The CBRA is a knowledge center for burden of disease and risk assessment methodology. It applies these methods to study the health and economic impact of public and animal health threats.


In Catalonia (north-eastern Spain), Taenia saginata has been described in cattle but its occurrence in humans is unclear. Moreover, whether cattle acquired the infection in Catalonia or outside Catalonia and its economic impact have not been investigated. In a new study published in Parasites & Vectors, we estimated the prevalence and spatial distribution of bovine cysticercosis in Catalonia (2008–2015), and the burden from T. saginata upon the animal and human sectors in Catalonia (2013–2015).

Read more in our publications section.
Despite increasing of the Belgian health expenditures, several indicators related to population health showed poor results. In a new study published in BMC Public Health, we performed an in-depth analysis of the secular trend of Belgian health status using the Global Burden of Disease (GBD) 2016 study results for Belgium, and compared these results with other European countries.

Read more in our publications section.
Primary Toxoplasma gondii infection in pregnant women may result in abortion, stillbirth, or lifelong disabilities of the unborn child. One of the main transmission routes to humans is consumption of raw or undercooked meat containing T. gondii tissue cysts. In a new study published in Scientific Reports, we determined and compared the regional distribution of T. gondii seroprevalence in pregnant women and meat-producing livestock in China through a systematic literature review and hierarchical meta-analysis.

Read more in our publications section.
Bovine cysticercosis (BCC) (due to Taenia saginata) is often claimed to cause considerable economic losses to the livestock industry, particularly in beef cattle, but recent studies estimating the economic impact are lacking. In a new study published in Parasites & Vectors, we quantified the annual economic impact of BCC in Belgium from 2012 to 2016, by gathering data from diverse sources in the meat and human health sectors.

Read more in our publications section.
The zoonotic parasite Taenia solium is endemic in Angónia district, Tete province, Mozambique, though the burden of the disease complex is unknown. In a new study published in BMC Infectious Diseases, we assessed the societal cost of Taenia solium in Angónia district, Mozambique.

Read more in our publications section.
Priority setting is a challenging task for public health professionals. To support health professionals with this and in following a recommendation from the Food and Agriculture Organization of the United Nations and World Health Organization, 35 European parasitologists attended a workshop from 8–12 February 2016 to rank food-borne parasites in terms of their importance for Europe and regions within Europe. Results of this exercise have now been published in Eurosurveillance.

Read more in our publications section.
05 February 2018 | Malaria true prevalence
Malaria is one of the major causes of childhood death in sub-Saharan countries. A reliable estimation of malaria prevalence is important to guide and monitor progress toward control and elimination. In a new study published in Malaria Journal, we estimated the true prevalence of malaria in children under five in the Democratic Republic of the Congo, Uganda and Kenya, using a Bayesian modelling framework that combined in a novel way malaria data from national household surveys with external information about the sensitivity and specificity of the malaria diagnostic methods used in those surveys--i.e., rapid diagnostic tests and light microscopy.

Read more in our publications section.
Burden and risk assessment play an increasingly important and accepted role in defining control policies for foodborne parasites. For the second edition of Foodborne Parasites, edited by Ynes Ortega and Charles Sterling, we wrote a chapter on the methodological basis of burden and risk assessment, within the context of foodborne parasites.

Read more in our publications section.
In a new study published in International Journal of Cancer, we summarize the evidence on the relationship between intake of 12 major food groups. Findings of this meta-analysis showed that a diet characterized by high intake of whole grains, vegetables, fruit and dairy products and low amounts of red meat and processed meat was associated with lower risk of colorectal cancer.

Read more in our publications section.
In a time of increasing threats and decreasing financial resources, monitoring and controlling all possible foodborne hazards at the same time and to the same extent has become more challenging than ever. Therefore, attention is increasingly being paid to the so-called "risk ranking" methods that enable decision makers to focus on the most important foodborne hazards — even when time is limited and knowledge incomplete. In a new review paper published in Food and Waterborne Parasitology, we provide an overview of the most common quantitative methods and metrics used for ranking the risks associated with foodborne parasites and present the state of the art on risk ranking exercises for foodborne parasites.

Read more in our publications section.
The performances of existing tools for the diagnosis of porcine cysticercosis need further assessment, and their shortcomings call for alternatives. In a new study published in Parasites & Vectors, we evaluated the performance of tongue palpation and circulating antigen detection for the detection of porcine cysticercosis in naturally infected pigs of slaughter age compared to full carcass dissections; additionally, we investigated alternative postmortem dissection procedures.

Read more in our publications section.
Despite growing evidence for food-based dietary patterns' potential to reduce cardiovascular disease risk, knowledge about the amounts of food associated with the greatest change in risk of specific cardiovascular outcomes and about the quality of meta-evidence is limited. In a new study published in Critical Reviews in Food Science and Nutrition, we performed a meta-analysis to synthesize the knowledge about the relation between intake of 12 major food groups and the risk of coronary heart disease, stroke and heart failure.

