Risk factors for the incursion, spread and persistence of the foot and mouth disease virus in Eastern Rwanda.

BACKGROUND: Identification of risk factors is crucial in Foot-and-mouth disease (FMD) control especially in endemic countries. In Rwanda, almost all outbreaks of Foot-and-Mouth Disease Virus (FMDV) have started in Eastern Rwanda. Identifying the risk factors in this area will support government control efforts. This study was carried out to identify and map different risk factors for the incursion, spread and persistence of FMDV in Eastern Rwanda. Questionnaires were administered during farm visits to establish risk factors for FMD outbreaks. Descriptive statistical measures were determined and odds ratios were calculated to determine the effects of risk factors on the occurrence of FMD. Quantum Geographic Information System (QGIS) was used to produce thematic maps on the proportion of putative risk factors for FMD per village. RESULTS: Based on farmers' perceptions, 85.31% (with p < 0.01) experienced more outbreaks during the major dry season, a finding consistent with other reports in other parts of the world. Univariate analysis revealed that mixed farming (OR = 1.501, p = 0.163, CI = 95%), and natural breeding method (OR = 1.626; p = 0.21, CI = 95%) were associated with the occurrence of FMD indicating that the two risk factors could be responsible for FMD outbreaks in the farms. The occurrence of FMD in the farms was found to be significantly associated with lack of vaccination of calves younger than 12 months in herds (OR = 0.707; p = 0.046, CI = 95%). CONCLUSIONS: This is the first study to describe risk factors for persistence of FMDV in livestock systems in Rwanda. However, further studies are required to understand the role of transboundary animal movements and genotypic profiles of circulating FMDV in farming systems in Rwanda.

Knowledge and risk factors for foot-and-mouth disease among small-scale dairy farmers in an endemic setting.

Foot-and-mouth disease (FMD) is a highly contagious viral infection of cloven-hoofed animals. In Kenya, the disease is endemic with outbreaks typically occurring throughout the year. A cross-sectional study was undertaken in Nakuru County to investigate farmer knowledge and risk factors for clinical disease. Semi-structured interviews were conducted on 220 smallholder farmers, selected using random spatial sampling. The majority of respondents (207/220 [94.1%]) knew of FMD and 166/207 (80.2%) of them could correctly identify the disease based on their knowledge of the clinical signs. Forty-five out of 220 farmers (20.4%) vaccinated their livestock against FMD in the previous 6 months, although of those who knew of FMD only 96/207 (46.4%) perceived it as a preventive measure undertaken to reduce the risk of disease in their farm. FMD had occurred in 5.9% of the surveyed farms within the previous 6 months (from May to November 2016). Using multivariate analysis, the use of a shared bull (OR = 9.7; p = 0.014) and the number of sheep owned (for each additional sheep owned OR = 1.1; p = 0.066) were associated with an increased likelihood of a farm experiencing a case of FMD in the previous 6 months, although the evidence for the latter was weak. This study reports risk factors associated with clinical FMD at the farm level in a densely populated smallholder farming area of Kenya. These results can be used to inform the development of risk-based strategic plans for FMD control and as a baseline for evaluating interventions and control strategies.

Production diseases in smallholder pig systems in rural Lao PDR.

Pigs in Lao People's Democratic Republic are important for income and food security, particularly in rural households. The majority of pigs are reared in smallholder systems, which may challenge the implementation of any disease control strategies. To investigate risk factors for pig production diseases in such farming systems in the country a serological survey was conducted during 2011. A total of 647 pigs were sampled, accounting for 294 households in Luang Prabang and 353 in Savannakhet province representing upland and lowland, respectively. The results demonstrated that pigs in Lao PDR had antibodies against erysipelas (45.2%), CSF (11.2%), PRRS (8.6%), FMD O (17.2%) and FMD Asia 1, (3.5%). Differences in the housing systems influenced disease risk, for example, penned pigs had reduced odds of FMD and CSF, compared to those in scavenger systems. Pigs owned by farms using a sanaam (a communal area where pigs are kept for some time of the year) had 3.93 (95% confidence interval (CI): 1.09-14.7) times the odds of having pigs seropositive for FMD. Farms on which sudden piglet deaths had been experienced were more likely to have pigs seropositive for FMD O and erysipelas. These diseases constrain the development of village farming and the wider livestock industry due to their impact on productivity and trade. Vaccination coverage for FMD and CSF was low and there was a lack of national funding for livestock disease control at the time of the study. Further investigation into sustainable low-cost control strategies for these pathogens is warranted.

