The performance of the interferon gamma assay when used as a diagnostic or quality assurance test in Mycobacterium bovis infected herds.

There are two different contexts in the Irish bTB eradication programme in which the interferon-gamma assay (IFN-γ) is applied. Firstly, the IFN-γ assay is applied routinely to high risk cohorts in herds with four or more reactors to the SICTT. The IFN-γ test is then carried out on blood samples submitted to the laboratory within 8h of collection (diagnostic testing). Secondly, the use of the IFN-γ assay has recently been extended to test SICTT reactors as part of a general quality assurance (QA) scheme to monitor the performance of the SICTT. Blood samples from reactors are tested one day after blood collection (QA testing). In this study, we analysed the relative performance of the SICTT and IFN-γ when used in parallel as an 8h diagnostic test and as a 24h QA test on SICTT reactors. A total of 17,725 IFN-γ tests were included in the analysis (11,658 diagnostic tests and 6067 QA tests). Of the samples submitted for diagnostic testing, the proportion positive to IFN-γ decreased with the severity of interpretation of the SICTT result. Of the standard reactors that were tested with IFN-γ in the QA programme, 92.2% were positive to the IFN-γ test. Among animals that were SICTT -ve/IFN-γ +ve, 18.9% were positive at post-mortem compared to 11.8% of those that were SICTT +ve (standard reactor)/IFN-γ -ve. These results highlight the risk associated with retaining SICTT -ve/IFN-γ +ve animals, and suggest that prompt removal of these animals is necessary to reduce the potential for future transmission.

The relative effectiveness of testers during field surveillance for bovine tuberculosis in unrestricted low-risk herds in Ireland.

In Ireland, new bovine tuberculosis (bTB) cases are detected using both field and abattoir surveillance. Field surveillance is conducted on all cattle annually using the single intradermal comparative tuberculin test (SICTT). Testing is reliant on the skills and experience of the tester and a broad range of factors may adversely affect test accuracy. There is considerable emphasis on quality control (QC) within the national programme and field inspection of testers has been conducted in Ireland for many years. Since 2008, inspection has been supplemented with quantitative performance reports, enabling testers to be evaluated and ranked using a range of performance indicators. The objectives of this study were first, to quantify the relative effectiveness of testers during field surveillance and, second, to assess whether there has been any change in the performance of testers between 2008 and 2011. Mixed logistic regression was used to assess the relative effectiveness of testers. The study population included all testers who carried out at least ten eligible tests in Ireland during 2008 or 2011. The outcome measure was a herd restriction at the eligible test. Results from the mixed model indicated that the variation by tester had significantly (p=0.039) decreased from 0.589 in 2008 to 0.426 in 2011, indicating an increase in consistency of testing, after accounting for other known risk factors. This study provides objective data on the variation in tester performance over time and the relative performance of testers during field surveillance in Ireland.

Age related influence on screening coverage and satisfaction. with CervicalCheck.

The aim of this study was to evaluate levels of satisfaction of women attending the CervicalCheck programme and reasons for the age differential in screening uptake. A questionnaire was sent to 5,000 randomly selected attenders with a normal smear test (3,500 aged 25-44, 1,500 aged 45-60). Almost all in both age groups said they would return to CervicalCheck if invited (98.5%; 98.5%) and recommend the service to family/friend (99.6%; 99.5%). The single independent predictor of 'would recommend to family/friend' was willingness to return to CervicalCheck (OR = 31 (5.2-183.7)). Predictors of 'would return if invited' were knowledge of when due to return (OR = 2.5 (1.3-5.0)) and having contacted or having received a letter of invitation from CervicalCheck (OR = 3.1 (1.6-6.1)). Independent predictors of 'knowledge of when due to return' were older age group (OR = 0.5 (0.4-0.7)) and willingness to return to CervicalCheck (OR = 3.2 (1.2-6.3)). The GP is particularly important in informing older women and encouraging attendance.

Attitudes of parents and staff towards medical students on the paediatric wards.

This study investigates attitudes of parents and staff to medical students on paediatric wards in a Dublin teaching hospital. We invited 100 parents of patients and 30 staff involved in the care of children on the paediatric wards to participate. The majority of parents agreed or strongly agreed that they would be happy for a student to interview them (n = 87; (87%)), interview their child (80%) or examine their child (74%). Of 30 staff, 12 (40%) staff agreed that the presence of medical students on the ward increased their job satisfaction, 13 (43%) agreed or strongly agreed that medical student presence encouraged them to keep up to date with recent medical developments and 6 (20%) felt that it increased the quality of patient care. Attitudes of both parents and staff to medical students on paediatric wards are positive with both emphasising the need for professional behaviour.

Bovine tuberculosis trends in the UK and the Republic of Ireland, 1995-2010.