Read more in our publications section.
In Belgium, socio-economic inequalities in mortality have long been described at country-level. As Belgium is a federal state with many responsibilities in health policies being transferred to the regional levels, regional breakdown of health indicators is becoming increasingly relevant for policy-makers, as a tool for planning and evaluation. In a new study published in Archives of Public Health, we analyzed the educational disparities by region for all-cause and cause-specific premature mortality in the Belgian population.

Read more in our publications section.
Previous studies have shown that smoking has a significant and negative association with health-related quality of life (HRQOL). A question remains, however, as to whether this association between smoking and HRQOL differs by gender or educational level. In a new study published in Preventive Medicine, we examined this question by extracting data from the 2013 Belgian Health Interview Survey (n = 5668), which assessed HRQOL using the EuroQol 5D-5L instrument.

Read more in our publications section.
Salmonellosis, campylobacteriosis and listeriosis are food-borne diseases. In a new study published in Eurosurveillance, we estimated and forecasted the number of cases of these three diseases in Belgium from 2012 to 2020, and calculated the corresponding number of disability-adjusted life years (DALYs).

Read more in our publications section.
Taenia solium is believed to be widely endemic across most of Latin America. However, there is little information readily available for Central America and the Caribbean basin. In a new study published in Parasites and Vectors, we mapped the occurrence of Taenia solium taeniosis/cysticercosis at national level within Central America and the Caribbean basin, the distribution of porcine cysticercosis at first-level administrative subdivision level (department level), and the porcine population at risk.

Read more in our publications section.
Recently the World Health Organization, Foodborne Disease Burden Epidemiology Reference Group (FERG) estimated that 31 foodborne diseases (FBDs) resulted in over 600 million illnesses and 420,000 deaths worldwide in 2010. Knowing the relative role importance of different foods as exposure routes for key hazards is critical to preventing illness. In a new study published in PLOS ONE, we report the findings of a structured expert elicitation providing globally comparable food source attribution estimates for 11 major FBDs in each of 14 world subregions.

Read more in our publications section.
In 2015, new disability weights (DWs) for infectious diseases were constructed based on data from four European countries. In a new study published in European Journal of Public Health, we evaluated if country, age, sex, disease experience status, income and educational levels have an impact on these DWs.

Read more in our publications section.
On 6 September 2017, Brecht presented the FERG estimates of the global burden of foodborne parasites, during the International Symposium of the International Association for Food and Waterborne Parasitology, at the WAAVP 2017 conference in Kuala Lumpur, Malaysia.

Slides of the presentation are available here.
A key challenge of public health nutrition is to provide the majority of the population with a sufficient level of micronutrients while preventing high-consumers from exceeding the tolerable upper intake level. In a new study published in Nutrients, we used data of the 2014 Belgian food consumption survey to assess fat-soluble vitamin (vitamins A, D, E and K) intake from the consumption of foods, fortified foods and supplements.

Read more in our publications section.
Taenia solium and Taenia saginata are zoonotic parasites of public health importance. Data on their occurrence in humans and animals in western Europe are incomplete and fragmented. In a new study published in Parasites & Vectors, we updated the current knowledge on the epidemiology of these parasites in this region.

Read more in our publications section.
Congenital toxoplasmosis and cytomegalovirus infection may cause significant morbidity and even fetal or neonatal mortality. In a new study published in Clinical Infectious Diseases, we quantified the disease burden of both congenital infections in Belgium in terms of disability-adjusted life years (DALYs) and identify data gaps.

Read more in our publications section.
A new study published in Journal of Epidemiology and Community Health documents trends in educational inequalities in premature mortality in Belgium between the 1990s and the 2000s and identifies the contribution of specific causes of deaths. Absolute inequalities decreased in men while increasing in women; relative inequalities increased in both sexes. Mortality inequalities from lung cancer, IHD, COPD in both sexes, suicide in men and stroke in women have the largest impact on population level inequalities.

Read more in our publications section.
A new publication in PLOS Neglected Tropical Diseases presents cystiSim, an agent-based disease model for Taenia solium transmission and control. cystiSim is a valuable tool in designing future control programmes and will assist in the elimination of T. solium as a public health problem.

Read more in our publications section.
A new study published in Population Health Metrics proposes a simulation model for integrating individual-level heterogeneity in disease burden assessment models. We show that ignoring heterogeneity can bias disease burden estimates.

Read more in our publications section.
New work published in the Bulletin of the World Health Organization showed that the screening of specific risk groups for active tuberculosis in Flanders has a limited effectiveness and cost-effectiveness.