Foot and mouth disease risk assessment in Mongolia--local expertise to support national policy.

To address weaknesses in the current foot and mouth disease (FMD) control system and to inform the formulation of a national control strategy, Mongolia conducted two separate risk assessments, one for the Eastern region which in the past has seen re-current introductions of infection, and one for the Western region, where freedom from disease had been demonstrated over several years until FMD was re-introduced in 2013. The risk assessment was conducted in three stages: first local experts developed entry, exposure and consequence pathways during separate workshops in both regions, then data was collected, compiled and analysed, and finally, during a second workshop local experts provided risk estimations for both regions and identified recommendations for risk management. Risk estimates for each pathway were individually recorded, which ensured that views of all experts were equally represented in the risk estimation and which allowed assessing possible impact of different factors related to the background of participating local experts on risk estimates. Entry risk pathways with highest risk estimates were related to livestock movements and in the consequence assessment due to direct contacts. Uncertainty, for which disagreement between participants acted as a proxy, was high in entry pathways and in the assessment of effectiveness of control measures. The risk assessment was conducted with local experts who had no previous risk assessment experience. Through their involvement in the whole process however, they assumed a high level of ownership and despite lively discussions for some risk pathways, a high level of agreement was achieved and credible results were communicated to decision makers. Especially valuable were the derived recommendations. Through the risk assessment the local experts gained a thorough understanding of the FMD risk which resulted in sensible and realistic recommendations, which, if implemented, can lead to a sustainable strengthening of the Mongolian capacities to prevent, control and eradicate FMD. The process was underlined by extensive field data collection, which helped to address important data gaps and therefore to improve quality and reliability of findings. The Mongolian veterinary authority was very committed to the risk assessment and several recommendations have already been integrated in the revision of the national FMD strategy.

Epidemiological simulation modeling and spatial analysis for foot-and-mouth disease control strategies: a comprehensive review.

Foot-and-mouth disease (FMD) is one of the most serious transboundary, contagious viral diseases of cloven-hoofed livestock, because it can spread rapidly with high morbidity rates when introduced into disease-free herds or areas. Epidemiological simulation modeling can be developed to study the hypothetical spread of FMD and to evaluate potential disease control strategies that can be implemented to decrease the impact of an outbreak or to eradicate the virus from an area. Spatial analysis, a study of the distributions of events in space, can be applied to an area to investigate the spread of animal disease. Hypothetical FMD outbreaks can be spatially analyzed to evaluate the effect of the event under different control strategies. The main objective of this paper is to review FMD-related articles on FMD epidemiology, epidemiological simulation modeling and spatial analysis with the focus on disease control. This review will contribute to the development of models used to simulate FMD outbreaks under various control strategies, and to the application of spatial analysis to assess the outcome of FMD spread and its control.

Factors associated with spatial clustering of foot-and-mouth disease in Nepal.

The purpose of this study was to quantify associations between hypothesized epidemiological factors and the spatial distribution of foot-and-mouth disease (FMD) in Nepal. Spatial clustering of reports of at least one FMD case by Village Development Committee (VDC) in 2004 was examined by use of the spatial scan statistic. A Bayesian Poisson multivariate regression model was used to quantify the association between the number of reports and 25 factors hypothesized to be associated with FMD risk. The spatial scan statistic identified (P < 0.01) two clusters of FMD reports. Large numbers of people, buffalo, and animal technicians in a district were associated with an elevated risk of a VDC reporting >or=1 FMD case. The knowledge of high-risk areas and factors associated with the risk of FMD in Nepal could be applied in future disease control programs.

