Epidemic disease risks and implications for Veterinary Services.

Growth in the livestock sector is associated with heightened risk for epidemic diseases. The increasing spillover of new diseases from wildlife is being driven by wide-scale anthropogenic changes allowing for more frequent and closer wildlife-human and wildlife-livestock contacts. An increasing number of epidemics in livestock are associated with rapid transition of livestock systems from extensive to intensive, and local to global movement of livestock and their products through value chain networks with weak biosecurity. Major livestock epidemics in the past two decades have had substantial economic impacts, and the COVID-19 pandemic highlights the devastating socio-economic consequences that spillovers can have when not identified and controlled early in the process of emergence. This highlights the importance of Veterinary Services to integrated, whole-of-society efforts to control infectious diseases in animals. Emphasis within Veterinary Services must be placed on prevention and preparedness. The authors suggest four areas for continued improvement in Veterinary Services to meet this challenge. These are a) continued development of staff capacity for risk assessment and value chain analysis, together with improved policies and communication, b) appropriate adaptation of approaches to prevention and control in resource-poor settings, c) improved multi-sectoral and transboundary cooperation, which enables the sharing of resources and expertise, and d) systematic approaches that enable Veterinary Services to influence decisionmaking for trade, markets, business, public health, and livelihood development at the national and regional levels.

La croissance du secteur de l'élevage est associée à un risque accru de maladies épidémiques. Les changements anthropiques à grande échelle sont à l'origine du nombre croissant de maladies émergentes atteignant de nouvelles espèces réceptives (spillover) à partir de réservoirs sauvages, à la faveur de contacts plus fréquents et plus rapprochés entre la faune sauvage et les humains, d'une part, et entre la faune sauvage et les animaux domestiques, d'autre part. On considère qu'un nombre croissant d'épidémies affectant le bétail sont dues à la transition rapide des systèmes d'élevage extensif vers des systèmes intensifs, et aux mouvements du bétail et des produits de l'élevage de l'échelle locale à l'échelle mondiale par le biais de réseaux de chaînes de valeur dotés d'un faible niveau de biosécurité. Au cours des deux dernières décennies, d'importantes épidémies affectant le bétail ont eu un impact économique considérable ; en outre, la pandémie de COVID-19 a mis en évidence les conséquences socio-économiques dévastatrices des atteintes de nouvelles espèces réceptives par des agents pathogènes, lorsque ces maladies ne sont pas détectées et maîtrisées dès le processus d'émergence. Cela souligne l'importance cruciale des Services vétérinaires dans les efforts de lutte contre les maladies infectieuses chez les animaux, qui doivent être intégrés et mobiliser la société entière. Les Services vétérinaires doivent mettre un accent particulier sur la prévention et la préparation. Les auteurs proposent quatre aspects d'amélioration continue pour que les Services vétérinaires puissent relever ce défi. Il s'agit : a) du développement permanent des compétences des personnels vétérinaires en matière d'évaluation du risque et d'analyse des chaînes de valeur, et leur articulation avec de meilleures politiques et une communication plus performante ; b) une adaptation adéquate des méthodes de prévention et de contrôle dans les configurations faiblement dotées en ressources ; c) une meilleure coopération multisectorielle et transfrontalière afin de partager les ressources et les compétences ; d) des dispositifs systémiques permettant aux Services vétérinaires d'influencer les prises de décision en matière d'échanges internationaux, de marchés, de commerce, de santé publique et de développement des moyens de subsistance, à l'échelle nationale et régionale.

