Foot-and-mouth disease: the question of implementing vaccinal control during an epidemic.

The question of whether or not to use vaccines during an epidemic of foot-and-mouth disease (FMD) has interested veterinary administrators for many decades. This review assesses the historical uses, successes and failures of vaccinal control, and addresses the questions of where, how, and when to use vaccination against FMD. Approaching the problem in this manner can aid in identifying which tools are likely to be most effective during an epidemic, and how successful a given contingency plan might be. The infection status (endemic, semi-endemic, disease-free) of a region has historically mapped where global vaccination has been implemented according to the generality: endemic>semi-endemic>disease-free. More specifically, biomodels and cost-benefit analyses can indicate when vaccination should be implemented for optimal disease control. Finally, numerous local epidemiological factors will provide useful insights into how vaccinal controls can be used effectively.

Predictions for the timing and use of culling or vaccination during a foot-and-mouth disease epidemic.

First-fortnight incidence (FFI) is a modelling parameter that can be used to predict both the prevalence and duration of a foot-and-mouth disease (FMD) epidemic at regional and national levels. With an indication of how long an epidemic may last by the end of week two, it becomes possible to estimate whether vaccination would be economically viable from the start of an epidemic. Where FFI indicates that an epidemic is unlikely to last for as long as an export ban on agricultural produce, it may be inappropriate to implement a policy of 'vaccination to live'. Alternatively where FFI indicates that an epidemic will equal or exceed the ban length, then the benefits of vaccination should be considered at an early stage, during or after the first fortnight. Since blanket vaccination of the national or regional herds and flocks would be both costly and heighten the risk of producing carrier animals, targetting vaccination through risk assessment becomes useful.

A review of foot-and-mouth disease with special consideration for the clinical and epidemiological factors relevant to predictive modelling of the disease.

Modelling the epidemiology of foot-and-mouth disease (FMD) has been undertaken since the early 1970s. We review here clinical factors and modelling procedures that have been used in the past, differentiating between those that have proved to be more relevant in controlling FMD epidemics, and those that have showed less significance. During the 2001 UK FMD epidemic, many previously developed FMD models were available for consideration and use. Accurate epidemiological models can become useful tools for determining relevant control policies for different scenarios and, conversely, inaccurate models may become an abuse for disease control. Inaccuracy presents two opposing difficulties. Firstly, too much control (in terms of animal slaughter for 2001) would negatively impact the farming community for many subsequent years, whilst too little control would permit an epidemic to persist. Accuracy however, presents the optimal permutation of control measures that could be implemented for a given set of conditions, and is a prerequisite to boosting public confidence in the use of epidemiological models for future epidemics.

The role of management segregations in controlling intra-herd foot-and-mouth disease.

Transmission of foot-and-mouth disease virus (FMDV) by aerosol spread can occur over considerable distances. However, this is less effective in hot, dry environmental conditions, and a detailed study of an outbreak within a large dairy herd in Saudi Arabia has shown that contact spread is the main mode of transmission within a herd: both physical and spatial barriers curtailed the course of disease across the farm. Hence, the speed and path of an outbreak can be altered by changing the positioning of spatial or physical barriers. Extending the distances between pens, increasing the number of farm pens, decreasing the number of animals within the pens, and placing pens of well-protected stock between those of susceptible stock, can all contribute to the control of FMD involving contact and short-distance aerosol spread. Such management techniques offer a cost-effective supplement to control by vaccination.

Predicting the level of herd infection for outbreaks of foot-and-mouth disease in vaccinated herds.

Foot-and-mouth disease (FMD) is a highly contagious virus infection of sheep, goats, cattle, pigs and other, non-domesticated species of artiodactyls, and causes both clinical and subclinical infection according to the natural or acquired immunity of the host. Within vaccinated dairy herds FMD may appear as an acute, mild or subclinical infection, dependent upon the immune status of the herd, the level of challenge and the efficacy of the vaccine used. In the large dairy herds of Saudi Arabia, sub-clinical FMD was on a number of occasions, found to have spread amongst the cattle before signs of disease were seen. Such undetected transmission resulted in a large incidence on the first day of diagnosis and curtailed the impact of post-outbreak vaccination (PoV). First day incidence (FDI) for these herds was found to correlate with the final cumulative incidence of clinical disease. Since FDI is available at the start of an outbreak it can be used as a predictive tool for the eventual outcome of an FMD outbreak. During the past 11 years 47 % of dairy herds examined in Saudi Arabia have experienced FMD initially as sub-clinical disease. For the remaining 53 %, waning vaccinal protection did not suppress clinical disease in the initially infected animals, and these showed severe rather than mild signs. Hence, in such herds there was a very low initial level of subclinical infection, so PoV was more effective, and the timing of PoV was found to give a good correlation with cumulative herd incidence: an early PoV resulted in low prevalence of clinically infected animals whilst late PoV permitted high prevalence. PoV timing can thereby be used in tandem with FDI as a predictive tool for future outbreaks, estimating the final cumulative incidence (or prevalence) of clinical FMD cases.

Control of foot-and-mouth disease through vaccination and the isolation of infected animals.

Foot-and-mouth disease (FMD) within Saudi Arabian dairy herds has been controlled for the past decade through vaccination. Data from 19 outbreaks on Saudi farms has suggested that the durability of these vaccines extended for 2.5 months, providing an 81-98% level of protection. Vaccination has nevertheless failed to prevent the establishment and sometimes persistence of the disease. This is probably because the highly contagious nature of FMD creates increasing levels of viral excretion during an outbreak, and the co-habitation in Saudi farms of affected/susceptible animals following diagnosis, predisposes the herds to re-infection. Pre-clinical excretion of the virus leads to the infection of additional in-contact susceptible animals prior to diagnosis, so the isolation of clinically infected animals does not guarantee a removal of infection. Saudi Arabian farms are subdivided into managed farm pens and isolation (away from the farm) of all animals in infected pens not only removes the infectious individuals showing clinical signs, but also those that are sub-clinical and excreting virus. Simulations suggest that removing all infectious animals from the herd significantly reduces the per cent infected in the herd.