Investigations into a trigger-based approach for initiating emergency vaccination to augment stamping out of foot-and-mouth disease in New Zealand: a simulation study.

AIMS: To investigate an adaptive management approach to the deployment of emergency vaccination as an additional measure to stamping out (SO) during simulated outbreaks of foot-and-mouth disease (FMD) in New Zealand. METHODS: A simulation modelling (n=6000 simulations) approach was used. The study population comprised all known farms in New Zealand with FMD-susceptible livestock. Each simulation started with infection seeded into a single randomly selected farm. Each outbreak was randomly assigned to one of four control strategies, comprising SO only; trigger-based vaccination (TRV) where SO was augmented with vaccination if an early decision indicator trigger operating between Days 11-35 of the response indicated a large outbreak was developing; SO plus vaccination started randomly on Days 11-35 of the response (VACr); and SO plus vaccination with a fixed start on Day 21 of the response (VACf). Other parameters, such as the number of personnel available were also varied randomly. Generalised additive models (GAM) were used to evaluate variables associated with the number of infected premises (IP) and epidemic duration. RESULTS: The mean number of IP was 29 (median 9, min 1, max 757), while epidemics lasted on average 26.9 (median 18, min 1, max 220) days. These excluded 303 extreme outbreaks larger than the UK 2001 FMD epidemic (2,030 cases). Univariable analysis of the pooled vaccination results vs. SO, showed that vaccination significantly reduced the number of IP (p<0.001) and outbreak duration (p<0.001). GAM of large outbreaks revealed that only the TRV strategy was significantly protective compared to SO alone, reducing the odds of a large outbreak by 22% (OR=0.78; 95% CI=0.63-0.96). The number of veterinarians was non-linearly associated with large outbreaks, with low numbers increasing the odds of a large outbreak, but above 200 veterinarians, the odds reduced. Time to first detection was also non-linearly associated with large outbreaks, with detections <13 days protective and longer detection times increasing the odds of a large outbreak. GAM of long outbreaks showed similar findings, except that all three vaccination strategies significantly reduced duration. Overall, the TRV strategy resulted in the smallest and shortest epidemics. CONCLUSIONS AND CLINICAL RELEVANCE: An adaptive management approach that deployed vaccination in response to a trigger when a large outbreak was developing outperformed SO and reduced the odds of large or long outbreaks more than the other two vaccination strategies, although the differences between the three vaccination strategies were statistically small. This study provides highly relevant insights into the dynamics of disease establishment and spread that will guide New Zealand's readiness for responding to highly infectious disease incursions such as FMD.

Prevalence and characterisation of wounds in sheep attributed to attacks by kea (Nestor notabilis) on high country farms in New Zealand.

Aims: To characterise and classify wounds in sheep suspected to have been caused by attacks by kea (Nestor notabilis) (kea strike), and to report the prevalence of these wounds on five high country farms in the South Island of New Zealand.Methods: Data were collected from farms between 28 August 2012 and 20 September 2013. Sheep were examined opportunistically immediately after shearing for signs of wounds caused by kea. The age and sex of sheep were also recorded. Wounds were measured and characterised as recent, healing, or healed, and the estimated true prevalence was calculated for each farm.Results: Injuries consistent with kea strike wounds were identified in 70/13,978 (0.5%) sheep examined. The estimated true prevalence varied between farms, from 0 (95% CI = 0-0.16) to 1.25 (95% CI = 0.97-1.61)%. Of the 76 wounds identified, 61 (80%) were located in the lumbar region, and 74 (97%) consisted of full-thickness ulceration of the skin, one showed evidence of injury to muscle and one to bone. The median length of the 63 wounds measured was 6 (min 1, max 23.5) cm, and 10/63 (13%) were categorised as recently healed, 47/63 (62%) as healing, and 17/63 (22%) as recent wounds.Conclusions: The results of this study show that kea strike on sheep was occurring at a low prevalence on the high country farms surveyed. The wounds identified were survivable, but the welfare impact of kea strike on sheep should be considered in balance with the conservation status of kea. There was clear variation in the prevalence of wounds attributed to kea strike between the farms but we were not able to identify the risk factors contributing to these differences. Future studies of kea strike should examine variables such as altitude, local kea density and distribution, and differences in kea strike management and husbandry practices, and should include high country farms without a history of kea strike.

Prevalence of Candidatus Mycoplasma haemolamae, bovine viral diarrhoea virus, and gastrointestinal parasitism in a sample of adult New Zealand alpaca (Vicugna pacos).

