis, group a Streptococcus, rhinovirus and respiratory syncytial virus

BACKGROUND: Dose-response assessment is one step in quantitative microbial risk assessment (QMRA). Four infectious microbes capable of causing respiratory diseases important to public health, and for which dose-response functions have not been available are: Bordetella pertussis (whooping cough), group A Streptococcus (pharyngitis), rhinovirus (common cold) and respiratory syncytial virus (common cold). The objective of this study was to fit dose-response functions for these microbes to published experimental data. METHODS: Experimental infectivity data in human subjects and/or animal models were identified from the peer-reviewed literature. The exponential and beta-Poisson dose-response functions were fitted using the method of maximum likelihood, and models compared by Akaike's Information Criterion. RESULTS: Dose-response functions were identified for each appropriate data set for the four infectious microbes. Statistical and graphical measures of fit are presented. CONCLUSIONS: With the fitted dose-response functions it will be possible to perform QMRA for these microbes. The dose-response functions, however, have a number of limitations associated with the route of exposure, use of animal hosts, and quality of fit. As a result, thoughtfulness must be used in selecting one dose-response function for a QMRA, and the function should be recognized as a significant source of uncertainty. Nonetheless, QMRA offers a transparent, systematic framework within which to understand the mechanisms of disease transmission, and evaluate interventions.