Johne's disease in Irish dairy herds: considerations for an effective national control programme.

The Irish dairy industry has established a reputation for the production of safe and healthy dairy products and is seeking to further expand its export market for high value dairy products. To support its reputation, stakeholders aim to control Johne's disease. To assist decision-makers determine the most appropriate design for an Irish programme, a narrative review of the scientific literature on the epidemiology of Johne's disease, and selected control programmes throughout the world was undertaken. Two modelling studies specifically commissioned by Animal Health Ireland to assess testing methods used to demonstrate confidence of freedom in herds and to evaluate a range of possible surveillance strategies provided additional information. The majority of control programmes tend to be voluntary, because of the unique epidemiology of Johne's disease and limited support for traditional regulatory approaches. While acknowledging that test performance and sub-clinical sero-negative shedders contributes to the spread of infection, a range of socio-political issues also exist that influence programme activities. The paper provides a rationale for the inclusion of a Veterinary Risk Assessment and Management Plan (VRAMP), including voluntary whole herd testing to identify infected herds and to support assurance-based trading through repeated rounds of negative testing, national surveillance for herd-level case-detection, and improved understanding of biosecurity management practices. Identification and promotion of drivers for industry and producer engagement in Ireland is likely to guide the future evolution of the Irish Johne's Control Programme (IJCP) and further enhance its success. The provision of training, education and extension activities may encourage farmers to adopt relevant farm management practices and help them recognize that they are ultimately responsible for their herd's health and biosecurity.

Modeling of alternative testing strategies to demonstrate freedom from Mycobacterium avium ssp. paratuberculosis infection in test-negative dairy herds in the Republic of Ireland.

In light of the various adverse effects of Johne's disease on animal productivity and the debate on the role of its causative organism, Mycobacterium avium ssp. paratuberculosis, in the etiology of Crohn's disease, major dairy-producing countries around the world have implemented national control programs aimed at reducing the prevalence of this infection in cattle. A pilot control program was initiated in Ireland in 2013, with a key objective to provide farmers with test-negative dairy herds with tools and knowledge to increase their confidence of freedom over time. The aim of this study was to estimate the confidence of freedom obtained in test-negative Irish dairy herds over time with various sampling scenarios and to evaluate the cost-effectiveness of alternative scenarios for achieving an acceptable level of confidence of freedom in herds with no evidence of infection. A stochastic model was developed to simulate repeated annual testing of individual animals using ELISA and confirmatory assays over a period of 20 yr. Two scenarios modeled the current herd-screening options, whereas 14 alternative scenarios explored the effect of varying parameters from the current testing strategies, such as the frequency of testing, the eligibility criteria for selecting animals, the type of assay, the probability of introduction, and the assay sensitivity. Results showed that the current testing strategy with milk twice a year or serum once a year in all animals over 2 yr old provided the highest annual herd sensitivity, with a median value of 55%. Although the median confidence of freedom increased over time for all scenarios, the time required to reach 90 and 95% confidence of freedom was highly variable between scenarios. Under the testing scenario where serum tests were used once a year, the confidence of freedom reached 90% after 4 yr and 95% after 7 yr of testing. Some of the alternative scenarios achieved an acceptable level of confidence of freedom in a reasonable timeframe and at lesser cost than the current testing strategies. The results of this work are used to provide recommendations for the next phases of the program.

Evaluation of national surveillance methods for detection of Irish dairy herds infected with Mycobacterium avium ssp. paratuberculosis.

