Understanding veterinarians' prescribing decisions on antibiotic dry cow therapy.

In the United Kingdom, blanket antibiotic dry cow therapy (BDCT) is commonly prescribed. An alternate strategy is selective dry cow therapy (SDCT) whereby a teat sealant is given instead of an antibiotic to cows with a low probability of infection. Switching from BDCT to SDCT can significantly reduce antibiotic use. The aims of this study were to explore how veterinarians (vets) rationalized their prescribing decisions for mammary treatments at drying off, and the barriers and motivators they perceived to implementing SDCT. Face-to-face interviews were conducted with 20 purposively recruited vets from 6 practices in England, United Kingdom. The data were analyzed qualitatively using an inductive thematic analysis. The majority of participants stated a personal preference for SDCT because it constitutes more responsible antibiotic use. On the majority of farms, the prescribing decision was taken by a senior veterinarian and BDCT was prescribed. Less experienced vets expressed a desire to be more involved in the decision-making process. The first theme, prioritizing responsible antimicrobial prescribing, encapsulated the difficulties vets expressed engaging with farmers, conflicts of interest, and vets' determination to take action. The second theme, the effect of a vet's experience on their ability to influence farmers, focused on the specific challenges faced by less experienced vets and the importance of vets being both trusted by farmers and being knowledgeable. The third theme, vets' perceptions about the risk and complexity of implementing SDCT, revealed markedly different levels of concern and fears about adverse outcomes with teat sealants versus antibiotics. The results also showed differences in perceptions about how difficult SDCT is to implement in practice. The last theme, vets' suggestions for facilitating the introduction of SDCT, was wide ranging and provided useful insight from a veterinary perspective into ways to facilitate SDCT. Initiatives that seek to alter vets' perceptions of the risks associated with switching to using SDCT are likely to prove useful in facilitating change. Our results also suggest that it is vital for senior vets to take a leading role in facilitating farms to implement SDCT. Less experienced colleagues may benefit from more help from senior vets to gain the trust of farmers and to become involved more quickly in herd-level preventive medicine. Vets must work together and take a united approach to reduce antimicrobial use.

Investigation into sampling strategies in response to potential outbreaks of low pathogenicity notifiable avian influenza initiated in commercial duck holdings in Great Britain.

The aim of this study was to evaluate potential sampling strategies for detection of infected flocks that could be applied during an outbreak of low pathogenicity notifiable avian influenza (LPNAI) initiated in duck holdings, following initial detection. A simulation model of avian influenza virus transmission and spread within and between holdings, respectively, was used to predict the impact on the size and duration of an outbreak of (i) changing the tracing window within which premises that might be the source of infection or that may have been infected by the index premises were sampled and (ii) changing the number of birds sampled in the flock being tested. It has shown that there is potential benefit in increasing the tracing window in terms of reducing the likelihood of a large outbreak. It has also shown that there is comparatively little benefit from increasing the number of birds sampled per flock.

Epidemiological perspectives on West Nile virus surveillance in wild birds in Great Britain.

West Nile virus (WNV) is a zoonotic arthropod-borne pathogen with continued geographical expansion in Europe. We present and evaluate data on the temporal, spatial and bird species focus of the WNV surveillance programme in dead wild birds in Great Britain (2002-2009). During this period all bird samples tested negative for WNV. Eighty-two per cent of the 2072 submissions occurred during the peak period of vector activity with 53% tested during April-July before human and equine infection would be expected. Samples were received from every county, but there was significant geographical clustering (nearest neighbour index=0·23, P<0·001). Over 240 species were represented, with surveillance more likely to detect WNV in resident bird species (92% of submissions) than migrants (8%). Evidence indicates that widespread avian mortality is not generally a reported feature of WNV in Europe and hence additional activities other than dead bird surveillance may maximize the ability to detect WNV circulation before the onset of human and equine infections.

Evaluation of animal and public health surveillance systems: a systematic review.