El crecimiento del sector pecuario está condicionado por la existencia de un mayor riesgo de enfermedades epidémicas. La creciente diseminación de nuevas enfermedades a partir de animales silvestres es consecuencia de transformaciones antrópicas a gran escala que posibilitan un contacto más frecuente y estrecho de la fauna silvestre con el ser humano y el ganado. Cada vez son más las epidemias del ganado que tienen que ver con la rápida transición de los sistemas pecuarios de un régimen de producción extensiva a otro de producción intensiva y con el paso de la dimensión local a la mundial de la circulación de animales y sus derivados a través de redes de cadenas de valor que presentan una endeble seguridad biológica. En los últimos dos decenios ha habido grandes epidemias que han afectado al ganado y tenido importantes consecuencias económicas. La pandemia de COVID-19 es un elocuente ejemplo de los devastadores efectos socioeconómicos que puede tener la extensión de un patógeno cuando no se detecta y controla en un momento lo bastante precoz del proceso de emergencia. Ello pone de relieve la importancia que revisten los Servicios Veterinarios para que toda la sociedad pueda reaccionar de forma integrada a la hora de combatir las enfermedades infecciosas de los animales. Dentro de los Servicios Veterinarios, conviene poner el acento en la prevención y la preparación. Para lograr este objetivo los autores señalan cuatro ámbitos que exigen una constante mejora: a) el desarrollo continuo de la capacidad del personal en materia de determinación de riesgos y análisis de cadenas de valor, ligado a la mejora de las políticas y la comunicación; b) la adecuada adaptación de los métodos de prevención y control en contextos de escasos recursos; c) una mejor cooperación multisectorial y transfronteriza, que permita poner en común recursos y competencias técnicas; y d) enfoques sistemáticos que hagan posible que los Servicios Veterinarios influyan en los procesos decisorios relativos al desarrollo del comercio, los mercados, las empresas, la salud pública y los medios de sustento a escala tanto nacional como regional.

Quantifying the level of under-detection of Trypanosoma brucei rhodesiense sleeping sickness cases.

To formally quantify the level of under-detection of Trypanosoma brucei rhodesiense sleeping sickness (SS) during an epidemic in Uganda, a decision tree (under-detection) model was developed; concurrently, to quantify the subset of undetected cases that sought health care but were not diagnosed, a deterministic (subset) model was developed. The values of the under-detection model parameters were estimated from previously published records of the duration of symptoms prior to presentation and the ratio of early to late stage cases in 760 SS patients presenting at LIRI hospital, Tororo, Uganda during the 1988--1990 epidemic of SS. For the observed early to late stage ratio of 0.47, we estimate that the proportion of under-detection in the catchment area of LIRI hospital was 0.39 (95% CI 0.37--0.41) i.e. 39% of cases are not reported. Based on this value, it is calculated that for every one reported death of SS, 12.0 (95% CI 11.0--13.0) deaths went undetected in the LIRI hospital catchment area - i.e. 92% of deaths are not reported. The deterministic (subset) model structured on the possible routes of a SS infection to either diagnosis or death through the health system or out of it, showed that of a total of 73 undetected deaths, 62 (CI 60-64) (85%) entered the healthcare system but were not diagnosed, and 11 (CI 11--12) died without seeking health care from a recognized health unit. The measure of early to late stage presentation provides a tractable measure to determine the level of rhodesiense SS under-detection and to gauge the effects of interventions aimed at increasing treatment coverage.

Risk of infection with Brucella abortus and Escherichia coli O157:H7 associated with marketing of unpasteurized milk in Kenya.

As part of a study to assess zoonotic milk-borne health risks, seasonal survey data and unpasteurized milk samples were collected between January 1999 and February 2000 from randomly selected informal milk market agents (220 and 236 samples in the dry and wet seasons, respectively) and from households purchasing raw milk (213 and 219 samples in the dry and wet seasons, respectively) in rural and urban locations in central Kenya and screened for antibodies to Brucella abortus (B. abortus) and presence of Escherichia coli (E. coli) O157:H7. The latter was assessed based on samples from consumer households only. Antibodies to B. abortus were screened using the indirect antibody Enzyme Linked Immunosorbent Assay (ELISA) and the Milk Ring Test (MRT). The presence of E. coli O157:H7 was assessed by culture, biochemical characterisation, serological testing for production of verocytotoxin one (VT1) and two (VT2) and polymerase chain reaction (PCR) analysis for the presence of genes encoding for the toxins. The prevalence of antibodies to B. abortus varied considerably ranging from none in milk sold in small units and originating from intensive production systems to over 10% in samples that were bulked or originating from extensive production systems. E. coli O157:H7 was isolated from two samples (0.8%), one of which produced VT1. All urban consumers (100%) and nearly all rural consumers (96%) of marketed milk boiled the milk before consumption, mainly in tea, thus greatly reducing chances of exposure to live pathogens and potential health risks.