The aim of this study was to evaluate the utility and cost-effectiveness of a range of national surveillance methods for paratuberculosis in Irish dairy herds. We simulated alternative surveillance strategies applied to dairy cattle herds for the detection of Mycobacterium avium ssp. paratuberculosis (MAP)-infected herds (case-detection) or for estimation of confidence of herd freedom from infection (assurance testing). Strategies simulated included whole-herd milk or serum serology, serology on cull cows at slaughter, bulk milk tank serology, environmental testing, and pooled fecal testing. None of the strategies evaluated were ideal for widespread national case-detection surveillance. Herd testing with milk or serum ELISA or pooled fecal testing were the most effective methods currently available for detection of MAP-infected herds, with median herd sensitivity >60% and 100% herd specificity, although they are relatively expensive for widespread use. Environmental sampling shows promise as an alternative, with median herd sensitivity of 69%, but is also expensive unless samples can be pooled and requires further validation under Irish conditions. Bulk tank milk testing is the lowest cost option and may be useful for detecting high-prevalence herds but had median herd sensitivity <10% and positive predictive value of 85%. Cull cow sampling strategies were also lower cost but had median herd sensitivity <40% and herd positive predictive values of <50%, resulting in an increased number of test-positive herds, each of which requires follow-up herd testing to clarify status. Possible false-positive herd testing results associated with prior tuberculosis testing also presented logistical issues for both cull cow and bulk milk testing. Whole-herd milk or serum ELISA testing are currently the preferred testing strategies to estimate confidence of herd freedom from MAP in dairy herds due to the good technical performance and moderate cost of these strategies for individual herd testing. Cull cow serology and bulk tank milk sampling provide only minimal assurance value, with confidence of herd freedom increasing only minimally above the prior estimate. Different testing strategies should be considered when deciding on cost-effective approaches for case-detection compared with those used for building confidence of herd freedom (assurance testing) as part of a national program.

A novel approach to assess the probability of disease eradication from a wild-animal reservoir host.

Surveying and declaring disease freedom in wildlife is difficult because information on population size and spatial distribution is often inadequate. We describe and demonstrate a novel spatial model of wildlife disease-surveillance data for predicting the probability of freedom of bovine tuberculosis (caused by Mycobacterium bovis) in New Zealand, in which the introduced brushtail possum (Trichosurus vulpecula) is the primary wildlife reservoir. Using parameters governing home-range size, probability of capture, probability of infection and spatial relative risks of infection we employed survey data on reservoir hosts and spillover sentinels to make inference on the probability of eradication. Our analysis revealed high sensitivity of model predictions to parameter values, which demonstrated important differences in the information contained in survey data of host-reservoir and spillover-sentinel species. The modelling can increase cost efficiency by reducing the likelihood of prematurely declaring success due to insufficient control, and avoiding unnecessary costs due to excessive control and monitoring.

The effect of alternative testing strategies and bio-exclusion practices on Johne's disease risk in test-negative herds.

Herd classification is a key component of national Johne's disease (JD) control programs. Herds are categorized on the basis of test results, and separate sub-programs are followed for test-positive and test-negative herds. However, a test-negative herd result does not necessarily equate to JD freedom for reasons relating to disease pathogenesis and available diagnostic tests. Thus, in several countries, JD control programs define test-negative herds as having a "low risk" of infection below a specified prevalence. However, the approach is qualitative, and little quantitative work is available on herd-level estimates of probability of freedom in test-negative herds. This paper examines the effect over time of alternative testing strategies and bio-exclusion practices on JD risk in test-negative herds. A simulation model was developed in the programming language R. Key model inputs included sensitivity and specificity estimates for 3 individual animal diagnostic tests (serum ELISA, milk ELISA, and fecal culture), design prevalence, testing options, and testing costs. Key model outputs included the probability that infection will be detected if present at the design prevalence or greater (herd sensitivity; SeH), the probability that infection in the herd is either absent or at very low prevalence (i.e., less than the design prevalence; ProbF), the probability of an uninfected herd producing a false-positive result [P(False+)], and mean testing cost (HerdCost) for different testing strategies. The output ProbF can be updated periodically, incorporating data from additional herd testing and information on cattle purchases, and could form the basis for an output-based approach to herd classification. A high ProbF is very difficult to achieve, reflecting the low sensitivity of the evaluated tests. Moreover, ProbF is greatly affected by any risk of introduction of infection, decreasing in herds with poor bio-exclusion practices despite ongoing negative test results. The value of P(False+) was substantial when tests with imperfect specificity were used. Testing strategies can substantially influence testing costs but with little effect on test performance. This study illustrates an output-based approach to herd classification, with potential for national and field applications.

Evaluation of test-strategies for estimating probability of low prevalence of paratuberculosis in Danish dairy herds.