Disease surveillance programmes ought to be evaluated regularly to ensure they provide valuable information in an efficient manner. Evaluation of human and animal health surveillance programmes around the world is currently not standardized and therefore inconsistent. The aim of this systematic review was to review surveillance system attributes and the methods used for their assessment, together with the strengths and weaknesses of existing frameworks for evaluating surveillance in animal health, public health and allied disciplines. Information from 99 articles describing the evaluation of 101 surveillance systems was examined. A wide range of approaches for assessing 23 different system attributes was identified although most evaluations addressed only one or two attributes and comprehensive evaluations were uncommon. Surveillance objectives were often not stated in the articles reviewed and so the reasons for choosing certain attributes for assessment were not always apparent. This has the potential to introduce misleading results in surveillance evaluation. Due to the wide range of system attributes that may be assessed, methods should be explored which collapse these down into a small number of grouped characteristics by focusing on the relationships between attributes and their links to the objectives of the surveillance system and the evaluation. A generic and comprehensive evaluation framework could then be developed consisting of a limited number of common attributes together with several sets of secondary attributes which could be selected depending on the disease or range of diseases under surveillance and the purpose of the surveillance. Economic evaluation should be an integral part of the surveillance evaluation process. This would provide a significant benefit to decision-makers who often need to make choices based on limited or diminishing resources.

Salmonella Typhimurium and Salmonella Enteritidis in England: costs to patients, their families, and primary and community health services of the NHS.

This is the first study comparing societal costs of acute illness with Salmonella Typhimurium (ST) and Salmonella Enteritidis (SE) in the UK. It included the cost and severity of the illness and explored the impact of each Salmonella serovar on the patients, their families, the NHS, and the wider economy. The study ascertained confirmed cases of ST and SE between July and November 2008. The mean costs per case were £1282 (ST) and £993 (SE). The indirect costs associated with the work-time lost by the case, parents, or carers were £409 (ST) and £228 (SE); this difference was statistically significant. The aggregate cost of ST and SE identified using laboratory test results for the UK as a whole was estimated as £6.5 million. Work-time lost and caring activities are cost categories that are not frequently investigated within the infectious intestinal disease literature, although they represent an important societal cost.

Application of variable number of tandem repeat analysis to track Salmonella enterica ssp. enterica serovar Typhimurium infection of pigs reared on three British farms through the production cycle to the abattoir.

AIMS: This study investigated the diversity and persistence of Salmonella strains through the pork finishing cycle, from the farm into the abattoir. METHODS AND RESULTS: Isolates from four batches of finishers, from farm to abattoir, were used. Salmonella Typhimurium isolates were subjected to molecular typing using pulsed-field gel electrophoresis and variable number of tandem repeat analysis. The results demonstrated that infection was transferred from the farm to the abattoir. Within the abattoir, infection from individual pigs contaminated the exterior of the carcass and pigs exposed to Salmonella in the lairage were infected. CONCLUSIONS: Salmonella can be introduced at various points in the pig production and slaughter process. Carcass contamination may arise from infection on farm and exposure in the lairage and abattoir environment. Pigs could be contaminated by previous batches of pigs while in lairage or during the dressing process. Salmonella infection on farms is dynamic with multiple serovars present from different sources. SIGNIFICANCE AND IMPACT OF THE STUDY: Molecular typing methods facilitated the tracing of Salm. Typhimurium through the production cycle and differentiated some farm-acquired from abattoir-acquired strains. The findings emphasize the importance of integrated control strategies along the pork food chain.

Factors limiting the health of semi-scavenging ducks in Bangladesh.

Duck rearing is well suited to coastal and lowland areas in Bangladesh. It is an important component of sustainable livelihood strategies for poor rural communities as an additional source of household income. An epidemiological study was conducted during January 2005-June 2006 on 379 households in Chatkhil of the Noakhali District, Bangladesh which were using the recently devised "Bangladesh duck model". The overall objective of the study was to identify factors that significantly contributed to mortality and constrained productivity and to generate sufficient knowledge to enable establishment of a disease surveillance system for household ducks. The overall mortality was 15.0% in Chatkhil, with predation causing a significantly higher mortality compared with diseases (p < 0.001). Common diseases were duck plague and duck cholera. Morbid ducks frequently displayed signs associated with diseases affecting the nervous and digestive systems. Haemorrhagic lesions in various organs and white multiple foci on the liver were frequently observed in dead ducks. Epidemiological analysis with a shared frailty model that accounted for clustering of data by farm was used to estimate the association between survival time and risk factors. The overall mortality rate due to disease was significantly lower in vaccinated than in non-vaccinated ducks in all zones except zone 2 (p < 0.001). Only vaccinated ducks survived in zone 1. In conclusion, duck mortality and untimely sale of ducks appeared to be important constraints for household duck production in Chatkhil. Vaccination against duck plague appears to be an effective preventive strategy in reducing the level of associated duck mortality. A successful network was established amongst farmers and the surveillance team through which dead ducks, with accompanying information, were readily obtained for analysis. Therefore, there is an opportunity for establishing a long-term disease surveillance programme for rural ducks in Chatkhil of the Noakhali District of Bangladesh.

