A review of risk factors for bovine tuberculosis infection in cattle in the UK and Ireland.

Bovine tuberculosis (bTB) is an important disease of cattle caused by infection with Mycobacterium bovis, a pathogen that may be extremely difficult to eradicate in the presence of a true wildlife reservoir. Our objective was to identify and review relevant literature and provide a succinct summary of current knowledge of risk factors for transmission of infection of cattle. Search strings were developed to identify publications from electronic databases to February 2015. Abstracts of 4255 papers identified were reviewed by three reviewers to determine whether the entire article was likely to contain relevant information. Risk factors could be broadly grouped as follows: animal (including nutrition and genetics), herd (including bTB and testing history), environment, wildlife and social factors. Many risk factors are inter-related and study designs often do not enable differentiation between cause and consequence of infection. Despite differences in study design and location, some risk factors are consistently identified, e.g. herd size, bTB history, presence of infected wildlife, whereas the evidence for others is less consistent and coherent, e.g. nutrition, local cattle movements. We have identified knowledge gaps where further research may result in an improved understanding of bTB transmission dynamics. The application of targeted, multifactorial disease control regimens that address a range of risk factors simultaneously is likely to be a key to effective, evidence-informed control strategies.

Long-term temporal trends and estimated transmission rates for Mycobacterium bovis infection in an undisturbed high-density badger (Meles meles) population.

We describe epidemiological trends in Mycobacterium bovis infection in an undisturbed wild badger (Meles meles) population. Data were derived from the capture, clinical sampling and serological testing of 1803 badgers over 9945 capture events spanning 24 years. Incidence and prevalence increased over time, exhibiting no simple relationship with host density. Potential explanations are presented for a marked increase in the frequency of positive serological test results. Transmission rates (R0) estimated from empirical data were consistent with modelled estimates and robust to changes in test sensitivity and the spatial extent of the population at risk. The risk of a positive culture or serological test result increased with badger age, and varied seasonally. Evidence consistent with progressive disease was found in cubs. This study demonstrates the value of long-term data and the repeated application of imperfect diagnostic tests as indices of infection to reveal epidemiological trends in M. bovis infection in badgers.

Cattle movements and bovine tuberculosis in Great Britain.

For 20 years, bovine tuberculosis (BTB) has been spreading in Great Britain (England, Wales and Scotland) and is now endemic in the southwest and parts of central England and in southwest Wales, and occurs sporadically elsewhere. Although its transmission pathways remain poorly understood, the disease's distribution was previously modelled statistically by using environmental variables and measures of their seasonality. Movements of infected animals have long been considered a critical factor in the spread of livestock diseases, as reflected in strict import/export regulations, the extensive movement restrictions imposed during the 2001 foot-and-mouth disease outbreak, the tracing procedures after a new case of BTB has been confirmed and the Government's recently published strategic framework for the sustainable control on BTB. Since January 2001 it has been mandatory for stock-keepers in Great Britain to notify the British Cattle Movement Service of all cattle births, movements and deaths. Here we show that movements as recorded in the Cattle Tracing System data archive, and particularly those from areas where BTB is reported, consistently outperform environmental, topographic and other anthropogenic variables as the main predictor of disease occurrence. Simulation distribution models for 2002 and 2003, incorporating all predictor categories, are presented and used to project distributions for 2004 and 2005.

Evidence of genetic resistance of cattle to infection with Mycobacterium bovis.

Anecdotal evidence points to genetic variation in resistance of cattle to infection with Mycobacterium bovis, the causative agent of bovine tuberculosis (BTB), and published experimental evidence in deer and cattle suggests significant genetic variation in resistance and reactivity to diagnostic tests. However, such genetic variation has not been properly quantified in the United Kingdom dairy cattle population; it is possible that it exists and may be a factor influencing the occurrence of BTB. Using models based on the outcome of the process of diagnosis (ultimate fate models) and on the outcome of a single stage of diagnosis (continuation ratio models, herd test-date models), this study shows that there is heritable variation in individual cow susceptibility to BTB, and that selection for milk yield is unlikely to have contributed to the current epidemic. Results demonstrate that genetics could play an important role in controlling BTB by reducing both the incidence and the severity of herd breakdowns.

