The foot-and-mouth disease epidemic in Dumfries and Galloway, 2001. 2: Serosurveillance, and efficiency and effectiveness of control procedures after the national ban on animal movements

After the foot-and-mouth disease (FMD) epidemic in Dumfries and Galloway in south-west Scotland in 2001, serosurveillance of sheep remaining in the 3 km radius Protection Zones around Infected Premises (IPS), and within a 10 km radius of IPS, revealed no evidence of infection. The epidemic was brought under control by a range of traditional techniques: slaughter of all animals on IPS and of veterinary-assessed Dangerous Contacts (DCS), movement restrictions, biosecurity, tracing of potential sources and spread of virus, and surveillance of At-Risk premises. Novel pre-emptive slaughter of FMD-susceptible animals on premises contiguous to IPS, and small ruminants and pigs on premises within 3 km of IPSs, commenced after the epidemic had peaked. Most of the traditional control procedures were undertaken quickly and with appropriate priority. Animals on IPS were usually slaughtered within one day of confirmation, and veterinary-assessed DCS within two days of confirmation of relevant IPS (a median of two days). The pre-emptive contiguous and 3 km culls took somewhat longer (medians of five and 17 days, respectively). IPS were most commonly identified as a result of reporting by farmers or their veterinarians (72 per cent of IPS); veterinary clinical patrols identified 16 per cent, while veterinary assessment of DCS and tracing each identified 5 per cent. No evidence of infection was found on any pre-emptively contiguously culled premises, and IPS were declared only on three 3 km cull premises. The time from estimated first lesion to end of slaughter on an IP was found, by regression analysis, to be a key component in effective control, manifested by a reduction in the estimated dissemination rate (EDR); there was little evidence that the intensity of contiguous culling affected the EDR. Patrols and serological surveillance of residual animals within 10 km of IPS, supported by more extensive evidence from elsewhere in the UK, suggested that cryptic infection in sheep was not widespread. Ultimately, there was insufficient evidence to support the effectiveness of 3 km pre-emptive culling as a control procedure.     

The foot-and-mouth disease epidemic in The Netherlands in 2001

An outbreak of foot-and-mouth disease (FMD) in Great Britain was reported on 21 February 2001, followed by an outbreak of FMD in The Netherlands a month later. This Dutch index outbreak occurred on a mixed, veal-calf/dairy-goat farm in Oene, in the central part of The Netherlands. The most-likely route of infection was the import of Irish veal-calves to this Dutch herd via an FMD-contaminated staging point in France. With hindsight, more herds seemed to be infected by the time the index outbreak was confirmed. The regular EU control measures were implemented, in combination with pre-emptive culling of herds within 1km of each outbreak. Nevertheless, more outbreaks of FMD occurred. Most of the virus infections on those farms were "neighborhood infections". Because the situation seemed out of control locally and the destruction capacity became insufficient, it was decided to implement an emergency vaccination strategy for all biungulates in a large area around Oene to stop further spread of the virus. All susceptible animals on approximately 1800 farms in this area were vaccinated. All farms subsequently were depopulated, starting from 2 weeks after vaccination. In total, 26 outbreaks were detected (the last outbreak on 22 April 2001). In total, approximately 260,000 animals were killed.     

Predictive spatial modelling of alternative control strategies for the foot-and-mouth disease epidemic in Great Britain, 2001

A spatial simulation model of foot-and-mouth disease was used in March and early April 2001 to evaluate alternative control policies for the 2001 epidemic in Great Britain. Control policies were those in operation from March 20, 2001, and comprised a ban on all animal movements from February 23, 2001, and a stamping-out policy. Each simulation commenced with the known population of infected farms on April 10, 2001, and ran for 200 days. For the control policy which best approximated that actually implemented from late March, the model predicted an epidemic of approximately 1800 to 1900 affected farms, and estimated that the epidemic would be eradicated between July and October 2001, with a low probability of continuing beyond October 2001. This policy included the slaughter-out of infected farms within 24 hours, slaughter of about 1.3 of the surrounding farms per infected farm within a further 48 hours, and minimal interfarm movements of susceptible animals. Delays in the slaughter of animals on infected farms beyond 24 hours after diagnosis slightly increased the epidemic size, and failure to achieve pre-emptive slaughter on an adequate number of at-risk farms substantially increased the expected size of the epidemic. Vaccination of up to three of the most outbreak-dense areas carried out in conjunction with the adopted control policy reduced the predicted size of the epidemic by less than 100 farms. Vaccination of buffer zones (designed to apply available vaccine and manpower as effectively as possible) carried out in place of the adopted control policy allowed the disease to spread out of control, producing an epidemic involving over 6000 farms by October 2001, with no prospect of immediate eradication.     