Patterns, risk factors and characteristics of reported and perceived foot-and-mouth disease (FMD) in Uganda.

Patterns of outbreaks of foot-and-mouth disease (FMD) in Uganda were elucidated from spatial and temporal retrospective data retrieved from monthly reports from District Veterinary Officers (DVOs) to the central administration for the years spanning 2001-2008. An assessment of perceived FMD occurrence, risk factors and the associated characteristics was made based on semi-structured questionnaires administered to the DVOs. During this period, a total of 311 FMD outbreaks were reported in 56 (70%) out of Uganda's 80 districts. The number of reported FMD outbreaks changed over time and by geographical regions. Occurrence of FMD was significantly associated with the dry season months (p = 0.0346), the time when animals movements are more frequent. The average number of FMD outbreaks was higher for some sub-counties adjacent to national parks than for other sub-counties, whilst proximity to international border only seemed to play a role at the southern border. DVOs believed that the major risk factor for FMD outbreaks was animal movements (odds ratio OR 50.8, confidence interval CI 17.8-144.6) and that most outbreaks were caused by introduction of sick animals.

Incidence and distribution of foot-and-mouth disease in Asia, Africa and South America; combining expert opinion, official disease information and livestock populations to assist risk assessment.

Risk assessment procedures frequently require quantitative data on the prevalence of the disease in question. Although most countries are members of the World Organization for Animal Health (OIE), the importance attached to foot-and-mouth disease (FMD) reporting or surveillance for infection varies enormously between infected countries. There is a general consensus that FMD outbreaks in endemic countries are greatly under-reported, to a degree related either to the economic or the political development level of the country. This exploratory study was first undertaken by FAO, but thereafter extended and reviewed by the working group on FMD risk co-ordinated by the European Food Safety Authority (EFSA). The paper attempts to overcome the lack of reporting through using expert opinion to extrapolate incidence indices from countries considered to have 'representative' levels of FMD. These were combined with livestock density distributions to provide maps of prevalence indices, which were found to be highest in China (pigs), India (cattle), the Near East (small ruminants) and the Sahel (small ruminants and cattle). Similar patterns were found when weighted expert rankings of a range of additional ranked disease parameters were also produced, and then combined with susceptible animal densities to produce a weighted multi-species density. Results suggest that the methods can provide useful information at both national and sub-national resolution, even for countries for which quantitative FMD data is currently unavailable: two of the regions identified provide little or no data on a regular basis to the OIE and therefore may be overlooked if the level of officially reported FMD is only used. As the estimated prevalences are based on recent disease history and expert opinion, they are most likely to be inaccurate where FMD incursions are infrequent as a result of the preventive measures and geographical and trade isolation. This study, therefore, highlights the need for specific detailed country risk assessments where livestock trade is under consideration. Validating the approach including ground truthing, will require collaboration between a number of agencies and institutions, in critical countries, particularly those with high disease burdens that share borders or trade livestock with currently FMD-free nations.

The importance of quality assurance/quality control of diagnostics to increase the confidence in global foot-and-mouth disease control.

The last decade international trade in animals and animal products was liberated and confidence in this global trade can increase only if appropriate control measures are applied. As foot-and-mouth disease (FMD) diagnostics will play an essential role in this respect, the Food and Agriculture Organization European Commission for the Control of Foot-and-Mouth Disease (EUFMD) co-ordinates, in collaboration with the European Commission, several programmes to increase the quality of FMD diagnostics. A quality assurance (QA) system is deemed essential for laboratories involved in certifying absence of FMDV or antibodies against the virus. Therefore, laboratories are encouraged to validate their diagnostic tests fully and to install a continuous quality control (QC) monitoring system. Knowledge of performance characteristics of diagnostics is essential to interpret results correctly and to calculate sample rates in regional surveillance campaigns. Different aspects of QA/QC of classical and new FMD virological and serological diagnostics are discussed in respect to the EU FMD directive (2003/85/EC). We recommended accepting trade certificates only from laboratories participating in international proficiency testing on a regular basis.