Paratuberculosis is a chronic infection affecting cattle and other ruminants. In the dairy industry, losses due to paratuberculosis can be substantial in infected herds and several countries have implemented national programmes based on herd-classification to manage the disease. The aim of this study was to develop a method to estimate the probability of low within-herd prevalence of paratuberculosis for Danish dairy herds. A stochastic simulation model was developed using the R programming environment. Features of this model included: use of age-specific estimates of test-sensitivity and specificity; use of a distribution of observed values (rather than a fixed, low value) for design prevalence; and estimates of the probability of low prevalence (PrLow) based on a specific number of test-positive animals, rather than for a result less than or equal to a specified cut-point number of reactors. Using this model, five herd-testing strategies were evaluated: (1) milk-ELISA on all lactating cows; (2) milk-ELISA on lactating cows4 years old; (4) faecal culture on all lactating cows; and (5) milk-ELISA plus faecal culture in series on all lactating cows. The five testing strategies were evaluated using observed milk-ELISA results from 19 Danish dairy herds as well as for simulated results from the same herds assuming that they were uninfected. Whole-herd milk-ELISA was the preferred strategy, and considered the most cost-effective strategy of the five alternatives. The five strategies were all efficient in detecting infection, i.e. estimating a low PrLow in infected herds, however, PrLow estimates for milk-ELISA on age-cohorts were too low in simulated uninfected herds and the strategies involving faecal culture were too expensive to be of practical interest. For simulated uninfected herds, whole-herd milk-ELISA resulted in median PrLow values>0.9 for most herds, depending on herd size and age-structure. None of the strategies provided enough power to establish a high PrLow in smaller herds, or herds with a younger age-structure. Despite this, it appears as if the method is a useful approach for herd-classification for most herds in the Danish dairy industry.

Demonstrating freedom from disease using multiple complex data sources 2: case study--classical swine fever in Denmark.

A method for quantitative evaluation of surveillance for disease freedom has been presented in the accompanying paper (Martin et al., 2007). This paper presents an application of the methods, using as an example surveillance for classical swine fever (CSF) in Denmark in 2005. A scenario tree model is presented for the abattoir-based serology component of the Danish CSF surveillance system, in which blood samples are collected in an ad hoc abattoir sampling process, from adult pigs originating in breeding herds in Denmark. The model incorporates effects of targeting (differential risk of seropositivity) associated with age and location (county), and disease clustering within herds. A surveillance time period of one month was used in the analysis. Records for the year 2005 were analysed, representing 25,332 samples from 3528 herds; all were negative for CSF-specific antibodies. Design prevalences of 0.1-1% of herds and 5% of animals within an infected herd were used. The estimated mean surveillance system component (SSC) sensitivities (probability that the SSC would give a positive outcome given the animals processed and that the country is infected at the design prevalences) per month were 0.18, 0.63 and 0.86, for among-herd design prevalences of 0.001, 0.005 and 0.01. The probabilities that the population was free from CSF at each of these design prevalences, after a year of accumulated negative surveillance data, were 0.91, 1.00 and 1.00. Targeting adults and herds from South Jutland was estimated to give approximately 1.9, 1.6 and 1.4 times the surveillance sensitivity of a proportionally representative sampling program for these three among-herd design prevalences.

A comparison of methods to estimate the prevalence of ovine Johne's infection from pooled faecal samples.

OBJECTIVE: To compare estimates of ovine Johne's infection prevalence produced by several alternate methods based on pooled faecal culture (PFC) results with prevalence estimates based on individual faecal culture (IFC). PROCEDURE: Seven methods for estimating prevalence of infection based on PFC results were incorporated in a computer program, including methods for imperfect test sensitivity and specificity, for variable pool size and a Bayesian method that incorporates prior knowledge about test performance and prevalence. These methods were then used to analyse PFC data at one observation 30 months post-vaccination in a field trial of a killed vaccine for the control of OJD, undertaken on three farms in New South Wales. RESULTS: Prevalence estimates, for three methods that assume a perfect test, were close to the IFC estimate, whereas for three other methods that assume an imperfect test, the estimated prevalence was generally higher than the IFC estimate. In comparison, the Bayesian approach produced more variable estimates that were substantially higher than the IFC estimate when an inappropriately high prior estimate of prevalence was used. CONCLUSION: Despite the limitations of each method, two methods provided accurate and reasonable estimates of the prevalence assessed by IFC in all instances, and are appropriate for the analysis of data from this vaccine trial. One of these methods also has the advantage of allowing for variable pool size. However, further research is needed to develop a method that will simultaneously account for variation in pool size and in test sensitivity and specificity.