AIM: To determine the prevalence of infection with Candidatus Mycoplasma haemolamae (Mhl), antibodies to bovine viral diarrhoea virus (BVDV), and BVDV antigen, and the prevalence of animals with elevated faecal nematode egg counts (FEC) in a sample of adult New Zealand alpaca (Vicugna pacos). METHODS: Blood samples were obtained from 175 alpaca, collected from 15 farms around New Zealand, and from 31 samples sent to a diagnostic laboratory for routine haematology. Blood smears (n=170) were examined microscopically for the presence of haemoplasma, and DNA was extracted from whole blood (n=206) for real-time PCR testing for Mhl. Packed cell volume (PCV) was determined for 193 samples. Serum samples (n=195) were tested for BVDV antibody using ELISA, and for BVDV antigen using a real-time PCR assay. Faecal samples were collected from 143 animals; FEC were measured, and samples pooled for larval culture. RESULTS: No haemoplasma organisms were present on blood smear examination. Of the 206 blood samples, two (from the same farm) were positive for Mhl by real-time PCR testing, giving a prevalence of infection with Mhl of 0.97%. Of the 195 serum samples tested, four (2.1%) were positive for antibodies to BVDV; animals with BVDV antibodies were from 3/15 (20%) farms, none of which farmed cattle. None of the serum samples were positive by PCR for BVDV antigen. The median FEC was 50 epg (min 0, max 4,700), with 55/143 (38.5%) samples having 0 epg, and 33/143 (23.1%) having ≥250 epg. Haemonchus spp. were the most common nematodes present in faecal larval cultures from the North Island. Log10 FEC was negatively associated with PCV (p=0.02), and was higher in males than females (p<0.001), and in animals that were positive compared with negative for Mhl (p=0.022). CONCLUSIONS AND CLINICAL RELEVANCE: The number of alpaca infected with Mhl was low, as was the seroprevalence of BVDV. Gastrointestinal parasitism was, however, a common finding in this sample of New Zealand alpaca.

Evaluating the benefits of vaccination when used in combination with stamping-out measures against hypothetical introductions of foot-and-mouth disease into New Zealand: a simulation study.

AIMS: To evaluate the benefits of vaccination against simulated outbreaks of foot-and-mouth disease (FMD) in New Zealand, when applied as an additional measure to stamping-out. METHODS: A simulation modelling approach was used. The study population comprised all known farms in New Zealand with FMD-susceptible livestock. Infection was seeded into three different areas of New Zealand. Transmission mechanisms included direct and indirect contacts, local spread and airborne spread. Efficacies of some of the stamping-out measures were varied. Vaccination strategies involved different start times, size and type of vaccination zone, and species vaccinated. Personnel resources for vaccination were varied as was the herd immunity profile following vaccination. Altogether, 336 models were specified, with 100 iterations conducted for each model. Generalised linear modelling and boosted regression trees were used to evaluate which variables had the biggest effect on the number of infected premises (IP), epidemic duration and area under control. RESULTS: Vaccination, when used as an adjunct to the standard stamping-out programme, significantly reduced the outbreak size. Vaccination reduced the median number of IP by 26 (95% CI=18-35), epidemic duration by 16 (95% CI=13-19) days and area under control by 474 (95% CI=250-699) km2 when there was no airborne spread; and when there was airborne spread the median reduction was 87 (95% CI=70-105) IP, 32 (95% CI=28-35) days and 898 (95% CI=665-1139) km2, respectively. Multivariable analyses showed that starting vaccination 11 days after first detection of FMD produced greater benefits than starting 16 or 21 days after detection. Increasing vaccination zones resulted in increased benefits. Boosted regression tree analyses showed that the most influential variables on the outcome measures were interval to first detection, incursion location, whether there was airborne spread or not and herd immunity profile. CONCLUSIONS AND CLINICAL RELEVANCE: This study showed that there are benefits to the use of vaccination in combination with a stamping-out policy for control of FMD outbreaks under New Zealand conditions. The optimal vaccination strategy was identified as being a 3-5 km radius suppressive vaccination zone deployed between 11-16 days after first detection. Vaccination had a greater benefit during larger outbreaks, such as when there was airborne transmission. The key factors which were identified from this study will help inform New Zealand's competent authority on how best to deploy vaccination to further strengthen its approach to FMD eradication should New Zealand ever experience an outbreak.

Compatibility between livestock databases used for quantitative biosecurity response in New Zealand.