Zoonoses action plan Salmonella monitoring programme: an investigation of the sampling protocol.

The Zoonoses Action Plan (ZAP) Salmonella Programme was established by the British Pig Executive to monitor Salmonella prevalence in quality-assured British pigs at slaughter by testing a sample of pigs with a meat juice enzyme-linked immunosorbent assay for antibodies against group B and C(1) Salmonella. Farms were assigned a ZAP level (1 to 3) depending on the monitored prevalence, and ZAP 2 or 3 farms were required to act to reduce the prevalence. The ultimate goal was to reduce the risk of human salmonellosis attributable to British pork. A mathematical model has been developed to describe the ZAP sampling protocol. Results show that the probability of assigning a farm the correct ZAP level was high, except for farms that had a seroprevalence close to the cutoff points between different ZAP levels. Sensitivity analyses identified that the probability of assigning a farm to the correct ZAP level was dependent on the sensitivity and specificity of the test, the number of batches taken to slaughter each quarter, and the number of samples taken per batch. The variability of the predicted seroprevalence was reduced as the number of batches or samples increased and, away from the cutoff points, the probability of being assigned the correct ZAP level increased as the number of batches or samples increased. In summary, the model described here provided invaluable insight into the ZAP sampling protocol. Further work is required to understand the impact of the program for Salmonella infection in British pig farms and therefore on human health.

Estimation of sample sizes for pooled faecal sampling for detection of Salmonella in pigs.

Salmonella infection in breeding pigs was the subject of a European survey in 2008. The prevalence of pig-breeding holdings infected with Salmonella was determined by microbiological culture of pooled pen faecal samples. The objective of this study was to estimate the sensitivity of pooled faecal sampling and to calculate the required sample sizes. To do this, individual and pooled faecal samples were collected from a sample of pens from nine farms. Bayesian methods were used to estimate the sensitivity of individual and pooled faecal sampling, and the degree of clustering of Salmonella at the pen level. Sample sizes were then calculated for various values of design prevalence, taking into account the clustering. Pooling was highly efficient compared to individual sampling, e.g. with 18 pooled samples required to detect a 10% prevalence with 95% certainty, compared to 35 individual rectal samples. We recommend that pooled sampling is used for detection of Salmonella in pigs. Results were influenced by the degree of clustering at pen level, and it is important to take this into account both in the estimation of appropriate sample sizes and the estimation of prevalence from pooled sample data.

Review of diagnostic laboratory submissions of adult cattle 'found dead' in England and Wales in 2004.

A total of 253 submissions from adult cattle 'found dead' in England and Wales were referred to the Veterinary Laboratories Agency in 2004. Carcases accounted for 54 per cent of the submissions and were of more diagnostic value than other types of sample. Whether the animals were beef or dairy, their distance from the laboratory and the number of deaths in the incident affected the likelihood of samples being submitted. The probability of reaching a diagnosis was influenced by the type of sample, the level of testing and the interval from sampling to receipt in the laboratory. Systemic disease was the most frequent cause of death in both dairy and beef cattle with hypomagnesaemia being the most frequent diagnosis (52 per cent) in beef cattle. In dairy cattle, 34 per cent of the diagnoses were for sporadic events, including haemorrhage and torsions of the digestive and reproductive tracts.

Use of laboratory data to reduce the time taken to detect new diseases: VIDA to FarmFile.

