An economic case study of the control of dog-mediated rabies by an animal welfare organisation in Jaipur, India.

A global strategic plan for the elimination of dog-mediated human rabies deaths by 2030 was announced in 2018. The cost-effectiveness of annual mass dog vaccination programmes, as a control and elimination method, has been advocated on many occasions. Complementary methods, such as animal birth control (ABC) activities, have received less attention. This paper provides a case-study of a programme operated by Help in Suffering (HIS) in Jaipur, India from 1994/95 until 2016/17 comprising both ABC and additional vaccination-only activities. The availability of cost data alongside information on dog numbers, dog bites and human rabies cases provided an exceptionally detailed and unique retrospective dataset recording actual events and expenditures. Updated to 2016/17 prices, the total cost of the programme was 658,744 USD. Since 2007/2008, activity costs have been separated and returned costs of 10.78 USD per dog, both sterilised and vaccinated, and 1.86 USD per dog, vaccinated only. Over the course of the programme, the number of disability-adjusted life years (DALYs) due to premature death and the distress associated with dog bites was estimated to be 36,246 fewer than would have been expected if HIS had not been operating, based on a counterfactual scenario using pre-intervention values. Linking the DALY figure to the cost of the activities undertaken by HIS yields a cost of 26 USD per DALY averted. Discounted at 3%, the DALYs averted equate to 16,587 at a cost of 40 USD per DALY averted. Both cases make it a very cost-effective intervention, in relation to the threshold of investing one year's gross domestic product (GDP) per DALY averted (1981 USD in 2016/17). The monetary benefit from fewer dog bites and clinical human rabies cases requiring treatment amounted to 5.62 million USD after discounting, which, if attributed to Help in Suffering, yields a monetary benefit-cost ratio of 8.5. Thus, the potential monetary benefits greatly outweigh the programme costs, even without considering the DALYs averted. If a modest notional monetary value of one year's GDP is assigned to represent the human capital or production value of DALYs averted, the discounted societal economic benefit reaches 38.48 million USD and implies a benefit-cost ratio of 58.4. These economic analyses demonstrate that ABC activities in combination with additional vaccination efforts can be a cost-effective control measure for dog-mediated human rabies.

Characterising and comparing animal-health services in the Rift Valley, Kenya: an exploratory analysis (part I).

Livestock are of vital importance to the livelihoods of millions of people across the world, playing a pivotal role in income generation, employment, food security, transport and social cohesion. Access to quality animal-health services by livestock owners is critical to sustainable food-animal production; therefore, animal-health practitioners represent key stakeholders within the world food system. A mixed-method study was conducted in the Rift Valley of Kenya to characterise and compare existing private animal-health services and to explore perceptions of veterinary services amongst pastoralists and farmers. Forty structured questionnaires were administered to staff at animal-health outlets, including franchise outlets of 'Sidai Africa Ltd.', and two focus group discussions were facilitated to explore the perceptions of a Maasai pastoralist group and members of a dairy-farmer cooperative of their local animal-health services. Results were analysed using descriptive methods and the confidence interval overlap technique. Differences were detected in the characteristics of Sidai outlets, agrovets (agricultural retailers), pharmacies and dukas (general shops). Sidai outlets offered a more professional and diverse portfolio of livestock services. Across all outlet types, staff knowledge and training gaps and a shortage of cold-chain facilities were identified. Farmers have strong preferences for certain products, which may foster the development of drug resistance. There is a disconnection between the sale of veterinary medicines and the provision of quality advice, with many agrovets, pharmacies and dukas selling veterinary medicines but lacking the capacity to provide clinical services. There is a clear demand from livestock keepers for accessible, affordable and quality animal-health services and products in Kenya; therefore, animal-health practitioners have the potential to provide increased support to livestock-based livelihoods.

Characterising and comparing drug-dispensing practices at animal health outlets in the Rift Valley, Kenya: an exploratory analysis (part II).