Assessing the delay to detection and the size of the outbreak at the time of detection of incursions of foot and mouth disease in Australia.

The time delay to detection of an outbreak of an emergency animal disease directly affects the size of the outbreak at detection and the likelihood that the disease can be eradicated. This time delay is a direct function of the efficacy of the surveillance system in the country involved. Australia has recently completed a comprehensive review of its general surveillance system examining regional variation in both the behaviour of modelled outbreaks of foot and mouth disease and the likelihood that each outbreak will be detected and reported to government veterinary services. The size of the outbreak and the time delay from introduction to the point where 95% confidence of detection was reached showed significant (p < 0.05) regional variation with the more remote northern areas experiencing smaller outbreaks that are less likely to spread and less likely to be reported to government services than outbreaks in the more developed southern areas of Australia. Outbreaks in the more densely populated areas may take up to 43 days until a 95% confidence of detection is achieved and at that time, the outbreak may involve up to 53 farms.

Assessing the efficacy of general surveillance for detection of incursions of livestock diseases in Australia.

Australia, as a relatively isolated country with a high level of agricultural production, depends on, and has the opportunity to maintain, freedom from a range of important diseases of livestock. Occasional incursions of such diseases are generally detected by 'passive', general surveillance (GS). In current surveillance planning, a risk-based approach has been taken to optimising allocation of resources to surveillance needs, and having mapped the relative risk of introduction and establishment of diseases of concern, a means of mapping the efficacy of GS for their detection was required, as was a means of assessing the likely efficacy of options for improving GS efficacy if needed. This paper presents the structure and application of a tool for estimating the efficacy of Australia's GS, using the example of foot and mouth disease (FMD). The GS assessment tool (GSAT) is a stochastic spreadsheet model of the detection, diagnosis and reporting of disease on a single infected farm. It utilises the output of an intraherd disease spread model to determine the duration and prevalence of infection on different types of farm. It was applied separately to each of twelve regions of Australia, demarcated by dominant livestock production practices. Each region supplied estimates of probabilities relevant to the detection of FMD, for each of fourteen farm types and all species susceptible to the disease. Outputs of the GSAT were the average probability that FMD on the farm would be detected (single farm sensitivity), the average time elapsed from incursion of the disease to the chief veterinary officer (CVO) being notified (time to detection), and the number of average properties that would need to be infected before the CVO could be 95% confident of detecting at least one. The median single farm sensitivity for FMD varied among regions from 0.23 to 0.52, the median time to detection from 20 to 33 days, and the number of properties infected for 95% confidence of detecting at least one from 4 to 12. The GSAT has proved a valuable tool in planning surveillance for detection of exotic livestock disease in Australia, and it provides a practical example of the use of probabilistic modelling to answer important questions in the face of imperfect information.

Sensitivity and specificity of pooled faecal culture and serology as flock-screening tests for detection of ovine paratuberculosis in Australia.

The flock-level sensitivity of pooled faecal culture and serological testing using AGID for the detection of ovine Johne's disease-infected flocks were estimated using non-gold-standard methods. The two tests were compared in an extensive field trial in 296 flocks in New South Wales during 1998. In each flock, a sample of sheep was selected and tested for ovine Johne's disease using both the AGID and pooled faecal culture. The flock-specificity of pooled faecal culture also was estimated from results of surveillance and market-assurance testing in New South Wales. The overall flock-sensitivity of pooled faecal culture was 92% (95% CI: 82.4 and 97.4%) compared to 61% (50.5 and 70.9%) for serology (assuming that both tests were 100% specific). In low-prevalence flocks (estimated prevalence <2%), the flock-sensitivities of pooled faecal culture and serology were 82% (57 and 96%) and 33% (19 and 49%), respectively, compared to 96% (85 and 99.5%) and 85% (72 and 93%), respectively, in higher-prevalence flocks (estimated prevalence > or =2%). A Bayesian approach incorporating prior knowledge on flock-specificity of pooled culture produced similar estimates and probability intervals. These estimates assume conditional independence of the two tests, and therefore might have over-estimated the true flock-sensitivities of the tests if the flock-sensitivities of pooled faecal culture and serology were correlated. The estimated minimum flock-specificity of pooled culture when used for surveillance and assurance testing was 99.1% (96.9 and 99.9%). Surveillance and assurance programs in Australia are designed to provide a flock-sensitivity of 95% for an assumed prevalence of 2%. Pooled faecal culture is performing at close to this level--whereas the flock-sensitivity of serology appears to be lower than expected, particularly in lower prevalence flocks.