The analysis of laboratory data can provide information about the health of livestock populations; in Great Britain the Veterinary Investigation Diagnosis Analysis (VIDA) system has provided such data since 1975. However VIDA covers only known diagnoses, with limited epidemiological characterisation. The unexpected outbreak of bse showed that it was necessary to improve surveillance to detect new diseases, and a necessary update of the VIDA database for the millennium date change provided the opportunity. The information required to enhance the value of laboratory data was identified, a new form and database, 'FarmFile', were designed to record it, and they began to be used in 1999. The detection of new diseases depends on making comparisons with the expected or 'usual' levels of unexplained disease. The data are analysed quarterly to assess any changes in the levels of unexplained disease in different species, categorised in terms of clinical sign or body system, by comparison with previous years. No new diseases have been detected either through FarmFile or more traditional means since the new analyses started in earnest in 2004, but they have indicated that an unexplained event was not a new disease of concern, and developments continue to improve the system's sensitivity and specificity.

Survey of the prevalence of Salmonella on commercial broiler farms in the United Kingdom, 2005/06.

Between October 2005 and September 2006, all European Union member states were required to carry out standardised surveys of the prevalence of Salmonella in broiler flock holdings to establish baseline data from which to derive national targets for disease reduction. In the uk 382 holdings were sampled, 41 of which were positive for Salmonella, giving an estimated weighted prevalence of 10.7 per cent (95 per cent confidence interval [ci] 8.1 to 13.1 per cent). The serotype most frequently isolated was Salmonella Ohio, with a weighted prevalence of 2.2 per cent (95 per cent ci 1.2 to 3.7 per cent), followed by Salmonella Kedougou at 1.7 per cent (95 per cent ci 0.9 to 3.2 per cent). There were no isolates of Salmonella Enteritidis and only a single isolation of Salmonella Typhimurium (0.2 per cent, 95 per cent ci 0.0 to 1.6 per cent). Of the three other serotypes given top priority by the eu owing to their public health significance, Salmonella Virchow was isolated from one holding, but Salmonella Hadar and Salmonella Infantis were not detected on any of the holdings.

Survey of the prevalence of Salmonella species on commercial laying farms in the United Kingdom.

A survey of salmonella infection on 454 commercial layer flock holdings in the uk was carried out between October 2004 and September 2005. Fifty-four (11.7 per cent, 95 per cent confidence interval 9.3 to 14.0 per cent) were salmonella positive. The most common serovar identified was Salmonella Enteritidis at a prevalence of 5.8 per cent, and 70 per cent of these isolates were phage types 4, 6, 7 and 35. Salmonella Typhimurium was the second most prevalent serovar, found in 1.8 per cent of the farms. Of the three other serovars given top priority by the eu because of their public health significance, Salmonella Virchow and Salmonella Infantis were each isolated from one holding, but Salmonella Hadar was not isolated from any of the holdings. Analysis of antimicrobial resistance patterns revealed that over 76 per cent of the isolates were sensitive to all of the 16 drugs tested, and all the isolates were sensitive to ciprofloxacin, gentamicin, ceftazidime, apramycin, amikacin, amoxicillin/clavulanic acid, neomycin and cefotaxime.

Understanding how new evidence influences practitioners' beliefs regarding dry cow therapy: A Bayesian approach using probabilistic elicitation.

This study used probabilistic elicitation and a Bayesian framework to quantitatively explore how logically practitioners' update their clinical beliefs after exposure to new data. The clinical context was the efficacy of antibiotics versus teat sealants for preventing mammary infections during the dry period. While most practitioners updated their clinical expectations logically, the majority failed to draw sufficient strength from the new data so that their clinical confidence afterwards was lower than merited. This study provides quantitative insight into how practitioners' update their beliefs. We discuss some of the psychological issues that may be faced by practitioners when interpreting new data. The results have important implications for evidence-based practice and clinical research in terms of the impact that new data may bring to the clinical community.

SERVAL: a new framework for the evaluation of animal health surveillance.

Animal health surveillance programmes may change in response to altering requirements or perceived weaknesses but are seldom subjected to any formal evaluation to ensure that they provide valuable information in an efficient manner. The literature on the evaluation of animal health surveillance systems is sparse, and those that are published may be unstructured and therefore incomplete. To address this gap, we have developed SERVAL, a SuRveillance EVALuation framework, which is novel and aims to be generic and therefore suitable for the evaluation of any animal health surveillance system. The inclusion of socio-economic criteria ensures that economic evaluation is an integral part of this framework. SERVAL was developed with input from a technical workshop of international experts followed by a consultation process involving providers and users of surveillance and evaluation data. It has been applied to a range of case studies encompassing different surveillance and evaluation objectives. Here, we describe the development, structure and application of the SERVAL framework. We discuss users' experiences in applying SERVAL to evaluate animal health surveillance systems in Great Britain.