Selected demographic features and trends in bovine tuberculosis (BTB) from 1995 to 2010 are described for the countries of the UK and the Republic of Ireland, using standardised definitions and measures. All countries experienced a reduction in the number of cattle and herds and in the proportion of dairy herds, while average herd size increased. In general, the trends indicate a stable situation of very low BTB prevalence in Scotland and, over most of the period, a rising prevalence in England and Wales. The prevalence in the Republic of Ireland declined while Northern Ireland experienced both a rise and fall. Differences in demography, BTB programme structure and test results were noted, particularly between the island of Ireland and Great Britain. Further investigation of these differences may provide valuable insights into risk factors for BTB and optimisation of existing BTB programmes.

Quality control in the national bovine tuberculosis eradication programme in Ireland.

The Irish bovine tuberculosis (BTB) eradication programme operates under national legislation and fulfils the requirements of the European Union Trade Directive 64/432. The programme includes annual single intradermal comparative tuberculin test (SICTT) screening of all herds, prompt removal of test reactors and further consequential retesting of herds. Continuous evaluation of all relevant activities is essential to deliver an effective national programme and to reassure all stakeholders thatthe highest possible standards are attained. Quality control (QC) is a recognised process in the delivery of quality products or services. This paper presents a review of QC in the BTB eradication programme in Ireland, with particular emphasis on field surveillance and the assessment of private veterinary practitioner performance. A broad range of programme elements subjected to QC are described, including personnel, training, equipment, tuberculins and laboratories.

Shorter-term risk of Mycobacterium bovis in Irish cattle following an inconclusive diagnosis to the single intradermal comparative tuberculin test.

In Ireland, new cases of bovine tuberculosis (bTB) are detected using both field and abattoir surveillance (More and Good, 2006). Field surveillance is conducted through annual testing of all cattle using the single intradermal comparative tuberculin test (SICTT). An animal may be deemed a 'standard inconclusive reactor' (SIR) to the SICTT if the bovine response is >2mm and between 1 and 4mm>the avian response. The herdowner then has three choices for the management of the SIR: option 1 is to have the animal retested after a minimum period of 42 days (an inconclusive reactor retest, IRR), option 2 is to slaughter the SIR and, provided the animal has no visible lesions, have a full herd test 42 days after the SIR leaves the herd, option 3 is to slaughter the SIR and have the lymph nodes examined using histology and/or culture for bTB. In the current study, we examine the bTB risk for SIRs both at slaughter prior to the IRR and at the IRR, and the future bTB risk of TIR animals (so-called 'transient SIRs'; SIR animals with a negative SICTT result at the subsequent IRR) that moved from the herd of disclosure within 6 months of the IRR. We also investigate factors associated with the future bTB status of SIRs at slaughter prior to the IRR and at the IRR. The study population included all SIRs identified in Ireland between 2005 and 2009 inclusive in a herd otherwise Officially TB free (OTF). Between 11.8% and 21.4% of SIRs slaughtered prior to the IRR were confirmed bTB positive at post mortem (using histology or culture if histology was not definitive), compared to 0.13-0.22% of SICTT -ve cohort animals. The post mortem bTB lesion rate of SIRs is lower than the lesion rate reported for reactor animals between 2005 and 2009 of between 34% and 39%, reflecting the doubtful infection status of these animals. Between 20.3% and 27.9% of herds were restricted at the IRR. The herd restriction rate amongst the national herd between 2005 and 2009 varied from 5.09% to 6.02%. TIRs that moved out of the disclosing herd within 6 months of the IRR were 12 times more likely to be bTB positive at the next test/slaughter compared to all animals in the national herd. The same increased risk did not apply to the SICTT -ve cohort animals that moved out of the same herds at the same time. Based on a range of measures, SIRs and TIRs are each at increased bTB risk into the future. Consequently, differential treatment of TIR animals would be justified.

Impact of the national full herd depopulation policy on the recurrence of bovine tuberculosis in Irish herds, 2003 to 2005.

This study evaluated the impact of the Irish herd bovine tuberculosis (bTB) depopulation policy (depopulation, disinfection, contiguous testing and local badger removal where implicated) on the recurrence of bTB infection, by comparing the future risk in restocked herds following depopulation for either bTB or bovine spongiform encephalopathy (BSE) during 2003 to 2005. Each herd was assigned a 'previous bTB risk', based on bTB history during the five years before depopulation. Future bTB risk was estimated, using a multivariable Cox proportional hazard model for time-to-breakdown for each study herd, to identify risk factors associated with bTB. Future bTB risk varied significantly by reason for depopulation and previous bTB risk. Herds depopulated for bTB (by definition, at high bTB risk) were not significantly different from BSE herds with no or a low previous bTB risk. BSE herds with a high previous bTB risk were found to be at significantly greater future bTB risk. Herd bTB depopulation measures, as currently applied in Ireland, are shown to be effective in enabling herds to attain and retain bTB freedom following restocking. Based on the data presented, and consistent with current knowledge of the bTB epidemiology, local badger removal contributes to efforts to limit recurrence of bTB in Ireland.

Longer-term risk of Mycobacterium bovis in Irish cattle following an inconclusive diagnosis to the single intradermal comparative tuberculin test.