Evaluation of an absorbed ELISA and an agar-gel immuno-diffusion test for ovine paratuberculosis in sheep in Australia.

The sensitivities and specificities of an absorbed enzyme-linked immunosorbent assay (ELISA) and an agar-gel immuno-diffusion (AGID) test for the detection of Johne's disease in sheep were estimated using data from six known infected and 12 assumed uninfected sheep flocks. Sensitivities were estimated for all histologically positive sheep, as well as by histological lesion score, lesion type (paucibacillary or multibacillary) and sheep body-condition score, with ELISA sensitivities estimated at 95 and 99% specificity. Logistic-regression analysis was used to test for significant effects of lesion score and condition score, with flock included in the model as a random effect. Estimated specificities were 95% (95% CI: 93.4, 95.6%) and 99% (98.4, 99.4%) for ELISA cut-point ratios of 2.4 and 3.6, respectively, and 100% (99.7, 100.0%) for the AGID. Estimated sensitivities for all infected sheep were 41.5% (35.0, 48.3%), 21.9% (16.6, 27.9%) and 24.6% (19.1, 30.7%) for ELISA cut-point ratios of 2.4 and 3.6 and for AGID, respectively. Sensitivities of all tests and cut-points varied significantly between flocks and between categories of lesion score and condition score. Sensitivity ranged from 25 to 73, 10 to 47 and 9.2 to 63% between flocks, for the ELISA with cut-points of 2.4 and 3.6, and for the AGID, respectively. Sensitivity was highest in thin sheep and in sheep with multibacillary lesions. The effects of lesion type and condition score on test sensitivity were significant in the logistic regressions for the AGID and ELISA at both cut-points and the flock effect was significant for the AGID but not for the ELISA at either cut-point.

Ovine Johne's disease in Australia--the first 20 years.

OBJECTIVE: To review the history of ovine Johne's disease in Australia. PROCEDURE: Relevant publications and reports were identified and reviewed to document the spread of ovine Johne's disease (OJD) from 1980 until the end of 2000, as well as the response of industry and government to the spread of this disease. RESULTS: OJD was first diagnosed in the central tablelands region of New South Wales in 1980. Since then it has spread, either from the initial focus or through separate introductions so that by December 2000 a total of 823 infected flocks had been identified. Cases have been confirmed in New South Wales, Victoria, the Australian Capital Territory, on Flinders Island in Tasmania, on Kangaroo Island in South Australia and in Western Australia. In early 1999, agreement was reached to fund and implement a 6-year, $40 million National OJD Control and Evaluation Program (NOJDP). This program is jointly funded by the sheep industries (national and state), and Commonwealth and State governments, and is managed by Animal Health Australia. CONCLUSION: A national program is now in place to support the control of OJD and research to determine the feasibility and cost-effectiveness of eradication. The development of new diagnostic techniques, such as abattoir surveillance and pooled faecal culture, provide opportunities to refine surveillance strategies and to define better the distribution and prevalence of this disease, as required by the national program. Effective control measures, combined with quality surveillance data, will enable informed decision making for the future national management of OJD.

Progress towards understanding the spread, detection and control of Mycobacterium avium subsp paratuberculosis in animal populations.