The incidence of calf morbidity and mortality due to vector-borne infections in smallholder dairy farms in Kwale District, Kenya.

An observational longitudinal study was carried out on 92 randomly selected smallholder farms in two coastal lowland zones of Kwale District in Kenya between December 1997 and November 1999. The objective was to estimate the incidence of the main vector-transmitted diseases in pre-weaned calves. From an initial 41 pure or cross-bred Bos taurus calves which were less than 2 months and whose birth and disease histories were known, study calves were recruited progressively and monitored until they were weaned at around 146 days. Overall, 130 calves in 67 farms were monitored and these contributed a total risk period of 30,062 days. Disease parameters were analysed and compared as true annual and age-specific incidence rates. The incidences of East Coast fever (ECF) (23.1%) and trypanosomosis (29.1%) were the highest among the vector-borne diseases. The corresponding mortality incidence rates of ECF and trypanosomosis were 10.9 and 3.6%, respectively. The annual incidence rates of anaplasmosis and babesiosis were 10.9 and 1.2%, respectively. There was no mortality arising specifically from anaplasmosis or babesiosis. Analysis of survival times to natural infection indicated that the field challenge resulting to cases of trypanosomosis was much higher compared to the risk of either ECF or anaplasmosis. It was concluded that these vector-borne diseases constrain production of replacement stock in this coastal lowlands region of Kenya.

Spatial and temporal risk factors for the early detection of Trypanosoma brucei rhodesiense sleeping sickness patients in Tororo and Busia districts, Uganda.

We have carried out a study of risk factors for early detection of Trypanosoma brucei rhodesiense sleeping sickness. Records of sleeping sickness patients from 1987 to 2001 from Tororo and Busia districts in Uganda were reviewed for their village of origin and clinical stage (early or late). All villages that reported sleeping sickness and fixed post-diagnostic sleeping sickness health units in Tororo and Busia districts were geo-referenced. The spatial distribution of early and late stage patient detection by health units was analysed using Geographical Information Systems (GIS). Of 1316 sleeping sickness patients admitted at the Livestock Health Research Institute and Busolwe hospitals and Lumino health centre from Tororo and Busia districts, 471 (35.8%) were early stage, 825 (62.7%) were late stage, while 20 (1.5%) were not staged. Five hundred and eighty-five (44.5%) came from within a 10 km radius of the reporting health units. After multivariate analysis, the proportion of early stage patients detected was found to be significantly associated with patients originating from within a 10 km radius of the health unit (P < 0.01), with adults (>19 years) (P < 0.01), and with annual parish incidence (P < 0.01). Application of GIS and the early to late stages ratio are an informative and powerful means of determining efficiency of surveillance of sleeping sickness.

Assessing the patterns of health-seeking behaviour and awareness among sleeping-sickness patients in eastern Uganda.

For those with sleeping sickness, the consequences of delayed diagnosis include poor prognosis at treatment and an increased risk of tsetse infection. Data on their socio-demographic and clinical characteristics, health-seeking behaviour and delays in presentation and diagnosis were collected from 119 diagnosed cases of rhodesiense sleeping sickness in eastern Uganda. The median total delay, from onset of the illness to diagnosis, was 60 days. The median service-provider delay (30 days) was markedly longer than the median patient delay (17 days). Each of these delays was, however, considerable and independently associated with patients presenting with late-stage sleepiness, giving odds ratios and (95% confidence intervals) of 7.29 (3.10-17.14) and 2.98 (1.38-6.43), respectively. A blood examination at the first visit was also associated with the service-provider delay (odds ratio = 0.45; 95% confidence interval = 0.22-0.95). Most of the patients (77.4%) had either been referred to the local sleeping-sickness hospital by other members of their community or presented at the hospital on their own initiative; few had been referred by other components of the local health system. The results are disappointing, not only in showing long delays in diagnosis (and therefore in treatment) but also in indicating that much of the delay is attributable to the service provider failing to diagnose sleeping sickness among symptomatic individuals.