Outbreak of tuberculosis caused by Mycobacterium bovis in golden Guernsey goats in Great Britain.

An outbreak of caprine tuberculosis caused by Mycobacterium bovis was disclosed in June 2008, affecting goats of the golden Guernsey breed kept on 10 separate smallholdings in south-west Wales and the west of England. Following the initial diagnosis at postmortem examination, 30 goats that reacted positively to the single intradermal comparative cervical tuberculin (SICCT) test, together with five in-contact animals, were euthanased and subjected to postmortem examination and mycobacterial culture. Spoligotyping and variable number tandem repeat analysis of isolates showed that they were all of the same genotype, endemic to south-west Wales. Retrospective movement tracings identified a goat herd in south-west Wales, by then completely dispersed, as the probable common source of infection. There was a perfect correlation between the SICCT test and culture results in all slaughtered goats. Grossly visible tubercular lesions were observed at postmortem examination in all but one reactor.

Trace micro-nutrients may affect susceptibility to bovine tuberculosis in cattle.

Bovine tuberculosis (bTB) is a continuing problem in British herds. Micro-nutrients are important for the maintenance of well-functioning immune system. The aim of this study was to determine whether the selenium, copper and vitamin B12 status of cattle was associated with Mycobacterium bovis (M. bovis) infection. Between 2002 and 2005, 200 cattle (43% dairy, mean age 4.6 years), reactors according to the standard interpretation of the tuberculin test, and 200 in-contacts (41% dairy, mean age 4.4 years) non-reactors, which had been in contact with cattle with bTB, were selected from herds in England and Wales. Levels of the seleno enzyme glutathione peroxidase (GSHPx), copper and vitamin B12 were measured in blood. Confirmation of bTB infection was made by bacteriological culture and histopathology following a detailed postmortem. Levels of selenium and copper were also measured in a random sample of 63 livers. bTB was confirmed by culture/histology in 23/200 (11.5%) of in-contacts and 110/200 (55%) of reactors. In blood drawn at recruitment, GSHPx was lower in cattle with confirmed bTB compared to other cattle (geometric means 59.7 u/mL versus 78.9 u/mL red blood cells (RBC), p<0.01). Vitamin B12 was similar (geometric means 161.5 pmol/L versus 165.5 pmol/L, p=0.62) and copper was similar (geometric means 14.4 micromol/L versus 14.1 micromol/L, p=0.55). In logistic regression models including all micro-nutrients simultaneously and controlling for age, sex, animal production class, herd size, number of reactors, postmortem laboratory and seasonal trends, lower levels of GSHPx (adjusted OR 0.42, 95% CI 0.21-0.81 per 100 u/mL RBC, p=0.01) and higher levels of copper (adjusted OR 1.69, 95% CI 1.21-2.36 per 5 micromol/L, p<0.01) were associated with an increased risk of confirmed bTB but there was no association with vitamin B12. There was evidence for a stronger association between confirmed bTB and GSHPx in in-contacts (adjusted OR 0.21, 95% CI 0.06-0.79 per 100 u/mL RBC) compared to reactors (adjusted OR 0.50, 95% CI 0.21-1.23 per 100 u/mL RBC) (p=0.08 for interaction). Lower liver copper was associated with a higher risk of confirmed bTB (adjusted OR 0.15, 95% CI 0.02-1.0 per 5,000 micromol/kgdry mass, p=0.05) but there was no association between liver selenium and bTB. Trace micro-nutrient status may affect susceptibility to M. bovis infection in cattle. Further studies are needed.

Pathology of naturally occurring bovine tuberculosis in England and Wales.