OBJECTIVE: To review and interpret aspects of the pathogenesis and epidemiology of paratuberculosis (Johne's disease) for veterinarians involved in current Johne's disease control programs. PROCEDURE: An electronic and manual search was undertaken to identify published information which, together with limited unpublished data, was interpreted and summarised. CONCLUSIONS: Paratuberculosis, a chronic enteropathy of ruminants, is caused by Mycobacterium avium subsp paratuberculosis and is transmitted mainly in faeces to young animals by infected adults, some of which may not have clinical signs. The incubation period is inversely related to the size of the challenge dose but can be extremely prolonged. Clinical cases may not be seen within the economic lifespan of farm animals, particularly when stocking rates are low, pasture is spelled, or when animals are culled at a relatively young age. Other as yet unknown influences may determine the rate of progression or recovery from infection. Paratuberculosis appears in a range of forms from a disease with high prevalence and significant mortality through to one with very low prevalence and little obvious morbidity or mortality. Detection of infected flocks and herds relies on use of laboratory tests. Bacteriological culture of faeces is the most sensitive herd-level test. The passage of time and repeated testing are the greatest allies in detecting paratuberculosis because infected animals progress in the disease process and most tests are more effective in the later stages of the disease. These factors generally cause the prevalence of paratuberculosis to be underestimated at both herd or flock and regional level. Greater understanding of the epidemiology and pathogenesis of M a paratuberculosis infection is critical in order to design improved diagnostic strategies, assess the feasibility of eradication and develop control options, particularly in small ruminants.

The estimated prevalence of Johne's disease infected sheep flocks in Australia.

OBJECTIVE: To estimate the likely geographical distribution and flock-prevalence of ovine Johne's disease (OJD) in Australia. DESIGN: A cross-sectional study design was used. PROCEDURE: The results of abattoir surveillance for OJD carried out during 2000 were analysed to estimate the prevalence of infected flocks in three regions of New South Wales and in other States. A Bayesian approach was used to adjust apparent prevalence estimates for the assumed flock-sensitivity and flock-specificity of abattoir surveillance, and to allow for uncertainty about the true values of these measures. RESULTS: The 95% probability limits for flock-prevalence at 31 December 2000 were 0.04%-1.5%, 8%-15% and 29%-39% for low, moderate and high prevalence regions of New South Wales respectively. The other States generally had an upper 97.5% probability limit of about 1% or less. Based on these estimates about 6 to 10% of flocks in New South Wales and 2.4 to 4.4% of flocks Australia-wide are likely to be infected. CONCLUSION: This study suggests that OJD has a highly clustered distribution in Australia, and provides estimates of the prevalence of infected flocks by State or region. Based on this analysis there were probably between 2000 and 3700 infected flocks in Australia at 31 December 2000, with more than 80% of these in a relatively small geographic area of central and southern New South Wales. Some States, such as Queensland and Western Australia, may have a prevalence equal or close to 0%, however the technique used was unable to demonstrate the absence of infection in these States with the intensity of surveillance undertaken to date.

A syndrome of hepatogenous photosensitisation, resembling geeldikkop, in sheep grazing Tribulus terrestris.

Two outbreaks of photosensitivity disease occurred in weaner sheep in south western New South Wales during early autumn 1982. In each instance there was a history of access to the annual herb, Tribulus terrestris and both the clinical and pathological findings were consistent with geeldikkop, a major disease in the Republic of South Africa. The prevalence rates of clinical cases were 21 and 37%, while the case fatality rates approached 70%. Clinical signs were dominated by jaundice and photosensitisation. Ochre and khaki discolouration were present in the liver and kidneys, respectively. Histopathologically, the most characteristic lesion was the presence of acicular, cholesterol-like clefts in the lumens of bile ducts and in the cytoplasm of hepatocytes and Kupffer cells. Similar structures were also evident in the lumens of nephrons in association with segmental hyperplasia of the neighbouring tubular epithelium. The possible pathogenesis of the hepatogenous photosensitisation and its resemblance to geeldikkop are discussed.

Estimate of the sensitivity of an ELISA used to detect Johne's disease in Victorian dairy cattle herds.