Characterisation of shops selling veterinary medicines in a tsetse-infested area of Kenya.

In a tsetse-infested area of Kenya, we characterised veterinary-drug outlets based on personnel and business characteristics to assess their capacities to provide clinical veterinary services. Structured questionnaires were administered to the retailers and sought information on the characteristics of the owners, salespersons and businesses. A total of 41 retail outlets (20 agro-veterinary, 11 pharmacy, and 10 general shops) were identified. There was poor response to questions on owner characteristics. Proprietors, who had no more than secondary education owned 15 out of 28 shops. Few shops (4/29) were owned by proprietors, who had professional qualifications (in animal health). Most salespersons had only secondary education but no qualifications. Animal-health assistants (AHAs), veterinarians and manufacturer's package inserts (drug leaflets) were the preferred information sources for the retailers. We concluded that drug retailers were poorly equipped with the technical knowledge necessary for drug dispensation and advice.

Transition models to assess risk factors for new and persistent trypanosome infections in cattle-analysis of longitudinal data from the Ghibe Valley, southwest Ethiopia.

The objective of this study was to apply transition models to distinguish between factors associated with both incident and persistent trypanosome infections. Data collected from 1561 cattle were analyzed from a long-term study involving 8 herds in which both trypanosome infections (a total of 56,931 cattle sampling-months) and tsetse (Glossina spp.) challenge were monitored monthly from March 1986 to March 1998. Both pour-on and insecticide-target tsetse control programs and mass treatment with diminazene aceturate before tsetse control were associated with significant decreases in both incidence and persistence of trypanosome infection relative to noncontrol periods, as were seasonal and sex effects. The magnitudes of the effects were, however, often different for new and persistent infections. For persistence of infection, there were 2 trends. In general, the duration of infection increased during the study, despite the regular treatment with diminazene aceturate. The transition model had 2 major benefits. The first was to identify an increasing duration of infections with time, taking into account other factors associated with increasing infection risk. The second was to highlight different patterns in the effects of certain factors on new and persistent trypanosome infections.

Analysis of correlated discrete observations: background, examples and solutions.

The goal of this paper is to highlight the use and interpretation of statistical techniques that account for correlation in epidemiological data. A conceptual statistical background is provided, and the main types of regression models for correlated data are highlighted. These models include marginal models, random effect models and transitional regression models. For each model type an example with data from the veterinary literature is provided. The examples are specifically used to highlight estimation procedures for parameters, and the interpretation of the estimated parameters. This paper emphasizes that statistical techniques and software to fit them are more widely available now, but that parameters have different interpretations in different model types. Consequently, we stress the importance of focusing on choosing the most appropriate model for the specific purpose of the analysis.

Drug sensitivity of trypanosome populations from cattle in a peri-urban dairy production system in Uganda.

Cattle from 50 farms in Mukono County, Uganda, were monitored for trypanosomes every second month over an 18-month period (1995-1996) by mini-anion exchange chromatography and haematocrit centrifugation techniques. Eighteen trypanosome isolates collected from cattle during this period were characterised in cattle, goats and mice for their sensitivity to homidium, isometamidium and diminazene; 10 of the isolates were selected randomly, 8 were from animals that had the highest serum isometamidium concentrations at the time the isolates were collected. All the isolates contained only Trypanosoma brucei and/or T. vivax. In nai;ve Boran (Bos indicus) cattle the isolates exhibited low pathogenicity and were sensitive to diminazene aceturate at 3.5 mg/kg body weight (bw) and isometamidium chloride at 0.5 mg/kg bw. In goats, 5 of 8 isolates were highly pathogenic, producing clinical signs indicative of central nervous system involvement within 60 days of infection; all such isolates contained T. brucei. However, all 8 populations were sensitive in goats to diminazene aceturate at 3.5 mg/kg bw. In contrast, 4 populations were refractory to treatment with isometamidium chloride at 0.5 mg/kg bw in at least 1 out of 3 goats each. Furthermore, 5 populations were refractory to treatment with homidium chloride at 1.0 mg/kg bw in a minimum of 2 out of 3 goats each. In mice, the 50% curative dose values for 11 Mukono isolates that contained T. brucei ranged from 0.30 to 1.89 mg/kg bw for diminazene aceturate, from 0.02 to 0.17 mg/kg bw for isometamidium chloride and from 0.90 to 4.57 mg/kg bw for homidium chloride. Thus, by comparison to reference drug-sensitive populations, all the stabilates were highly sensitive to diminazene and isometamidium, while some expressed low levels of resistance to homidium.