The aim of this study was to obtain a contemporary data set of pathology in tuberculin reactor and in-contact cattle in England and Wales. Four hundred animals (200 reactors and 200 in-contacts) from 242 farms located in 14 counties in Western England and Wales were examined. The mean number of lymph nodes (LNs) with tuberculosis (TB)-like lesions per TB-confirmed animal was 1.7 in reactors and 1.5 in in-contact animals. Tuberculous lesions in both reactor and in-contact animals were most commonly observed in the LNs of the thorax, followed by the head and abdomen, particularly the mediastinal, retropharyngeal and tracheobronchial LNs. Twenty-five reactors had macroscopic lesions in the palatine tonsils. Among TB-confirmed cattle, 27% of reactors and 9% of in-contact animals had gross TB-like lesions in the lungs, particularly in the caudal lobes. Gross lesions that were not TB-confirmed were parasitic granulomas (45%), bacterial or mycotic club-forming pyogranulomas (27%) and bacterial abscesses (23%). Diagnostic sensitivity was maximised when bacteriology and histopathology were used concurrently. Stage IV granulomas, alone or in combination with other stages, constituted 63% of lesions, while 16% of lesions were stage I/II granulomas. Caseous necrosis and calcification were common features of the granulomas encountered in natural Mycobacterium bovis infections, even with pathology limited to a small number of sites. Granulomas often covered large areas of histological sections and typically contained only small numbers of acid fast bacilli.

Histological observations of bovine tuberculosis in lung and lymph node tissues from British deer.

Deer are recognized as hosts of Mycobacterium bovis and assessing the role of wild cervids in perpetuating tuberculosis among cattle has motivated extensive research on several continents. In this paper, the histopathology of lymph node and lung tuberculous granulomas in M. bovis positive British deer is presented. The overall aim was to seek further insights into the potential for onward transmission from infected deer to other species, including cattle. Samples were obtained from an extensive survey of wild mammals in South-West England and from statutory tuberculosis surveillance. M. bovis culture-positive samples were characterised microscopically as to their stage of lesion advancement, number of acid-fast bacilli and granuloma encapsulation. Seventy percent of the deer developed granulomas containing far greater numbers of M. bovis bacilli than typically reported in cattle. Red and fallow deer had the largest number of poorly encapsulated granulomas often containing many hundreds of bacilli. The results are consistent with infected wild British deer being a potential source of environmental contamination and onward transmission to other species. However, further work on levels of bacillary shedding is required before this can be confirmed.

Comparison of a standard and a detailed postmortem protocol for detecting Mycobacterium bovis in badgers.

A standard postmortem protocol, consisting of gross pathology, culture for mycobacteria and limited selective histopathology, was used in the randomised badger culling trial in Great Britain to detect Mycobacterium bovis infection. This standard protocol was compared with a more detailed protocol in which more tissues were examined grossly, more tissues were cultured, more culture slopes were seeded, the culture period was extended and tissues were examined routinely by histopathology. The standard protocol was more sensitive in badgers with gross visible lesions than in badgers with no gross visible lesions. When applied to the study population of badgers, the overall sensitivity of the standard protocol relative to the more detailed protocol was estimated to be 54.6 per cent (95 per cent confidence interval 44.9 to 69.8 per cent). Badgers with tuberculosis (tb) detected by the standard protocol had a mean of 7.6 tissues with microscopic lesions suspicious of tb. The additional badgers detected by the detailed protocol had a mean of 4.4 tissues with microscopic lesions suspicious of tb.

Bovine tuberculosis infection in wild mammals in the South-West region of England: a survey of prevalence and a semi-quantitative assessment of the relative risks to cattle.