OBJECTIVE: To estimate the sensitivity of the ELISA used in dairy cattle herds participating in the Victorian Bovine Johne's Disease Test and Control Program (TCP). PROCEDURE: The percentage of ELISA reactors in age and test cohorts was estimated from age-specific test data derived from TCP herds with long testing histories. Age-distribution data from production-tested herds enabled estimation of reactor rates in animals that were culled or died. RESULTS: ELISA sensitivities at the first test round in herds achieving five, six and seven annual herd tests were 16.1, 14.9 and 13.5% respectively. The ELISA sensitivity in 2, 3 and 4-year-old animals at the first test round in herds testing seven times was 1.2, 8.9 and 11.6% respectively but remained between 20 and 30% in older age-groups. CONCLUSION: The sensitivity of the ELISA is considerably lower than previous estimates, probably because previous estimates were predominantly measured against faecal culture, which has subsequently been shown to have low sensitivity itself, and did not appreciate the long period that appears to precede detectable faecal excretion in most animals.

Asthma care by nurse practitioners in the United States.

PURPOSE: To survey nurse practitioners (NPs) in the United States on their level of input to asthma care prior to enrolling in The National Asthma and Respiratory Training Centre (NARTC) specialist asthma education program in the UK. DATA SOURCES: Responses of 134 (66%) of the 202 NPs who self-selected for enrollment in the NARTC program on a preliminary questionnaire. CONCLUSIONS: Nearly all (133 or 99%) currently work with asthmatics and 122 (91%) prescribe asthma drugs. Only 92 (69%) measure peak flow(PF), 84 (63%) check inhaler technique, 76 (57%) teach use of a home PF meter and diary, and 63 (47%) provide written self-management plans on any regular basis. Many have not established follow-up procedures (56 or 42%), or evaluated their asthma management practices (55 or 41%). IMPLICATIONS FOR PRACTICE: Successful asthma management requires correct medication, systematic follow-up, patient education, and self-management. Specialist asthma training should encourage practitioners to combine effective drug usage with a long-term preventative approach.

Structure, dynamics and movement patterns of the Australian pig industry.

OBJECTIVE: To assess management practices and movement patterns that could influence the establishment and spread of exotic animal diseases (EAD) in pigs in Australia. METHODS: A literature review of published information and a telephone survey of 370 pig producers owning >10 pigs who were registered with the PigPass national vendor declaration scheme. RESULTS: The movement and marketing patterns of Australian pig producers interviewed were divided into two groups based predominantly on the size of the herd. Major pig producers maintain closed herds, use artificial insemination and market direct to abattoirs. Smaller producers continue to purchase from saleyards and market to other farms, abattoirs and through saleyards in an apparently opportunistic fashion. The role of saleyards in the Australian pig industry continues to decline, with 92% of all pigs marketed directly from farm to abattoir. CONCLUSIONS: This survey described movement patterns that will assist in modelling the potential spread of EAD in the Australian pig industry. Continued movement towards vertical integration and closed herds in the Australian pig industry effectively divides the industry into a number of compartments that mitigate against the widespread dissemination of disease to farms adopting these practices.

Use of a multi-criteria analysis framework to inform the design of risk based general surveillance systems for animal disease in Australia.

Australia is a major exporter of livestock and livestock products; a trade assisted by a favourable animal health status. However, increasing international travel and trade, land use changes and climatic change increase the risks of exotic and emerging diseases. At the same time, public sector resources for managing these risks are static or declining. Animal health authorities in Australia identified the need to develop a consistent national approach to surveillance that allocates resources according to risk. A study was undertaken to assess the relative likelihood of occurrence of eight significant diseases of concern to animal health authorities with the aim of producing risk maps to better manage animal disease surveillance. The likelihood of disease occurrence was considered in terms of the likelihood that a disease is introduced and the likelihood that the disease establishes and spreads. Pathways for introduction and exposure and for establishment and spread were identified and data layers representing the factors contributing to each pathway produced as raster maps. A multi-criteria analysis process was used to combine data layers into pathways and pathways into likelihood maps using weightings that reflect the relative importance of each layer and pathway. The likelihood maps for introduction and exposure and for establishment and spread were combined to generate national likelihood maps for each disease. To inform Australia's general surveillance system that exists to detect any disease of importance, the spatial profiles of the eight diseases were subsequently combined using weightings to reflect their relative consequences. The result was a map of relative likelihood of occurrence of any significant disease. Current surveillance activity was assessed by combining data layers for government disease investigations, proximity to vets and wildlife disease investigations. Comparison of the overall risk and current surveillance maps showed that the distribution of current effort was well matched to the distribution of risk.