The 2001 epidemic of foot-and-mouth disease in the United Kingdom: epidemiological and meteorological case studies

The possibility of the airborne spread of foot-and-mouth disease during the 2001 epidemic in the uk has been investigated in three epidemiological case studies. On the basis of evidence from field investigations, and a simple meteorological analysis, it is concluded that the spread of disease was consistent with the airborne transport of virus. The distances ranged from less than 1 km to 16 km; six of the farms were over 6 km from the source and involved the passage of virus over the sea combined with meteorological conditions which strongly favoured airborne disease transmission. The results of detailed atmospheric modelling demonstrated that airborne virus could have challenged livestock on all the farms studied. However, with one exception the 24-hour average daily concentrations of the virus were significantly below the experimentally estimated threshold for infection. A detailed model intercomparison established that, under stable atmospheric conditions, peak concentrations of virus up to two orders of magnitude higher might have been experienced for short periods, owing to fluctuations within the plume of virus, and model limitations. This finding would significantly reduce the apparent discrepancy between the experimentally estimated threshold for infection and the modelling results.     

The 2010 foot-and-mouth disease epidemic in Japan

Foot-and-mouth disease (FMD) occurred recently for the first time in a decade in Japan. The index case was detected on a beef-breeding farm in Miyazaki Prefecture, Southern Japan, on April 20, 2010. After confirmation of this first case, control measures such as stamping out, movement restriction and disinfection were implemented. However, these strategies proved insufficient to prevent the spread of FMD and emergency vaccination was adopted. Up until the last outbreak on July 4, 2010, a total of 292 outbreaks had been confirmed, with about 290,000 animals having been culled. The epidemic occurred in an area with a high density of cattle and pigs, making disease control difficult. Invasion of the disease into a high-density area aided its rapid spread and led to difficulties in locating suitable burial sites. Epidemiological investigations indicated that the disease was introduced into Japan approximately one month before detection. This delay in initial detection is considered to have allowed an increased number of outbreaks in the early stage of the epidemic. Nevertheless, the epidemic was contained within a localized area in Miyazaki Prefecture and was eradicated within three months because of intensive control efforts including emergency vaccination. Although this epidemic devastated the livestock industry in Japan, many lessons can be learnt for the future prevention and control of infectious diseases in animals.     

Descriptive epidemiology of the 2001 foot-and-mouth disease epidemic in Great Britain: the first five months.

In February 2001, foot-and-mouth disease (FMD) was confirmed in Great Britain. A major epidemic developed, which peaked around 50 cases a day in late March, declining to under 10 a day by May. By mid-July, 1849 cases had been detected. The main control measures employed were livestock movement restrictions and the rapid slaughter of infected and exposed livestock. The first detected case was in south-east England; infection was traced to a farm in north-east England to which all other cases were linked. The epidemic was large as a result of a combination of events, including a delay in the diagnosis of the index case, the movement of infected sheep to market before FMD was first diagnosed, and the time of year. Virus was introduced at a time when there were many sheep movements around the country and weather conditions supported survival of the virus. The consequence was multiple, effectively primary, introductions of FMD virus into major sheep-keeping areas. Subsequent local spread from these introductions accounted for the majority of cases. The largest local epidemics were in areas with dense sheep populations and livestock dealers who were active during the key period. Most affected farms kept both sheep and cattle. At the time of writing the epidemic was still ongoing; however, this paper provides a basis for scientific discussion of the first five months.     