In the United Kingdom, badgers are implicated in the transmission of Mycobacterium bovis to cattle, but little information is available on the potential role of other wild mammals. This paper presents the results of the largest systematic UK survey of M. bovis infection in other wild mammals. Mammal carcasses (4715) from throughout the South-West region of England were subjected to a systematic post mortem examination, microbiological culture of tissues and spoligotyping of isolates. Infection was confirmed in fox, stoat, polecat, common shrew, yellow-necked mouse, wood mouse, field vole, grey squirrel, roe deer, red deer, fallow deer and muntjac. Prevalence in deer may have been underestimated because the majority were incomplete carcasses, which reduced the likelihood of detecting infection. Infected cases were found in Wiltshire, Somerset, Devon and Cornwall, Gloucestershire and Herefordshire. Lesions were found in a high proportion of spoligotype-positive fallow, red and roe deer, and a single fox, stoat and muntjac. M. bovis spoligotypes occurred in a similar frequency of occurrence to that in cattle and badgers. Data on prevalence, pathology, abundance and ecology of wild mammals was integrated in a semi-quantitative risk assessment of the likelihood of transmission to cattle relative to badgers. Although most species presented a relatively low risk, higher values and uncertainty associated with muntjac, roe, red and in particular fallow deer, suggest they require further investigation. The results suggest that deer should be considered as potential, although probably localised, sources of infection for cattle.

Ante mortem diagnosis of tuberculosis in cattle: a review of the tuberculin tests, gamma-interferon assay and other ancillary diagnostic techniques.

The early, preclinical stages of bovine TB can be detected in live animals by the use of tests of cellular immunity (the skin, gamma-interferon and lymphocyte transformation tests). Tests of humoral (antibody) immunity, Mycobacterium bovis PCR probes on early tissue cultures or live cattle specimens, and tests based on "electronic nose" technology have been developed more recently. The key measure of diagnostic test accuracy is the relationship between sensitivity and specificity, which determines the false-positive and false-negative proportions. None of the tests currently available for the diagnosis of bovine TB allow a perfectly accurate determination of the M. bovis infection status of cattle. Although various factors can reduce the sensitivity and specificity of the skin tests, these remain the primary ante mortem diagnostic tools for TB in cattle, providing a cost-effective and reliable means of screening entire cattle populations. Despite the inescapable limitations of existing diagnostic tests, bovine TB has been effectively eradicated from many developed countries and regions with the implementation of sound programmes of regular tuberculin skin testing and removal of reactors, coupled with slaughterhouse surveillance for undetected infections, repeat testing and culling of infected herds, cattle movement restrictions to prevent introduction of infected animals and occasional slaughter of entire herds with intractable breakdowns. This is likely to remain the mainstay of bovine TB control programmes for the foreseeable future. Additionally, newer ancillary in vitro diagnostic assays are now available to TB control programme managers to supplement the skin tests in defined circumstances according to the specific disease situation in each country or region. The strategic deployment of ancillary in vitro tests alongside the primary skin tests has enhanced the detection of M. bovis-infected cattle and reduced the number of animals slaughtered as false positives.

Introduction of bovine tuberculosis to north-east England by bought-in cattle.

The source of bovine tuberculosis was investigated in 31 herds in north-east England that experienced confirmed breakdowns between January 2002 and June 2004; nine of the herds had been restocked after the UK outbreak of foot-and-mouth disease in 2001. In all but one of the breakdowns the most likely source of infection was identified as one or more purchased animals. In 17 of the breakdowns, reactor animals were traced to herds from which the same combination of spoligotype and variable number tandem repeats was isolated, and in five breakdowns a different spoligotype was isolated. The most likely sources were located in Wales and the west and north of England, and included a Cheshire herd that was the most likely source of nine of the breakdowns. Three breakdowns were traced to Irish imports. Reactors in five of the breakdowns included homebred as well as purchased animals, providing evidence for the likely spread of the disease within the herds. The lack of geographical clustering of molecular types pointed to the overwhelming source of infection being cattle that had been bought-in.

Cattle-to-cattle transmission of Mycobacterium bovis.

This review, illustrated with data on the characteristics of herds infected with Mycobacterium bovis (TB) in Great Britain (GB), attempts to identify the role of cattle-to-cattle transmission (CCT) of TB. CCT plays a part in the entry of infection into herds, through purchased infected animals or contiguous spread, although CCT can have a relatively small role in comparison with an established wildlife source. Experimental studies have shown that it is possible for CCT to occur within herds. In 1999, more than one reactor was found in over two-thirds of confirmed TB incidents in Great Britain. The details of transmission from an infectious animal to a susceptible animal are described: proximate, which depends on factors such as closeness of contact and ventilation, or indirect, which also depends on survival outside the host. Herd size is a risk factor for the incidence of TB, both in herds and in individual cattle. Control of TB is considered in relation to the skin test: failure of the test to remove all infected animals from incidents is possible, but probably of less significance than failure to prevent reinfection from sources external to the herd. It is concluded that CCT may have significance in determining the total number of reactors. Safeguarding herds from other sources of TB is likely to reduce CCT as a side effect.