FMD vaccines: reflections on quality aspects for applicability in European disease control policy.

Most foot-and-mouth disease (FMD) vaccines used around the world are inactivated vaccines for prophylactic or emergency use, generally manufactured by the same basic methodology outlined in the OIE Manual and, for Europe, in the European Pharmacopoeia, and for the EU Member States in compliance with Directive 2001/82/EC of the European Parliament and of the Council of 6 November 2001 on the Community code relating to veterinary medicinal products as amended by Directive 2004/28/EC. Most of the requirements that apply to all immunological veterinary medicinal products apply equally to FMD vaccines. There are, however, some unique features of the disease and vaccines used against it that require a different approach to fulfil the requirements of the relevant legislation, if a vaccinate-to-live policy will be applied with 'authorized' vaccines. Several aspects of vaccine efficacy and safety are elaborated with emphasis on quality assurance/quality control (QA/QC). The purity of the vaccine in respect of the presence of non-structural protein antibodies could be checked indirectly by serology after vaccination. The viability of a vaccine bank approach was greatly aided by the principle of storing inactivated concentrated FMD viral antigen (Ag) over liquid nitrogen for subsequent formulation into vaccine. A worldwide Ag bank network might be an option for the far future and a solution to the problem of covering many different FMDV serotypes and strains. The producers should respect the strict FMD biosecurity rules worked out by the FAO EUFMD and described in Council Directive 2003/85/EC. Making the experience related to vaccine QA/QC available to all countries will reduce the risk of an FMD outbreak within these countries and consequently will reduce the FMD risk around the world.

John Burns Brooksby CBE: 25 December 1914 - 17 December 1998.

John Brooksby was an outstanding veterinary virologist, who worked at the Animal Virus Disease Research Institute, Pirbright, for 40 years, for 16 of which he was Director of the Institute. He will be remembered for his contributions to the diagnosis of foot-and-mouth disease, for his discovery of four new types, for the classification of subtypes and for fundamental studies of the virus. As Deputy Director and Director he was responsible for programmes on fundamental investigations of foot-and-mouth disease virus and other viruses exotic to the UK and for the application of the results both in the UK and worldwide. His advice on the distribution and the control of foot-and-mouth disease was sought by international organizations and by individual countries and was responsible for reducing the risk of spread of disease.

Comparisons of original laboratory results and retrospective analysis by real-time reverse transcriptase-PCR of virological samples collected from confirmed cases of foot-and-mouth disease in the UK in 2001.

There were 2030 designated cases of foot-and-mouth disease (FMD) during the course of the epidemic in the UK in 2001 (including four from Northern Ireland). Samples from 1720 of the infected premises (IPs) were received in the laboratory and examined for either the presence of FMD virus (virological samples from 1421 IPs) or both FMD virus and antibody (virological and serological samples from 255 IPs) or antibody alone (from 44 IPs). The time taken to issue final diagnostic results ranged from a few hours in cases in which positive results were obtained by ELISA on epithelia containing sufficient virus to be detected, to several days for samples containing small amounts of virus requiring amplification through cell culture, negative samples or samples tested for antibody. Two subsets of samples were analysed retrospectively by real-time reverse transcriptase-PCR (RT-PCR); first, epithelia that were negative by both ELISA and virus isolation (VI) in cell culture, and secondly, samples that were negative by ELISA on epithelial suspension but positive by VI. There was broad agreement between the RT-PCR and VI/ELISA combined, except that the RT-PCR procedure did not detect a group of related virus isolates from Wales. These viruses had evidently evolved during the epidemic and had a nucleotide substitution in the RT-PCR probe site, which prevented them from being detected by the routine diagnostic probe. No evidence of FMD virus, antibody or nucleic acid was found in approximately 23 per cent (390 of 1730) of IPs from which samples were received, suggesting that the incidence of FMD during the outbreak may have been over-reported.

Spatial statistical modeling of disease outbreaks with particular reference to the UK foot and mouth disease (FMD) epidemic of 2001.