Comparison of vaccination strategies for the control of dog rabies in Machakos District, Kenya.

Demographic and epidemiological field data were used in a deterministic model to describe dog rabies transmission in Machakos District, Kenya and to predict the impact of potential vaccination strategies for its control. The basic reproduction number (R0) was estimated to be 2.44 (1.52-3.36, 95% confidence limits). There were three key model predictions. The first was that a threshold dog density (K(T)) of 4.5 dogs km(-2) (3.8-5.2 dogs km(-2), 95% confidence limits) was required to maintain transmission. The second was that the estimated annual vaccination rate of 24% failed to decrease incidence and actually increased the stability of transmission and may be counter-productive. Thirdly, to control rabies, it was predicted that 59% (34%-70%, 95% confidence limits) of dogs should be vaccinated at any one time. This requires approximately 70% coverage for annual but only 60% coverage for semi-annual vaccination campaigns. Community-level vaccination trials are needed to test these predictions.

The impact of Theileria parva infections and other factors on calf mean daily weight gains in smallholder dairy farms in Murang'a District, Kenya.

The association between mean daily weight gain, Theileria parva infections, clinical East Coast fever and other possible determinants of weight gain were examined in a longitudinal observational study that was conducted in cohorts of female calves from five agro-ecological zone (AEZ)-grazing strata. The strata were upper-midlands (UM) 1 zero-grazing, UM 1 open-grazing, UM 2 zero-grazing, UM 4 zero-grazing and UM 4 open-grazing. In total, 225 calves on 188 smallholder dairy farms were visited within the first 2 weeks of life and thereafter at biweekly intervals up to the age of 6 months between March 1995 and August 1996. During each visit, the calves were weighed and other calf-management practices in the farm during the visit such as housing, feeding and tick control also were recorded. Other events such as morbidity and mortality between or during the visits were also recorded. The overall mean daily weight gains were 0.24-0.29 kg (S.D.=0.17-0.22 kg) and were lower than the recommended targets for smallholder farms of 0.40-0.50 kg. The major tendency in variability of daily weight gains was due to visit-to-visit variation (especially in calves >3 months old). Differences in mean daily gains were associated with AEZ-grazing strata and calf-level factors that included breed of calf, calf sickness, incidence of ECF, feeding of milk, concentrate feeds and minerals and interaction between calf age and AEZ-grazing strata (P<0.05). ECF and other calf sicknesses exerted a temporal effect on calf-growth at the height of illness and immediately after; calves later recovered the lost growth except where other factors such as poor calf nutrition prevailed. Improvement in calf-growth in Murang'a District is achievable and extension services should continue to target individual-calf-level management practices.

Comparing apples and oranges--model-based assessment of different tsetse-transmitted trypanosomosis control strategies.

The current control strategies for tsetse-transmitted trypanosomosis in cattle (trypanocidal drugs, tsetse control and trypanotolerant cattle) are briefly reviewed and their adoption rates in different geographic regions of sub-Saharan Africa are presented. The impact of these control strategies and the potential use of vaccines, should they be developed, on trypanosomosis transmission were compared using a mathematical model. The relative trypanosomosis prevalence compared with no control was estimated across a range of control coverages (from none to complete control coverage) by varying the change in specific model parameters influenced by individual control measures. Based on this comparison, the relative rankings of the effect of control strategies on reducing disease prevalence were: vector control, vaccination, and drug use, in that order. In this model, trypanotolerance was assumed to decrease disease prevalence, but not to influence transmission. Differences in the predicted impact of control measures on the transmission of human sleeping sickness are discussed. Finally, the role of transmission model outputs as inputs for economic models to guide investment decisions for trypanosomosis control is emphasised.