Wildlife disease reservoirs: the epidemiology of Mycobacterium bovis infection in the European badger (Meles meles) and other British mammals.

Mycobacterium bovis infection has been confirmed in a wide range of mammals hosts throughout the world. The European badger (Meles meles) and the brushtail possum (Trichosurus vulpecula) are implicated as significant sources of infection for domestic cattle in the UK and New Zealand respectively. The risk of transmission of infection between a wildlife population and domestic animals will be determined by both the epidemiology of the disease and the ecology of the host. In the UK, surveys by the UK Ministry of Agriculture, Fisheries and Food (MAFF) have identified M. bovis infection in deer (Cervus sp., Capreolus sp., Dama sp.), red fox (Vulpes vulpes), mink (Mustela vison), feral ferret (Mustela furo), mole (Talpa europaea), brown rat (Rattus norvegicus) and feral cat (Felis catus). However, the potential contribution to cattle herd breakdowns, of reservoirs of M. bovis infection in mammals other than the badger is poorly understood and is the subject of current research. In contrast, M. bovis infection in the badger has been the subject of a long term ecological and epidemiological study at Woodchester Park in South-West England, where the prevalence and distribution of infection in a wild population has been intensively monitored. The pattern of infection in the population and potential risks to cattle, are profoundly influenced by badger social organization and behaviour. The pattern of land use and cattle farming practices in the UK brings badgers into close contact with domestic animals and provides conditions that may enhance the likelihood of disease transfer.

Movement of badgers (Meles meles) in a high-density population: individual, population and disease effects.

The movement of 1763 badgers trapped between 36 social groups in Woodchester Park, Gloucestershire, over 18 years was analysed to determine the frequency and duration of moves, the factors associated with a predisposition to move and the spatial pattern of movements. Of those badgers whose capture history could be categorized, nearly half had moved. Of these, 73.1% were classified as 'occasional movers', 22.1% as 'permanent movers' and 4.8% as 'frequent movers'. Most adult badgers that moved made occasional moves (78.8%, n = 67). Cubs made all types of move including permanent moves (29%, n = 10). Seventy per cent of females were non-movers compared with 37% of males. Badgers were significantly more likely to move to smaller groups, whereas male badgers were significantly more likely to move to groups with a greater proportion of females. The spatial pattern of movement differed from the distribution of groups with bovine tuberculosis in the study area. However, temporal changes in movement were significantly related to the incidence of Mycobacterium bovis infection in the following year, indicating that as the movement of badgers between groups varies so does the incidence of bovine tuberculosis in the population. This finding is of central importance in the formulation of badger control policy.

Value of existing serological tests for identifying badgers that shed Mycobacterium bovis.

In the UK there has been a sharp rise in the incidence of bovine tuberculosis since the early 1990s and the badger has been identified as an important wildlife reservoir for this infection. Infected badgers can excrete Mycobacterium bovis, putting other badgers and cattle at risk of becoming infected. Vaccination has been proposed as an approach to reducing the excretion of M. bovis by tuberculous badgers. In order to evaluate the efficacy of a badger vaccine it will be necessary to accurately determine the number of badgers excreting M. bovis without removing them for post-mortem evaluation. The existing live tests for tuberculosis in the badger (culture, indirect ELISA, Western blot) have not been assessed for their ability to detect badgers excreting M. bovis. Over the past 18 years, badgers from 31 social groups have been trapped and sampled in a study area of the Cotswold escarpment. We have examined the serological responses of 128 badgers trapped between 1985 and 1998 from social groups where M. bovis infection was endemic. These responses were compared with culture from faeces, urine, tracheal aspirates and bite wound swabs taken from these animals while alive. ELISA was found to be more sensitive than Western blot in detecting badgers excreting M. bovis. The majority of culture-positive badgers excreted M. bovis intermittently over the period of study. As a result, there was only a 27.5% chance of sampling a badger for culture when it was excreting M. bovis. In contrast, a positive ELISA result correctly predicted 68.2% of badgers with a history of excreting M. bovis. In the absence of alternative live tests for the badger, the Brock Test indirect ELISA appears to be more valuable than culture for measuring the effect of vaccination on reducing the number of badgers at risk of transmitting tuberculosis.