AIM: To characterise New Zealand's livestock biosecurity databases, and investigate their compatibility and capacity to provide a single integrated data source for quantitative outbreak analysis. METHODS: Contemporary snapshots of the data in three national livestock biosecurity databases, AgriBase, FarmsOnLine (FOL) and the National Animal Identification and Tracing Scheme (NAIT), were obtained on 16 September, 1 September and 30 April 2014, respectively, and loaded into a relational database. A frequency table of animal numbers per farm was calculated for the AgriBase and FOL datasets. A two dimensional kernel density estimate was calculated for farms reporting the presence of cattle, pigs, deer, and small ruminants in each database and the ratio of farm densities for AgriBase versus FOL calculated. The extent to which records in the three databases could be matched and linked was quantified, and the level of agreement amongst them for the presence of different species on properties assessed using Cohen's kappa statistic. RESULTS: AgriBase contained fewer records than FOL, but recorded animal numbers present on each farm, whereas FOL contained more records, but captured only presence/absence of animals. The ratio of farm densities in AgriBase relative to FOL for pigs and deer was reasonably homogeneous across New Zealand, with AgriBase having a farm density approximately 80% of FOL. For cattle and small ruminants, there was considerable heterogeneity, with AgriBase showing a density of cattle farms in the Central Otago region that was 20% of FOL, and a density of small ruminant farms in the central West Coast area that was twice that of FOL. Only 37% of records in FOL could be linked to AgriBase, but the level of agreement for the presence of different species between these databases was substantial (kappa>0.6). Both NAIT and FOL shared common farm identifiers which could be used to georeference animal movements, and there was a fair to substantial agreement (kappa 0.32-0.69) between these databases for the presence of cattle and deer on properties. CONCLUSIONS: The three databases broadly agreed with each other, but important differences existed in both species composition and spatial coverage which raises concern over their accuracy. Importantly, they cannot be reliably linked together to provide a single picture of New Zealand's livestock industry, limiting the ability to use advanced quantitative techniques to provide effective decision support during disease outbreaks. We recommend that a single integrated database be developed, with alignment of resources and legislation for its upkeep.

Investigation of bovine haemoplasmas and their association with anaemia in New Zealand cattle.

CASE HISTORY AND CLINICAL FINDINGS: A dairy cow, from a herd in the Waikato region of New Zealand, was reported with regenerative anaemia on 12 September 2014. Testing of blood from the animal using PCR assays for Theileria orientalis produced a negative result for both Chitose and Ikeda types. LABORATORY FINDINGS: Using PCR and DNA sequencing, blood from the cow was positive for Candidatus Mycoplasma haemobos. Further testing of another 12 animals from the case herd, 27 days after the affected cow was first reported, showed 11 animals were positive for Candidatus M. haemobos or Mycoplasma wenyonii in the PCR. None of these cattle were clinically anaemic or positive for T. orientalis Ikeda type using PCR. A convenience sample of 47 blood samples from cattle throughout New Zealand, submitted to the Investigation and Diagnostic Centre (Ministry for Primary Industries) for surveillance testing for T. orientalis Ikeda, was selected for further testing for bovine haemoplasmas. Of these samples, 6/47 (13%) and 13/47(28%) were positive for M. wenyonii and Candidatus M. haemobos, respectively. There was no difference in the proportion of samples positive for the bovine haemaplasmas between cattle with anaemia that were negative for T. orientalis (6/20, 33%), or without anaemia or T. orientalis (10/18, 56%), or from cattle herds experiencing anaemia and infection with T. orientalis Ikeda type (3/9, 33%). DIAGNOSIS: Bovine haemoplasmosis. CLINICAL RELEVANCE: The presence of bovine haemoplasmas in blood does not establish causality for anaemia in cattle. Diagnosis of anaemia associated with haemoplasmosis would require exclusion of other causes of regenerative anaemia and an association of the agent with anaemia in affected cattle herds. The data collected in this study did not provide evidence that bovine haemoplasmas were associated with a large number of outbreaks of anaemia in cattle in New Zealand.

Network analysis of wildlife translocations in New Zealand.