Graphical approaches to support the analysis of linear-multilevel models of lamb pre-weaning growth in Kolda (Senegal).

Linear-multilevel models (LMM) are mixed-effects models in which several levels of grouping may be specified (village, herd, animal, ellipsis). This study highlighted the usefulness of graphical methods in their analysis through: (1) the choice of the fixed and random effects and their structure, (2) the assessment of goodness-of-fit and (3) distributional assumptions for random effects and residuals. An LMM was developed to study the effect of ewe deworming with morantel on lamb pre-weaning growth in a field experiment involving 182 lambs in 45 herds and 10 villages in Kolda, Senegal. Growth was described as a quadratic polynomial of age. Other covariates were sex, litter-size and treatment. The choice of fixed and random effects relied on three graphs: (1) a trellis display of mean live-weight vs. age, to select main effects and interactions (fixed effects); (2) a trellis display of individual growth curves, to decide which growth-curve terms should be included as random effects and (3) a scatter plot of parameters of lamb-specific regressions (live-weight vs. quadratic polynomial of age) to choose the random-effects covariance structure.Age, litter-size, agexlitter-size, litter-sizextreatment and agexlitter-sizextreatment were selected graphically as fixed effects and were significant (p<0.05) in subsequent statistical models. The selection of random-effect structures was guided by graphical assessment and comparison of the Akaike's information criterion for different models. The final random-effects selected included no random effect at the village level but intercept, age and squared-age at the herd and lamb levels. The structure of the random-effects variance-covariance matrices were blocked-diagonal at the herd level and unstructured at the lamb level. An order-1 autoregressive structure was retained to account for serial correlations of residuals. Smaller residual variance at 90 days than at younger ages was modeled with a dummy variable taking a value of 1 at 90 days and 0 elsewhere.Ewe-deworming with morantel during the rainy season lead to higher lamb live-weights (probably related to a better ewe-nutrition and -health status). A positive correlation was demonstrated between early weight and growth rate at the population level (with important lamb and herd-level random deviations). The persistence of this correlation at older ages should be checked to determine whether early weights are good predictors of mature weights and ewe-reproductive lifetime performance.

Differences in the epidemiology of theileriosis on smallholder dairy farms in contrasting agro-ecological and grazing strata of highland Kenya.

A prospective cohort study was conducted in five purposively-sampled agro-ecological zone (AEZ)-grazing system strata in Murang'a District, Kenya, between March 1995 and June 1996. The study strata were selected based on a preliminary characterization study to represent the widest range of risks to East Coast fever (ECF) in the District and included zero-grazing and open-grazing farms. In total, 225 calves from 188 smallholder farms were examined from birth to 6 months of age and visited within the first 2 weeks of life and thereafter at bi-weekly intervals for up to 14 visits. The purpose of the study was to characterize the differences in epidemiology (risks of infection, morbidity and mortality) and potential control of ECF between the selected strata. Evidence of Theileria parva infection was assessed by increased antibody levels as measured in an indirect ELISA assay by the percent positivity (PP) of serum samples relative to a strong positive reference serum. Sero-conversion risks of T. parva were highest in the open-grazing strata. Antibody prevalence in adult cattle and ECF morbidity and mortality risks were also highest in open-grazing strata. While different, all five AEZ-grazing strata were considered to be endemically unstable for ECF. East Coast fever challenge was low in all zero-grazing strata and this challenge is likely to remain low due to continuing intensification of smallholder farming in the central highlands. In the open-grazing strata, there was higher challenge and a greater impact of ECF.

Community-based active surveillance for rabies in Machakos District, Kenya.