Preliminary estimates of the direct costs associated with endemic diseases of livestock in Great Britain.

Many 'economic' studies of livestock diseases in Great Britain have been carried out over time. Most studies have considered just one or two diseases and used a different methodology and valuation base from other studies, hampering any comparative assessment of the economic impact of diseases. A standardized methodology was applied to the estimation of the direct costs to livestock production of some 30 endemic diseases/conditions of farm animals in Great Britain. This involved identification of the livestock populations at risk, estimation of the annual incidence of each disease in these populations, identification of the range and incidence of physical effects of each disease on production, valuation of the physical effects of each disease and estimation of the financial value of output losses/resource wastage due to a disease and the costs of specific treatment and prevention measures. The wider economic impacts of disease (such as the implications for human health, animal welfare and markets) were not included in the assessments. Using this standardized methodology with common financial values, a simple spreadsheet model was constructed for each disease. Given the paucity of appropriate disease data for economic assessment, 'low' and 'high' values were used to reflect uncertainties surrounding key disease parameters. Preliminary estimates of the value of disease output losses/resource wastage, treatment and prevention costs are presented for each disease. Despite the limitations of the spreadsheet models and of the estimates derived from them, we conclude that the models represent a useful start in developing a system for the comparative economic assessment of livestock diseases in Great Britain.

Tuberculosis in badgers; a review of the disease and its significance for other animals.

This review examines the current state of knowledge of aspects of tuberculosis in the badger. The gross pathology and pathogenesis are elaborated as well as the immune mechanism, diagnosis of infection and excretion and viability of infected products. The epidemiology in badgers is considered, as is the significance of infection in this species for other wildlife species as well as domestic animals sharing the same habitat. Trials of the effects of the removal of badgers on the occurrence of tuberculosis in cattle are summarised. It is concluded that badgers are well adapted as the primary host of bovine tuberculosis in parts of Britain and much of Ireland.

The status of Mycobacterium bovis infection in UK wild mammals: a review.

Bovine tuberculosis caused by Mycobacterium bovis is a zoonotic infection with a wide range of mammalian hosts. In parts of the UK M. bovis infection in cattle is a persistent problem. The European badger (Meles meles) is implicated in the transmission of M. bovis to cattle, and is widely believed to constitute the most important reservoir of infection in UK wildlife. However, few studies have been carried out on the status of M. bovis infection in other UK mammals. In this review we present information on the incidence and pathology of M. bovis infection in UK wild mammals from both published and previously unpublished sources. Although the evidence does not support the existence of a significant self-maintaining reservoir of infection in any wild mammal other than the badger, there is a clear lack of sufficient data to rule out the involvement of other species. In the light of this and the dynamic nature of epidemiological patterns, further surveillance for M. bovis infection in UK wild mammals, using modern methods of diagnosis, is essential.

Molecular epidemiology of bovine tuberculosis. II. Applications of genotyping.

The applications of genotyping of Mycobacterium bovis are reviewed. Published research to date has been conducted predominantly within the context of validating typing methods, and few studies have been specifically epidemiological. This is contrasted with the situation in human tuberculosis, where the application of restriction fragment length polymorphism typing using insertion sequence IS6110 has successfully led to insights into the epidemiology and molecular evolution of the pathogen. Based upon the medical experience, the adoption of an integrated approach which combines epidemiology and molecular biology is recommended for future studies. Accordingly, clear identification and explanation of type clustering should be possible, which should facilitate decisions related to disease control.