| Disease Transmission Models for Public Health Decision Making: Analysis of Epidemic and Endemic Conditions Caused by Waterborne Pathogens Joseph N. S. Eisenberg,1,2 M. Alan Brookhart,2 Glenn Rice,3 Mary Brown,3 and John M. Colford, Jr.1,2 1Center for Occupational and Environmental Health and 2School of Public Health, University of California, Berkeley, California, USA; 3U.S. Environmental Protection Agency, Office of Research and Development/National Center for Environmental Assessment, Cincinnati, Ohio, USA Abstract
Developing effective policy for environmental health issues requires integrating large collections of information that are diverse, highly variable, and uncertain. Despite these uncertainties in the science, decisions must be made. These decisions often have been based on risk assessment. We argue that two important features of risk assessment are to identify research needs and to provide information for decision making. One type of information that a model can provide is the sensitivity of making one decision over another on factors that drive public health risk. To achieve this goal, a risk assessment framework must be based on a description of the exposure and disease processes. Regarding exposure to waterborne pathogens, the appropriate framework is one that explicitly models the disease transmission pathways of pathogens. This approach provides a crucial link between science and policy. Two studies--a Giardia risk assessment case study and an analysis of the 1993 Milwaukee, Wisconsin, Cryptosporidium outbreak--illustrate the role that models can play in policy making. Key words: Cryptosporidium, epidemic, Giardia, infectious disease, mathematical models, waterborne pathogens. Environ Health Perspect 110:783-790 (2002) . [Online 17 June 2002] http://ehpnet1.niehs.nih.gov/docs/2002/110p783-790eisenberg/ abstract.html Address correspondence to J. Eisenberg, School of Public Health, University of California at Berkeley, 140 Warren Hall, MC 7360, Berkeley, CA 94720-7360 USA. Telephone: (510) 643-9257. Fax: (510) 642-5815. E-mail: eisenber@socrates.berkeley.edu We thank P. Murphy of the U.S. Environmental Protection Agency for her support for this project and her thoughtful insights into this problem area. We also thank R.M. Clark of the U.S. EPA. This work was funded by a cooperative agreement from the U.S. EPA, Office of Research and Development/National Center for Environmental Assessment in Cincinnati (CR 827424-01-0) . Received 4 October 2001 ; accepted 1 February 2002.
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