Read more in our publications section.
04 September 2016 | Dermoscopy cost-effectiveness
A new study published in European Journal of Cancer demonstrates how a previously developed melanoma disease model can be used in cost-effectiveness analyses in the melanoma detection field. The model and the methodology suggested in this new paper were applied to two cohorts of Belgian melanoma patients. Their analysis concluded that adequate dermoscopy training is cost-effective.

Read more in our publications section.
26 May 2016 | FERG methodology
On 26th May, Brecht presented the methodological framework developed by FERG for estimating the global burden of foodborne disease, at the Symposium of the Dutch Royal Society for Microbiology.

Slides of the presentation are available here.
On April 24th, Suzanne presented the current status of her assessment of the public health impact of congenital cytomegalovirus infection in Belgium at the 2016 meeting of the European Congenital Cytomegalovirus Initiative.

The slides of the presentation are available here.
10 February 2016 | Bovine cysticercosis in Europe
A new study published in Parasites & Vectors reviewed the epidemiology, impact and control of bovine cysticercosis in Europe. There appears to be a lack of complete and updated data on most countries, especially in eastern Europe. Further risk factor studies might be needed together with estimates on the burden of the disease in all European countries. Risk-based interventions are being encouraged but current data are limited to guide this approach.

Read more in our publications section.
On Wednesday, February 3, Niko answered questions on food safety during Hautekiet on Radio 1. "It is a myth to assume that our food is getting safer", Niko explains. "Government, industry and consumers should never let their guard down when it comes to food safety."

An interview with Niko is published in Knack [in Dutch only]. Also make sure to read the five tips for safer food!
The Foodborne Disease Burden Epidemiology Reference Group of the WHO recently published its foodborne disease burden attribution estimates in PLOS ONE. The study used global expert elicitation to assess the proportion of foodborne disease burden that is attributable to foodborne and other transmission routes.

Read more in our publications section.
In a new study published in Acta Tropica, we quantified the health and economic burden of human and porcine Taenia solium cysticercosis in Tanzania. The study was lead by researchers of the Department of Veterinary Disease Biology at the University of Copenhagen.

Read more in our publications section.
In a new study published in the European Journal of Cancer, we assessed the burden of melanoma by melanoma stage in terms of disability-adjusted life years. We developed a melanoma disease model to predict the evolution of patients from diagnosis until death, and calculated years lived with disability (YLD) and years of life lost (YLL) for each American Joint Committee on Cancer stage. We showed that YLD generated by localised melanoma which will never metastasize were inferior to YLL resulting from stage IA melanomas.

Go to our publications section to find out more.
12 December 2015 | New CBRA member
We are very pleased to welcome a new member to our team! Laurence Geebelen will be studying the epidemiology and burden of Lyme disease in Belgium, in collaboration with the Belgian Institute of Public Health and the Université catholique de Louvain.
Almost one third of all deaths from foodborne diseases are in children under the age of five years, despite the fact that they make up only 9% of the global population. This is among the findings of the World Health Organization's (WHO) Estimates of the Global Burden of Foodborne Diseases—the most comprehensive report to date on the impact of contaminated food on health and wellbeing. These estimates are the result of a decade of work and input from more than 100 experts from around the world, including several CBRA members.

The global burden of foodborne disease estimates were generated by the Foodborne Disease Burden Epidemiology Reference Group (FERG). The FERG estimates have been published in a dedicated PLOS collection, and can be explored through an interactive tool.
14 October 2015 | GBD 2013 Disability Weights
The CBRA contributed to the revision of the disability weights used in the Global Burden of Disease study. The results of this exercise have now been published in Lancet Global Health.
17 September 2015 | Methods in Epidemiology Symposium
On September 17, Charline presented on current and future Disability-Adjusted Life Years (DALYs) of Salmonella and Campylobacter in Belgium at the Methods in Epidemiology Symposium in Leuven. The abstract is published in Archives of Public Health.
New research published in Acta Tropica shows that there is considerable uncertainty about the true endemicity status of Taenia solium across Europe, but favourable conditions for T. solium transmission still exist in Eastern Europe. The code used for creating the EU maps is on GitHub.
New research published in Parasites & Vectors unravels the co-distribution of Taenia solium and Schistosoma in Africa. In this study, the prevalence package was used to estimate district-level informed prevalence of Taenia solium taeniosis and cysticercosis.
20 April 2015 | prevalence 0.4.0
The 'prevalence' package has been updated to version 0.4.0. Apart from some minor fixes, the new version includes two enhancements:
  • Functions `truePrev` and `truePrevPools` now also return the posterior samples for `SE` and `SP`, allowing to assess the difference between prior and posterior.
  • A new method `as.matrix` for objects of class `prev`.
prevalence 0.4.0 is on CRAN. The development version is on GitHub.
Reliable data are needed to safeguard food safety. However, food safety is just one of the many areas that requires monitoring. Choices therefore need to be made. We explain why food safety deserves more attention in De Morgen [in Dutch] and La Libre [in French].
World Health Day will be celebrated on 7 April, with WHO highlighting the challenges and opportunities associated with food safety under the slogan "From farm to plate, make food safe." In this context, WHO is issuing the first findings from what is a broader ongoing analysis of the global burden of foodborne diseases. The full results of this research, being undertaken by WHO's Foodborne Disease Burden Epidemiology Reference Group (FERG), are expected to be released in October 2015.
New research published in the Bulletin of the WHO provides insights in how health statistics may be extrapolated across space. Hierarchical regression models show promising results, but inclusion of informative covariates should be appraised carefully.
New research published in Food Control provides insights on needs and expectations of decision makers and stakeholders regarding risk ranking in the food chain. The majority of the questioned participants expressed a need for risk ranking, and their key expectation was improved transparency in decision making processes. Hurdles for performing risk ranking were identified, including lack of training.
On March 17, Brecht Devleesschauwer will defend his PhD thesis entitled "The Burden of Zoonoses in Nepal". The invitation is available via this link. The PhD thesis is available here.
04 February 2015 | FERG Symposium
Save the date: FERG Symposium on 'The Global Burden of Foodborne Diseases', 1-2 October 2015, jointly organized by WHO and RIVM.