The rabies problem in Kenya has been greatest in Machakos District where the disease has persisted endemically for over 40 years. This paper presents the results of a one-year community-based active surveillance for rabies in six randomly selected sublocations in the district for the period 1992-1993. Approximately 860 rabid dogs per 100000 dogs were confirmed in this study, compared to approximately 12 per 100000 confirmed rabid dogs reported by the existing passive-surveillance system. This active surveillance underestimated the true rabies incidence, because only 41% (130/317) of the potential specimens could be diagnosed. Dogs accounted for 92% (179/194) of primary animal-rabies suspects, 80% (66/83) of secondary suspects, and 81% of the confirmed animal-rabies cases. The annual incidence of animal-bites of humans was 234 per 100000 people and the point estimate of human-rabies incidence per year was 25 per million people. Almost all (97%) animal-bites of humans were due to dogs.The traditional passive-surveillance system grossly underestimated the importance of rabies as a public-health problem in Machakos District. Community-based active surveillance provides a potential cost-effective strategy for greatly improving estimates of rabies incidence and epidemiology to inform veterinary and policy decision-making.

The epidemiology of Theileria parva infections on smallholder dairy farms in Kenya.

The purpose of the study was to characterize the differences in epidemiology (risks of infection, morbidity, mortality) and potential control of East Coast fever (ECF) between the selected strata. Evidence of Theileria parva infection was assessed by increased antibody levels as measured in an indirect ELISA test by the percent positivity (PP) of serum samples relative to a strong positive reference serum. A prospective cohort study was conducted in five purposively sampled agroecological zone (AEZ)-grazing system strata in Murang'a District, Kenya, between March 1995 and June 1996. The study strata were selected to represent the widest range of ECF risks in the district and included, zero-grazing and open-grazing farms in the Upper Midlands (UM) one and four AEZs and zero-grazing farms in the UM2 AEZ. In total, 225 calves from 188 smallholder farms were examined from birth to age six months. Calves were recruited into the study at birth and visited within the first two weeks of life and thereafter at biweekly intervals for up to 14 visits. Important differences were observed between the different AEZ-grazing strata. Seroconversion risks of T. parva were highest in the UM4-open grazing stratum. Antibody prevalence in adult cattle and ECF morbidity and mortality risks were also highest in this stratum. In the open-grazing strata, particularly in the lower elevation AEZ, UM4, there was stronger challenge and a greater impact of ECF. There is likely to be an expansion of smallholder dairy farming into this area so that it is likely to be the most important target production system for ECF control in the central highlands of Kenya.

Study of brucellosis in a pastoral community and evaluation of the usefulness of clinical signs and symptoms in differentiating it from other flu-like diseases.

A study of differentials causing flu-like symptoms (malaria, typhoid, streptococcal infections and rheumatoid arthritis) in 488 patients from a pastoralist area is presented. The potential usefulness of clinical signs, symptoms and diagnostic tests in ruling-in or ruling-out these diseases was investigated in the District hospital and three outlying health dispensaries. For each patient a detailed clinical history plus diagnostic test for brucellosis, typhoid, streptococcal infections and rheumatoid arthritis, and for some patients malaria were conducted. Incidence levels of these diseases were estimated using laboratory test results; brucellosis, 13%, typhoid, 40%: streptococcal infections, 6% malaria, 9%: and rheumatoid arthritis, 10%. Brucellosis could not be differentiated clinically from the other flu-like diseases but rheumatoid arthritis could.

Study of Brucellosis in a Pastoral Community and Evaluation of the Usefulness of Clinical Signs and Symptoms in Differentiating it from other Flu-Like Diseases

A study of differentials causing flu-like symptoms (malaria; typhoid; streptococcal infections and rheumatoid arthritis) in 488 patients from a pastoralist area is presented. The potential usefulness of clinical signs; symptoms and diagnostic tests in ruling-in or ruling-out these diseases was investigated in the District hospital and three outlying health dispensaries. For each patient a detailed clinical history plus diagnostic test for brucellosis; typhoid; streptococcal infections and rheumatoid arthritis; and for some patients malaria were conducted. Incidence levels of these diseases were estimated using laboratory test results; brucellosis; 13; typhoid; 40: streptococcal infections; 6malaria; 9: and rheumatoid arthritis; 10. Brucellosis could not be differentiated clinically from the other flu-like diseases but rheumatoid arthritis could