Impact of Schmallenberg virus on British sheep farms during the 2011/2012 lambing season.

British sheep farmers were invited to complete a questionnaire about the impact of Schmallenberg virus (SBV) on animal health, welfare and their own emotional wellbeing during the 2011-2012 lambing season, through Defra and Farming Industry websites, letters to farmers who had requested SBV laboratory tests and advertisement at Sheep 2012. The 494 responders included SBV confirmed (positive by RT-PCR) (n=76), SBV suspected by farmer (n=140) or SBV not suspected (n=278). Percentage of barren ewes was similar across SBV groups, however, lamb and ewe losses were higher on responder farms where SBV was confirmed or suspected. The median percentages of all lambs born (and lambs born deformed ) that died within one week of birth was 10.4 per cent (5.5 per cent), 7.0 per cent (2.9 per cent) and 5.3 per cent (0 per cent), respectively, on SBV confirmed, suspected and not suspected farms (P<0.001). Eight to 16 per cent of SBV confirmed or suspected farms reported lamb mortality of ≥40 per cent. Farmer perceived impact was greater where SBV was confirmed or suspected (P<0.001): 25 per cent reported a high impact on emotional wellbeing (4 per cent of SBV not suspected), 13 per cent reported a high impact on flock welfare and financial performance and 6 per cent were less likely to farm sheep next year because of SBV (<2 per cent in SBV not suspected). Overall, SBV impact has been large relative to reported sheep loss.

Abattoir based survey of Salmonella in finishing pigs in the United Kingdom 2006-2007.

All European Union (EU) Member States (MSs) were required to conduct a baseline survey from October 2006 to September 2007 to estimate the prevalence of Salmonella infection in finisher pigs at slaughter. In the United Kingdom (UK), samples for microbiological culture were collected from the ileo-caecal lymph nodes, from carcass swabs and from caecal contents. Meat juice samples were also collected for testing in an enzyme-linked immunosorbent assay (MJE) to detect a serological response. Salmonella was isolated from 22% (CI95% 19-25%) of ileo-caecal lymph nodes, 15% (CI95% 12-18%) of carcass swabs and 22% (CI95% 19-26%) of caecal contents. A quarter (25%, CI95% 22-29%) of MJE samples were positive for Salmonella antibodies (cut-off, S/P≥0.25). The most frequently identified serovars were Salmonella typhimurium (57%) and Salmonella derby (26%). The results were used to investigate some factors associated with Salmonella infection in slaughter pigs. The weight of the carcass was significant, with a lower probability of obtaining a positive meat juice result from pigs with a weight greater than 75 kg (p=0.03). The weight of the lymph node sample was significantly associated with Salmonella status, with a heavier sample of lymph nodes being more likely to be positive (OR=2.16 CI95% 1.07-4.39). 'Carcass weight' in two of the classes - 75-79 kg and 80-84 kg - (OR=0.44 CI95% 0.28-0.70; OR=0.64 CI95% 0.49-0.85) and 'fewer-than-1500-pigs' scheduled for slaughter on the day of sampling' (OR=0.41 CI95% 0.24-0.71) were also associated with a reduced risk of isolating Salmonella from lymph node. The model for carcass swabs showed a positive association with 'time-elapsed-since-the-start-of-the-line' indicating a higher risk of contamination as the day progressed (p<0.01). This model also showed positive association between isolation of Salmonella from a carcass swab and the occurrence of Salmonella in caecal contents from the same pig (OR=2.22 CI95% 1.38-3.59) and a negative association with time in singeing units (OR=0.88 CI95% 0.79-0.98).

Descriptive and social network analysis of pig transport data recorded by quality assured pig farms in the UK.

