Food- and water-borne disease: using case control studies to estimate the force of infection that accounts for primary, sporadic cases.

Disease models which take explicit account of heterogeneities in the risk of infection offer significant advantages over models in which the risk of infection is assumed to be uniform across all hosts. However, estimating the incidence rate (force of infection) in the different at-risk (exposure) groups is no easy matter. Classically, epidemiologists differentiate groups of hosts with different infection-risks according to their exposure to putative explanatory risk factors. The importance of these risk factors is assessed by case-control studies, in which the measure of effect (the difference in disease occurrence between one population and another) is the odds ratio. This paper describes for the first time how - and under what circumstances - the incidence in these different exposure groups can be estimated from odds ratios derived from case control studies in which controls have been selected by density sampling. This new estimation technique can be applied to any transmission modality but is especially useful in the case of models of food- and water-borne disease for which the case control literature represents a vast and, as yet, untapped resource. The paper finishes with a worked example using one of the most common of all food- and water-borne pathogens, Toxoplasma gondii.