In Ireland, new bovine tuberculosis (bTB) cases are detected using both field and abattoir surveillance. During field surveillance, an animal may be deemed a 'standard inconclusive reactor' (SIR) to the single intradermal comparative tuberculin test (SICTT) if the bovine response is >2mm, and from 1 to 4mm greater than the avian response. Little is known about the future infection risk posed by SIR animals that pass a subsequent retest, so-called 'transient SIR' (TIR) animals. The objective of this study was to critically evaluate the future bTB status of TIR animals, by examining the future risk of bTB diagnosis over the 4 years following initial SIR diagnosis and clearance at the subsequent retest. The study included all TIRs that were identified as SIRs in 2005 in otherwise free herds at tests with no other reactors at that test and that were clear at the subsequent retest. The analysis was restricted to cows that were neither sold, other than direct to slaughter, nor exported from the herd during the follow up period (to the end of 2009). Five control cows were randomly selected from each study herd. A parametric survival model with shared frailties, to account for clustering within herds, was developed to model time from passing a retest to future bTB diagnosis. The final parametric survival model contained the variables: TIR status in 2005, inconclusive status during the follow-up period, location, herd restricted during the study, time since last restriction within the herd and age. The time ratio for the TIR status variable was significant (p<0.001) indicating that on average the time to diagnosis with bTB for TIRs was 78% shorter compared to the non-TIRs. The frailty term was significant (p<0.001) indicating that animals within some herds were more likely to become reactors compared to other herds. These results have important implications for national policy and future management of TIR animals. Further, private veterinary practitioners and their clients should be aware of the increased risk associated with TIRs.

Tuberculosis in goats on a farm in Ireland: epidemiological investigation and control.

This paper describes an outbreak of tuberculosis (TB) caused by Mycobacterium bovis in a dairy goat herd on a farm in Ireland, where 66.3 per cent of the herd tested positive to the single intradermal comparative tuberculin test (SICTT) at initial detection. An epidemiological investigation was conducted to determine the origin of the outbreak, considering issues such as animal movements and herd management practices. Infection was introduced with a consignment of goats, as determined by the variable number tandem repeat profile. Infection was eradicated using a test and cull programme involving the SICTT, the interferon-γ assay and a multiplex immunoassay (Enferplex TB).

An evaluation of the Irish Single Reactor Breakdown Protocol for 2005-2008 inclusive and its potential application as a monitor of tuberculin test performance.

Under the Irish Bovine Tuberculosis (bTB) Eradication Programme all herds are subjected to at least one test per annum. The Single Intra-dermal Comparative Tuberculin Test (SICTT) is used in Ireland for the detection of cattle infected with Mycobacterium bovis. There have been concerns regarding the specificity of the SICTT, notably by farmers, and particularly in herds where the detection of a single positive animal in the absence of an obvious source of (bTB) infection could be perceived as a "false" positive. To address this issue the so-called 'Singleton Protocol' was established as part of the Irish bTB eradication programme. This protocol allows for the early restoration of free trading status to herds where a single positive animal was detected and where the herd was not confirmed as infected with M. bovis by epidemiological investigation, by post mortem, by laboratory examination, or by further test. This paper presents data from the 2005 to 2008, inclusive, bTB programmes on the number of herds that were assessed, which qualified for inclusion under the 'Singleton Protocol' and the outcome for qualifying herds up to and including having status restored early as a consequence of inclusion in that programme. The outcome of this protocol reaffirms the reliability of the SICTT at current levels of infection. Furthermore it is advocated that the 'Singleton Protocol' be continued as a monitor of herds in which a single positive animal is disclosed, and as overall infection levels of bTB fall the outcome may be used as one means to assess progress towards bTB eradication in Ireland.

Vision in athletes with intellectual disabilities: the need for improved eyecare.

BACKGROUND: Special Olympics provides sporting opportunities for people with intellectual disabilities (ID), and Lions Clubs International Opening Eyes GB offers vision screening for athletes at Special Olympics Games. METHODS: Opening Eyes GB screened the vision of 505 UK athletes at its inaugural event in 2001. The results were analysed and are presented here. RESULTS: Results showed that athletes do not differ from other people with ID in being at high risk of ocular and visual defects and many are not accessing eyecare. 15% reported never having an optometric eye examination, and yet 19% of these athletes had a significant refractive error, 32% had ocular anomalies and 6% were visually impaired. Overall, findings confirmed the high prevalence of refractive errors and strabismus amongst people with ID. 40% of athletes had ocular abnormalities, including 15.6% with blepharitis, a readily treatable condition that causes discomfort. 9% had lens opacities, of which half were probably impairing sight. An important finding was that many athletes have reduced vision and 14% could be classified as visually impaired (WHO definition) even when refractive errors were fully corrected. CONCLUSIONS: Special Olympics athletes should be encouraged to have regular eye examinations (as indeed, should all people with ID), and educators, carers and coaches need appropriate information about the visual status of their charges.