A mixed-method study was conducted in the Rift Valley of Kenya to characterise drug-dispensing practices amongst staff at animal health outlets and to explore perceptions of veterinary medicines amongst pastoralists and farmers. Forty structured questionnaires were administered to staff at animal health outlets, including franchise outlets of 'Sidai Africa Ltd.', and two focus group discussions were facilitated to explore the perceptions of local animal health services by a Maasai pastoralist group and a dairy farmer cooperative. Differences were detected in the characteristics of Sidai outlets, agrovets, pharmacies and dukas. A greater proportion of Sidai outlet staff selected drugs based on principles of responsible drug use than staff at other types of outlet, and technical qualifications and training were associated with responsible drug use. Across all outlet types, staff knowledge and training gaps were identified, including in the correct administration of medicines. The majority of drug sales are accompanied by verbal advice to farmers. Members of the Maasai pastoralist group were concerned about accidental self-medication, withdrawal periods, drug residues and the misuse of drugs due to a lack of quality information and advice. The dairy farmer group raised similar concerns, reporting under-dosing as a common mistake amongst farmers. This study concludes that current knowledge, attitudes and practices of many service providers and livestock owners in the sale, purchase and use of veterinary medicines present risks of drug misuse and therefore the emergence of antimicrobial resistance. There is a clear demand from livestock keepers for accessible, affordable and quality animal health services and products in Kenya, and animal health practitioners have the potential to provide increased support to livestock-based livelihoods and act as stewards of our existing portfolio of animal and human medicines.

Destructive tension: mathematics versus experience--the progress and control of the 2001 foot and mouth disease epidemic in Great Britain.

The 2001 foot and mouth disease epidemic in Great Britain was characterised by control using both traditional and novel methods, some resulting from conclusions of mathematical models. Seven days before the implementation of the novel controversial automatic pre-emptive culling of all susceptible livestock on premises adjacent to infected premises (the 'contiguous cull'), the spread of infection had already been controlled by a combination of the traditional stamping out policy with a national movement ban on livestock. A second controversial novel policy requiring the slaughter of sheep within 3 km of premises on which disease had been confirmed (the 3-km cull) also commenced after the peak of infection spread, was untargeted and took several weeks to complete; serosurveillance of culled sheep detected infection in only one flock, suggesting that cryptic infection of sheep was not propagating the epidemic. Extensive post-epidemic serological surveillance of sheep found only a small number of seropositive animals in a very few flocks, suggesting that foot and mouth disease may self-limit in extensive sheep populations. The epidemic was finally brought to an end following the introduction of enhanced agricultural movement restrictions and biosecurity measures. A welfare culling scheme of unaffected animals was required to support the prolonged national livestock movement ban. The models that supported the contiguous culling policy were severely flawed, being based on data from dissimilar epidemics; used inaccurate background population data, and contained highly improbable biological assumptions about the temporal and quantitative parameters of infection and virus emission in infected herds and flocks.

Ageing in animal populations--an epidemiological perspective.

Major goals of epidemiology are estimation of disease morbidity and mortality and identification and quantification of the impact of risk factors. Age is a recognized risk factor, contributing to the occurrence of multifactorial diseases. Cohort, case-control and cross-sectional observational studies identify age and other putative risk factors and quantify their impact on disease occurrence by estimating relative risks and odds ratios. Ageing per se is not a key concern of epidemiologists, and detailed biological explanations of causal mechanisms may not be offered by the epidemiologist. Nevertheless, the relationships identified in epidemiological studies can offer practical solutions to disease prevention. Age also can confound relationships between disease and other putative risk factors and must be controlled during epidemiological study design and analysis, in order to avoid spurious causal inferences. Additionally, age can modify the effect of other risk factors, necessitating identification of such interactions and the differentiation of effect modifiers from confounders. Comparative epidemiology frequently compares human and animal populations. Meaningful comparisons can only be made by undertaking life span adjustment and age adjustment on animal study data, to address differences between the two populations stemming from different 'biological ages' and age structures, respectively.