In this paper we examine issues relating to the analysis of spatially-referenced disease data. Initially, we discuss the use of exploratory statistical tools such as density estimation and nonparametric regression. We then consider the need for descriptive epidemic models in space, time, and space-time models for epidemic dynamics. Implicitly space-time must be considered in any analysis of the spatial structure of epidemics. The use of Bayesian models for disease spread is discussed and applied to the recent foot and mouth outbreak in the UK.

Use of the scan statistic on disaggregated province-based data: foot-and-mouth disease in Iran.

The spatial scan statistic was applied to density-smoothed data that approximated the spatial distribution within the area and reduced the potential bias produced when location data have been aggregated for large areas. The method is illustrated, using data on the location of foot-and-mouth disease (FMD) outbreaks in Iran. Data examined were 4477 FMD outbreaks reported on a per province basis between June 1996 and September 2003. A kernel density of the outbreak locations was estimated, using a fixed radius and the centroid of each province as the designated location of all cases reported for the province. The radius that produced a density map with the highest correlation with expert opinion was 4 degrees (latitude/longitude). Livestock density was used as a proxy for the underlying population at risk of acquiring FMD. Livestock and outbreak density maps were overlain to obtain the number of outbreaks and livestock in each of 15,599 cells covering the mapped surface of the country. A spatial scan statistic was applied to the density-smoothed data assuming that the outbreaks had a Poisson distribution. Results were compared with those obtained using a spatial scan statistic on provincially aggregated data. Application of the spatial scan statistic on the density-smoothed data allowed identification of clusters (P<0.01) related more to the actual geographic distribution of cases (expert opinion) and of animals at risk, than to the distribution of the provinces. Significant clusters of FMD were identified that coincided with roads, neighboring countries, and high-density population areas, suggesting that the region may represent a route for cross-continent transmission of FMD.

A survey to investigate movements off sheep and cattle farms in New Zealand, with reference to the potential transmission of foot-and-mouth disease.

AIM: To quantify the numbers and extent of movements off sheep and cattle farms in New Zealand, in order to construct more realistic simulation models to investigate how infectious diseases such as foot-and-mouth disease (FMD) might spread. METHODS: Farmers from 500 randomly selected farms, comprising 100 from each of the following sectors, viz beef, dairy, grazing/dairy heifer rearing, sheep, and mixed sheep and beef, were asked to fill in diaries in which they recorded the movements of all animals, products, people, vehicles and equipment coming on to or leaving their farms during two separate 3-week periods, representing relatively 'busy' and 'quiet' times of the year with respect to livestock movements. Where possible, the destination of each movement was identified and geo-coded, to allow the distance travelled to be calculated. Each movement was then classified according to the risk of transfer of FMD virus (FMDV), should the disease have been present on the study farm at the time of the movement. The data were then analysed to establish movement frequencies and distributions of distances travelled, by the different pastoral livestock sectors. RESULTS: Two hundred and seventeen farmers returned one or more diaries. One hundred and ninety-three farmers completed a Busy-period diary, recording a total of 12,052 movements off their farms, a crude average of 62.4 per 3-week period, or 2.97 per day. Of these, 4.0% involved the transport of livestock, equating to 0.12 livestock consignments per day. In contrast, 186 Quiet-period diaries were returned, recording a total of 10,885 movements off, representing a crude average of 58.5 during the 3-week period, or 2.78 per day. Of these, 2.1% involved livestock, equating to 0.06 livestock consignments per day. The mean and median distances travelled during the Busy periods were 30.9 km and 13.1 km, respectively (range 0-1,167 km). In comparison, the mean and median distances travelled during Quiet periods were 41.3 and 14 km, respectively (range 0.4-1,203 km). CONCLUSIONS: People, vehicles, livestock and other items can travel off pastoral livestock farms in New Zealand to other farms either directly or via saleyards over extensive distances. This has implications for the potential spread of infectious diseases such as FMD. Movement parameters intended for use in the InterSpread Plus inter-farm simulation model of FMD were established, which will facilitate the prediction of likely spread and efficacy of controls in the unlikely event of a real-life outbreak.