The aim of this study was to examine farm-to-farm pig movement connections, and the usage of hauliers and abattoirs, for farms in the United Kingdom (UK), to determine the interconnectivity of the pig farm network and the implications this may have for the transmission and control of Salmonella, which was chosen as an example of an important endemic disease. Data were collected from three Quality Assurance Schemes on the use of abattoirs and livestock hauliers by commercial pig farms, and the supply of pigs to and from farms. The observed dataset had considerable variability in the number of direct (farm-to-farm) and indirect (via hauliers or abattoirs) connections between each farm over a 12-month period. The use of multiple hauliers and abattoirs by many farms resulted in considerable interconnectivity between farms due to these indirect routes. The network displayed a higher level of clustering, and short network distances between farms, than that shown by equivalent randomly generated datasets, indicating that infectious diseases might transmit quickly amongst farms but within certain clusters of farms, thus limiting the total number of farms affected. This structure and the occurrence of multiple indirect routes between many pairs of farms (via pig movements to other interconnected farms or from hauliers used by both farms), may indicate that targeting surveillance and controls on those farms with high network centrality characteristics (degree, betweenness) alone would not prove effective. Encouraging all farms within the network to reduce the number of connections might be a useful way of reducing Salmonella prevalence as it would reduce the effect of high prevalence on other farms within the network. The analysis also highlighted differences in the connections between geographical regions that were used to discuss the comparatively low Salmonella prevalence in Scotland detected by previous studies. Farms identified as belonging to large companies, as categorised by our analysis, were shown to mostly have movement connections within that company. However, small company farms had connections to farms belonging to large companies or other small companies, demonstrating that they may play an important role in creating links between large companies. The majority of farms in both Scotland and North-East and Eastern England belonged to large companies, and this finding is discussed in relation to how this may help explain the lower Salmonella seroprevalence in these areas. The study provides a first description of the characteristics of the UK pig movement network and the analysis has indicated a number of findings that might have implications for disease transmission and targeting surveillance and control.

Case-control study of cases of bovine spongiform encephalopathy born after July 31, 1996 (BARB cases) in Great Britain.

This paper reports the results of a case-control study of the bovine spongiform encephalopathy (BSE) cases born in Great Britain after the statutory reinforcement of the ban (BARB) on the feeding of mammalian-derived meat and bone meal on 31 July 1996. A total of 499 suspect clinical cases of BSE, born after 31 July 1996, and reported negative by July 31, 1996 and were compared with the set of 164 confirmed Great BARB cases in Great Britain detected by both passive and active surveillance. Animal-level risk factors (age and type of feed offered) and herd-level risk factors (herd size and type, number of prereinforced feed ban BSE cases born on the holding, the presence of other domestic species and waste management) were obtained for the analysis. BARB cases were 2.56 times (95 per cent CI 1.29 to 5.07) more likely to be exposed to homemix or a combination of homemix and proprietary feeds were 0.59 times (95 per cent CI 0.50 to 0.69) as less likely to be exposed to the unit increases in the number of prereinforced feed ban BSE cases diagnosed on the natal holding. A supplementary spatial analysis of these cases revealed three areas of excess BARB density: Northwest and Southwest of Wales and Northeast of Scotland.

Porcine circovirus type 2 infection before and during an outbreak of postweaning multisystemic wasting syndrome on a pig farm in the UK.

The presence of porcine circovirus type 2 (PCV-2) and other pathogens before and during an outbreak of postweaning multisystemic wasting syndrome (PWMS) in pigs is evaluated in this study. At the time of the outbreak on a large commercial pig farm in the UK, serum samples and data were collected in two independent on-going research projects, one in weaned pigs and the other in sows. Serum samples of growing pigs and sows were PCV-2-antibody and PCR positive before and during the PMWS outbreak. Upon sequencing, PCV-2 isolates collected before the outbreak were identified as PCV-2a, and isolates collected during the outbreak were identified as PCV-2b, suggesting a shift of PCV-2 genotypes present on the farm. Pigs in the weaner study were from sows originating from different breeders and an association of sow origin and PCV-2 serostatus in offspring was found. Further, pigs had higher odds to be PCV-2 antigen positive if the sow was PCV-2 antibody positive around farrowing, the sow was of higher parity, and were less likely to test antigen positive if the sow was sourced from a particular breeder. The findings of this study highlight the potential role of the immune status of the sow on the occurrence of PMWS.