Use and abuse of mathematical models: an illustration from the 2001 foot and mouth disease epidemic in the United Kingdom.

Foot and mouth disease (FMD) is a major threat, not only to countries whose economies rely on agricultural exports, but also to industrialised countries that maintain a healthy domestic livestock industry by eliminating major infectious diseases from their livestock populations. Traditional methods of controlling diseases such as FMD require the rapid detection and slaughter of infected animals, and any susceptible animals with which they may have been in contact, either directly or indirectly. During the 2001 epidemic of FMD in the United Kingdom (UK), this approach was supplemented by a culling policy driven by unvalidated predictive models. The epidemic and its control resulted in the death of approximately ten million animals, public disgust with the magnitude of the slaughter, and political resolve to adopt alternative options, notably including vaccination, to control any future epidemics. The UK experience provides a salutary warning of how models can be abused in the interests of scientific opportunism.

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.

Randomised, controlled field trial of two new techniques for the castration and tail docking of lambs less than two days of age.

Two methods to reduce the pain associated with the castration and tail docking of lambs with rubber rings were tested by 10 shepherds, each using 60 housed lambs. In 20 of the lambs the innervation to the scrotum, testes and tail was crushed with a 'Big Nipper' bloodless castrator, and in 20 local anaesthetic (2 per cent lignocaine with adrenaline) was injected with a newly developed high-pressure jet injector under the rubber rings after they had been applied; 10 lambs were given a placebo treatment and 10 were treated by the shepherds' routine elastrator ring procedure. Both new methods significantly decreased the incidence of limb and tail movement by 78 per cent and the time spent by the lambs in abnormal postures, when compared with either the shepherds' routine treatment or the placebo treatment. An experienced observer and most of the shepherds also assessed that the lambs suffered signficantly less pain when treated by the two new methods than when they were treated with rubber rings alone. No detrimental long-term effects of the two new methods were observed. On average the new methods took 68 seconds to apply, compared with 29 seconds for the rubber rings; of the two new methods most shepherds preferred using the pressure jet injector.

Response of pheasants to live attenuated turkey rhinotracheitis vaccine.

The entire crop of 18,120 pheasants for the 2000 rearing season (May 8 to August 7) of one estate in the south of England was vaccinated at one day and five weeks of age with a turkey rhinotracheitis (TRT) vaccine. Blood samples and oropharyngeal swabs were taken from the second week's hatching every three weeks throughout the growing season to assess the response of the birds. There was evidence of seroconversion in samples collected three weeks after vaccination, with positive titres being maintained in 33 per cent or more of the population up to at least 22 weeks of age. Positive titres were also recorded in samples taken on December 6 from shot birds between 22 and 30 weeks of age. Positive titres to infectious bronchitis virus (IBV) were identified in a high proportion of the poults as early as one day of age. Reverse-transcriptase PCR detected IBV-like virus and TRT of the same subtype as the TRT vaccine administered three weeks previously.

'Battered pets': sexual abuse.

A study of non-accidental injury in small animals in the UK, based on responses from a random sample of small animal practitioners, identified 6 per cent of the 448 reported cases as being sexual in nature. Twenty-one cases occurred in dogs, five in cats and two in unspecified species. Reasons for suspecting sexual abuse were: the type of injury; behaviour of the owner; statements from witnesses; and admission by the perpetrator. Types of injury included vaginal and anorectal penetrative (penile and non-penile) injury, perianal damage, and trauma to the genitals. Some injuries (such as castration) were extreme, and some were fatal. In contrast, other cases revealed no obvious damage. The type and severity of injuries were similar to those described in texts on child abuse and human forensic pathology.

'Battered pets': Munchausen syndrome by proxy (factitious illness by proxy).