AIMS: To identify network measures with relevance to disease spread in a network of movements derived from the Department of Conservation (DOC) translocation records from 1970 to mid-2014, and to identify conservation sites that should be prioritised for surveillance activities and improvements to data collection to make the best use of network analysis techniques in the future. METHODS: Data included the source and destination of translocated specimens, the species and the dates the translocations were expected to occur. The data were used to construct a directed, non-weighted network in which a translocation event represented a tie in the network. Network density, in-degree (movements entering a node of interest) and out-degree (movements leaving a node of interest) and reciprocity were calculated. RESULTS: The data analysed consisted of 692 unique translocations between 307 sites, with the majority (518; 73%) being for birds. The constructed network for bird, reptile and frog translocations comprised 260 nodes, with 34/260 (13%) having two-way movements and 47/260 (18%) non-reciprocal movements. The median degree score (sum of in- and out-degree) was two (min 0, max 36) with a mean of 3.5 in a right skewed distribution. Most sites acted as receivers or senders of consignments with only a few having both high in- and high out-degree, and thus had characteristics that made them sites of interest for surveillance activities. These included the National Wildlife Centre at Mount Bruce, Tiritiri Matangi Island and Te Kakahu (Chalky Island). CONCLUSIONS: The presence of linking sites that join larger clusters within the network creates the potential for rapid disease spread if a pathogen were to be introduced. The important sites that supply or receive specimens for translocations are already well recognised by those performing translocations in New Zealand, and this paper provides further information by quantifying their role within the network.

Investigation of mortalities associated with Salmonella spp. infection in wildlife on Tiritiri Matangi Island in the Hauraki Gulf of New Zealand.

CASE HISTORY: Salmonellosis was suspected as the cause of death in eight wild animals on Tiritiri Matangi Island, in the Hauraki Gulf of New Zealand, between November and September 2011, including three hihi (Notiomystis cincta), a tuatara (Sphenodon punctatus), a masked lapwing (Vanellus miles novaehollandiae), and a saddleback (Philesturnus carunculatus). An outbreak investigation to identify the source and distribution of infection was undertaken over the summer of 2011-2012. CLINICAL AND LABORATORY FINDINGS: Surveillance of five species of forest bird (n=165) in December 2011 returned a single positive result for Salmonella spp. Environmental sampling of 35 key water sources and hihi supplementary feeding stations conducted in December 2011 and March 2012 returned isolates of S. enterica subspecies houtenae and S. enterica serovar Saintpaul from a stream, a dam and a supplementary feeding station. The same serotypes were identified in tissue samples collected from post mortem specimens of the affected birds, and their similarity was confirmed by pulsed-field gel electrophoresis. DIAGNOSIS: Mortality in wildlife associated with infection with S. enterica subspecies houtenae and S. enterica serovar Saintpaul. CLINICAL RELEVANCE: This is the first detection of these Salmonella spp. from wild birds in New Zealand. Our study highlights how active surveillance in response to observed disease emergence (here mortalities) can provide important insight for risk assessment and management within populations of endangered species and inform risk assessment in translocation planning.

[Physical diagnosis--digital rectal examination]. / Fysische diagnostiek--rectaal toucher.

For a wide range of complaints, there is an indication for digital rectal examination. The position patients should adopt depends on their physical condition and the indication concerned. The reach of the palpating index finger is fairly short. The severity of micturition complaints has little or no relation to the size of the prostate. The sensitivity of digital rectal examination for detecting prostate carcinoma ranges from about 50 to 80%. Therefore, a prostate carcinoma cannot be excluded on the basis of digital rectal examination. The positive predictive value of digital rectal examination for detecting prostate carcinoma increases as the serum PSA level increases. Digital rectal examination can make an important contribution to the diagnosis of anorectal disorders, including rectal carcinoma. In total, 5-10% of consultations with general practitioners are related to anorectal or urogenital complaints and 50% of the elderly have micturition problems; therefore digital rectal examination is one of the physician's basic skills.

A cause célèbre: the so-called "ballpoint murder".

Transorbital intracranial injuries are uncommon but classic ophthalmologic traumas. This report describes a case of a woman who was found dead. Postmortem examination revealed a Bic ballpoint which had penetrated her head through her right eye. Detective forces believed a murder to be the most likely cause; however, medical expert consultants indicated that a tragic accident was more likely. The case and the results of crossbow test-firing on human cadavers are presented.

New material for low-cost intraocular lenses.

A UV-hardening lacquer material based on polyurethane, used in Philips compact disc lens systems, was tested as suitable material for low-cost intraocular lenses (IOLs). A slightly changed composition (code number I-0.5A) came out as the best and was subsequently tested, with reference to poly(methyl methacrylate) (PMMA), as a 'lobster-claw' lens in Hollander rabbit eyes for a period of 24 wk. No carcinogenic effects were found, while only minor vascularization of the cornea at the incision area occurred. The in vitro biocompatibility tests of the material were positive. Scanning electron microscopy images of the IOLs at 2, 6, 12 and 24 wk postoperative showed portions of an acellular membrane, multinuclear giant cells which hyalinize and stay as pigmented plaques, microphages and fibroblasts with fibrillar strands, long pseudopodia, and broad microplicea. The chosen UV lacquer showed a foreign body reaction and properties comparable with PMMA, and is suitable for manufacturing low-cost IOLs.