FERG is providing estimates of the global burden of foodborne diseases, according to age, sex and region, for a defined list of causative agents of microbial, parasitic, and chemical origin, thereby strengthening the capacity of countries to assess the burden of foodborne disease and increasing awareness and commitment for the implementation of food safety standards.

Join this symposium to learn about state-of-the art methodologies, acquaint with the results and engage in stakeholder discussions.

Learn more via http://rivm.nl/media/nieuwsbrief/Ferg-symposium/.
On December 09, Brecht presented the prevalence package at the Berliner Kolloquium on 'Statistische Methoden in der empirischen Forschung'. Slides of the talk are available here.
06 December 2014 | Trichinella outbreak in Belgium
Twelve Belgians are currently in hospital after having come down with food poisoning from eating wild boar in a restaurant. It is assumed they have been infected with Trichinella, a dangerous parasite that can be fatal. The suspect meat was supplied to eateries in the provinces of Antwerp and Limburg. Prof Dr Pierre Dorny provided background information on Belgian tv (in Dutch): http://deredactie.be/cm/vrtnieuws/videozone/programmas/journaal/2.36706?video=1.2170951 and http://nieuws.vtm.be/binnenland/118980-besmet-vlees-komt-van-slechts-een-dier
Routine quantification of disease burden in terms of DALYs would provide a significant added value to evidence-based public health policy in Belgium, conclude CBRA researchers in BMC Public Health.
16 November 2014 | University of Florida seminar
On November 18, Brecht Devleesschauwer will give a seminar on "Unravelling the Burden of Zoonoses in Nepal" at the Emerging Pathogens Institute of the University of Florida. More info via this link.
27 October 2014 | R package updates
We have released updates of our R packages to CRAN.

prevalence 0.3.0 contains a new function, truePrevMulti2, that implements a covariance scheme for estimating true prevalence and test characteristics. We have also launched a new website documenting the prevalence package.

DALY 1.4.0 mainly contains some bug fixes.
14 October 2014 | Diagnosis of melanoma patients
CBRA generated evidence of the significant cost reduction of the selective use of sequential digital dermoscopy imaging for patients with one-to-three atypical melanocytic lesions.
The CBRA generated the first ever estimates of the global burden of listeriosis, an ubiquitous foodborne infection. Go to our publications to find out more!
The first ever stage-specific utilities and disability weights for melanoma patients have been published in the British Journal of Dermatology.
The CBRA contributed to the first ever estimates of the global burden of trichinellosis, a cosmopolitan foodborne parasitic disease. Go to our publications to find out more!
14 June 2014 | PhD candidate vacancy
The CBRA is looking for a PhD candidate to work out risk-based control strategies for bovine cysticercosis and porcine trichinellosis in Belgium. More information can be found here.
11 May 2014 | DALY 1.3.0
The DALY package has been upgraded to version 1.3.0. This new version contains improved sensitivity analysis features and introduces scenario analysis features. Visit the DALY Calculator homepage for more information.
21 April 2014 | DALY Hints and Kinks
Two Hints and Kinks papers have been published in International Journal of Public Health, describing the calculation of disability-adjusted life years and providing a stepwise approach towards DALY calculations in practice.

Go to our publications to find out more.
04 April 2014 | CBRA website launched
Today the CBRA launched it brand-new website! Find out more about who we are, what we do and which software we are developing.