Nine cases of suspected Munchausen syndrome by proxy (MSBP), involving pets as proxies, were identified among 448 cases of non-accidental injury to small animals. These cases, recorded by a random sample of small animal practitioners in the UK, demonstrated several combinations of features, including attention-seeking behaviour by the owner, real and apparently factitious clinical signs, deliberate injury, markedly abnormal biochemical profiles, serial incidents, interference with surgical sites, recovery after separation from the owner, and 'veterinarian-shopping' by the owner. All of these features are consistent with those identified in the well documented MSBP in which children are the victims. Furthermore, one of the cases involved serial attempts at poisoning other animals and a child.

'Battered pets': non-accidental physical injuries found in dogs and cats.

Records of 243 cases of non-accidental injury (NAI) in dogs, and 182 cases in cats, submitted by a sample of small animal practitioners in the UK, revealed a wide range of injuries. These included bruises, fractures, repetitive injuries, burns and scalds, stab and incised wounds, poisoning, asphyxiation and drowning (which showed remarkable similarities to NAI in children), as well as sexual abuse and injuries specifically caused by firearms. Traumatic skeletal injuries in the dogs were more commonly found in the anterior part of the skeleton, in comparison with those resulting from road traffic accidents. Young male dogs and young cats were particularly at risk of NAI. A moderately increased risk was identified in the Staffordshire bull terrier, cross-breed dogs and the domestic shorthaired cat, whereas the Labrador retriever showed a decreased risk. No single injury or group of injuries, when divorced from the circumstances surrounding a suspect case, could be considered to indicate, conclusively, NAI. Repetitive injuries, however, were highly suggestive of NAI.

'Battered pets': features that raise suspicion of non-accidental injury.

A study of veterinarians' perceptions, and experience, of non-accidental injury (NAI) to pets was undertaken using an anonymous questionnaire distributed to a random sample of 1000 small animal practitioners in the UK. NAI was acknowledged by 91.3 per cent (95 per cent confidence interval, 88.2 to 93.9 per cent) of the 404 respondents who returned questionnaires, of whom 48.3 per cent (95 per cent confidence interval, 43.4 to 53.1 per cent) had either suspected or seen NAI. Four hundred and forty-eight cases were documented, predominantly in dogs (243) and cats (182). Factors either raising suspicion, or facilitating recognition, of NAI included: implication of a particular person, features of the history, referral agency involvement, behaviour of the owner and/or the animal, nature of the injuries, and socioeconomic class of owners. Additionally, sexual abuse and suspected cases of Munchausen syndrome by proxy were recorded.

The occurrence of Trypanosoma evansi in buffaloes in Indonesia, estimated using various diagnostic tests.

The prevalence and incidence of Trypanosoma evansi infections in village buffaloes in Central Java were estimated using parasitological tests, two antigen-detection ELISAs (2G6 Ag-ELISA and Tr7 Ag-ELISA), an antibody-detection ELISA (IgG ELISA) and a card agglutination test (CATT). Of 2387 village buffaloes tested in five districts, 4 % (95 % confidence interval [CI]: 3 %, 5 %) were positive with the microhaematocrit test (MHCT), 58 % (95 % CI: 56 %, 60 %) were positive with the 2G6 Ag-ELISA and 70 % (95 % CI: 68 %, 72 %) were positive with the Tr7 Ag-ELISA. An increasing prevalence with age was found and the proportion of positive buffaloes was highest in the over 84 months-old age-group (68 %) with the 2G6 Ag-ELISA and in the 37-60 months-old age-group (78 %) with the Tr7 Ag-ELISA. Parasitaemic buffaloes were found in more than half of the villages visited. Corrected village-specific prevalence values obtained with the two Ag-ELISAs ranged from 0% to over 100%, and prevalence differed significantly (P < or = 0.0001) between villages in four of the five districts. Overall, 10% of buffaloes tested in markets were found to be parasitaemic and 39, 56 and 47 % were found positive with the 2G6 Ag-ELISA, IgG ELISA and CATT, respectively. Incidence rates varied according to the test used and ranged from 0.22 (95 % CI: 0.09, 0.44) to 0.44 (95 % CI: 0.24, 0.76), per animal-year at risk, in two villages. The results highlight the importance of using validated diagnostic tests to obtain accurate estimates of prevalence and incidence. These parameters are needed, for example in mathematical models, for the development and evaluation of different control strategies for T. evansi infections in buffaloes.