Autoclavable highly cross-linked polyurethane networks in ophthalmology.

Highly cross-linked aliphatic polyurethane networks have been prepared by the bulk step reaction of low molecular weight polyols and hexamethylenediisocyanate (HDI). These polyurethane networks are optically transparent, colourless and autoclavable amorphous glassy thermosets, which are suited for use in ophthalmic applications such as intraocular lenses and keratoprostheses. The properties of these glassy polyurethanes, obtained from the reaction of the low molecular weight polyols triisopropanolamine (TIPA) or tetrakis (2-hydroxypropyl)ethylenediamine (Quadrol) and HDI in stoichiometric proportions, have been investigated in more detail. The glassy Quadrol/HDI-based polyurethane exhibits a reduction in ultimate glass transition temperature from 85 to 48 degrees C by uptake of 1% of water, and good ultimate mechanical properties (tensile strength 80-85 MPa, elongation at break ca 15%, modulus ca 1.5 GPa). IR spectra of these hydrophobic polyurethane networks revealed the absence of an isocyanate absorption, indicating that all isocyanates, apparently, had reacted during the cross-linking reaction. The biocompatibility could be increased by grafting tethered polyacrylamide chains onto the surface during network formation. These transparent cross-linked polyurethanes did not transmit UV light up to 400 nm, by incorporation of a small amount of the UV absorbing chromophore Coumarin 102, and could be sterilized simply by autoclaving. They were implanted in rabbit eyes, either in the form of small circular disks or in the form of a keratoprosthesis (artificial cornea). It was shown that the material was well tolerated by the rabbit eyes. Serious opacification of the cornea, a direct result of an adverse reaction to the implant, was never seen. Even 1 yr after implantation of a polyurethane keratoprosthesis the eye was still 'quiet'.

Mersilene (polyester), a new suture for penetrating keratoplasty.

Mersilene (polyester monofilament) seems to be suitable for penetrating keratoplasty because it is strong, shows no degradation by ultraviolet light, is insoluble, so that it can be left in situ, and offers the possibility of regulating postoperative astigmatism by suture adjustment. In 12 patients penetrating keratoplasty was performed with the combined interrupted/running suturing technique, using eight interrupted nylon 10-0 sutures and one running Mersilene 11-0 suture. The results were compared with those of 25 patients in whom eight interrupted nylon 10-0 sutures and one running nylon 11-0 suture were used. Six months after penetrating keratoplasty, no differences could be found between the two groups in keratometric astigmatism, visual acuity or slitlamp findings. In three patients postoperative adjustment of the running Mersilene suture reduced astigmatism by 50, 90 and 100% respectively. In an animal study the behaviour of Mersilene in the cornea was evaluated by slitlamp examination, histology and electron-microscopy. The tissue response to Mersilene was minimal. Considering the resemblance to nylon in clinical findings, minimal tissue response, lack of biodegradation and possibility of regulating postoperative astigmatism by suture adjustment, Mersilene seems to be a suitable material for penetrating keratoplasty.

King Sivi and Doctor Silva.

The classical legend of ca. 500 BC about Buddha who in his former life as King Sivi wished to give a part of his body to the first one who asked for it, lies at the root of the success story of the indefatigable Dr Silva of Colombo, who succeeded through the oldest known story about donation of organs to make Sri Lanka the 'world champion' in eye donation. The legend is quoted in this article, followed by a short introduction of Dr Hudson Silva and his remarkable activities.

Vasocystostomy, a new technique of sperm output measurement.

A vasocystostomy in the rat is described, a new technique simplifying the common methods of spermatozoa output measuring. In two series of different rat strains a mean output of 21.1 X 10(6) and 29.0 X 10(6) spermatozoa per 24 h were found. Perspectives of the new method are discussed.

The effect of hemicastration on daily sperm output in the rat as measured by a new method.

PIP: Anastomosis between the ductus deferens and the bladder in the rat allowed measurement of sperm output in 24-hour samples of uterine. A mean of 128,000 (Standard deviation = 160,000) sperm were liminated daily. Hemicastration produced significant decreases (p .01) in sperm output. The method is simple and gives more reliable sperm counts than the ejaculation techniques.^ieng