Evaluation of antigen detection and antibody detection tests for Trypanosoma evansi infections of buffaloes in Indonesia.

Two Ag-ELISAs, an IgG-specific antibody detection ELISA (IgG ELISA) and a card agglutination test (CATT) for the detection of Trypanasoma evansi infections in buffaloes in Indonesia, were compared. Diagnostic sensitivity estimates were obtained by testing sera from 139 Indonesian buffaloes which had been found to be infected by parasitological tests. Diagnostic specificity was estimated by testing sera from 263 buffaloes living in Australia. Response-operating characteristic curves were constructed, and optimal ELISA cut-off values, which minimized the number of false-negative and false-positive results, were chosen. The IgG ELISA had the highest sensitivity (89%) and the CATT had the highest specificity (100%). There was a significant difference between the sensitivities (71 and 81%), but not between the specificities (75 and 78%), of the two Ag-ELISAs. The four tests were further compared by calculation of post-test probabilities of infection for positive and negative test results using a range of prevalence values, and likelihood ratios. The results suggested that the CATT was the best test to 'rule-in' infection (i.e. the highest probability of infection in test-positive animals) and the IgG ELISA was the best test to 'rule-out' infection (i.e. the lowest probability of infection in test-negative animals).

Associations between age, parity, hormonal therapy and breed, and pyometra in Finnish dogs.

A case-control study of 953 dogs with pyometra and 10,660 unmatched control dogs was used to investigate the relationships between age, parity, hormonal therapy and breed, and pyometra in Finnish dogs. Cases were reported in animals between nine months and 18 years of age, with a median age at diagnosis of nine years. Nulliparous bitches had a moderately higher risk of developing pyometra than primiparous and multiparous animals (adjusted odds ratio point estimate, 6.63). The administration of oestrogen increased the risk of pyometra in bitches up to four years of age (odds ratio point estimate > 6). No significant risk-enhancing effect of progestin treatment was detected and it is unlikely that such a risk, if present, is high (likelihood of the odds ratio exceeding 2 < 0.18). Seventeen breeds had an increased risk, and the wire-haired dachshund and mongrels had a decreased risk of developing the condition.

Acquired urinary incontinence in bitches: its incidence and relationship to neutering practices.

A five-year cohort study was conducted on bitches chosen by a sample of 233 randomly selected practising veterinary surgeons in the UK, to estimate the incidence of acquired urinary incontinence (AUI) in neutered and entire animals, and to investigate possible risk factors associated with neutering practices. Information was collected using questionnaires, and data on 809 bitches, of which 22 developed AUI, were obtained. The estimated incidence rates in neutered and entire animals were 0.0174 and 0.0022 per animal-year, respectively (95 per cent confidence intervals: 0.0110, 0.0275 and 0.0009, 0.0058, respectively). The relative risk, neutered vs entire, was 7.8 (95 per cent confidence interval: 2.6, 31.5). The attributable proportion(exposed) and population attributable proportion were 87.1 per cent and 63.1 per cent (95 per cent confidence intervals: 61.9 per cent, 95.6 per cent, and 28.3 percent, 88.5 per cent, respectively). An increased risk, significant at the conventional 5 per cent level, was not demonstrated in animals neutered before, vs after, first heat (relative risk: 3.9, 95 per cent confidence interval: 0.8, 10.4), although the result was significant at the 10 per cent level. Removal of the cervix was not shown to be a risk factor in neutered dogs.