The epidemic of foot-and-mouth disease in Saskatchewan, Canada, 1951-1952.

The epidemic of foot-and-mouth disease in Saskatchewan in 1951 and 1952 was studied in order to determine origins of outbreaks and methods of spread. The epidemic was initially considered to be vesicular stomatitis and foot-and-mouth disease was not recognized until February 1952, three months after the initial infection. The reports prepared at that time were reviewed in order to obtain details of the numbers of animals infected and the source and date of infection for the outbreaks. Methods of spread were rated according to their likelihood. The introduction of infection by an immigrant through his clothes as well as by sausage was possible. The sequence of events from the first outbreak to the spread from a feedlot/packing plant and from a dairy farm, which failed to report the disease, were clarified. Methods of spread included movement of animals, animal products and people and the airborne route. Milk delivery and artificial insemination did not result in spread of infection. The quarantine of affected farms reduced spread by animals and deterred visits by people. The original diagnosis of vesicular stomatitis was due to misinterpretation of a lesion in an inoculated horse. Laboratory tests established the presence of foot-and-mouth disease. The limited extent of the epidemic, despite the delay in diagnosis, is attributed to (i) the low density of cattle, (ii) few infected pigs and hence less airborne virus and (iii) absence of waste food feeding and milk collection in addition to the limited quarantine imposed.     

Serosurveillance of wild deer and wild boar after the epidemic of foot-and-mouth disease in The Netherlands in 2001

Blood samples from 140 wild deer and 208 wild boar shot in the aftermath of the epidemic of foot-and-mouth disease in The Netherlands in 2001 were examined for antibodies to foot-and-mouth disease virus. They were all negative.     

Human-mediated foot-and-mouth disease epidemic dispersal: disease and vector clusters

Disease clusters were retrospectively explored at national level using a geo-referenced dataset from the 2001 Uruguayan Foot-and-Mouth Disease (FMD) epidemic. Disease location and time (first 11 epidemic weeks) were analysed across 250 counties (of which 160 were infected), without and with control for human mobility related factors (human population and road densities). The null hypothesis of random disease distribution over space and/or time was assessed with: (i) purely temporal; (ii) purely spatial; and (iii) space/time tests. At least within epidemic weeks 2 and 6, a principal disease cluster was observed in 33 contiguous counties (P < 0.01). Two secondary clusters, located at >100 km from each other, were also observed (P < 0.01). The purely spatial test that controlled for human population density identified two non-contiguous clusters (P < 0.01). Space and time analysis also revealed the same 33 counties as members of the principal cluster, of which 31 were also clustered when human population was controlled (P < 0.01). No clusters were reported by the spatial test when road density was assessed. The hypothesis that human mobility related factors autocorrelate with disease was empirically supported by two pieces of information: (i) removal of human population/road densities eliminated >93.9% of the counties included in the principal disease cluster; and (ii) statistically significant correlations (P < 0.05) were observed in the first three epidemic weeks between road density and the number of cases. Clusters where human population density was associated with 47% greater number of cases/sq. km than that of the principal cluster indicated possible roles as disease vectors (vector clusters). Selective control policy in vector clusters is recommended. Periodic (i.e. weekly) cluster and correlation analyses of both disease and other covariates may facilitate disease surveillance and help design space-specific control policy.     

The foot-and-mouth disease epidemic of 2001 in the UK: implications for the USA and the "war on terror"

While there is no evidence to suggest that the recent epidemic of foot-and-mouth disease (Fmd) in the Uk and its subsequent spread to continental Europe were caused by bioterrorism, the extent of the epidemic shows that Fmd could be a very powerful weapon for a bioterrorist wishing to cause widespread disease in livestock and economic disruption for the targeted country. This paper describes the epidemic. It then examines the contentious issues that arose through the use of extensive slaughter to control the epidemic and explores how, in turn, the concerns of society are being translated into a radical change in policy within the European Union with respect to the control of Fmd and other foreign animal diseases. The crisis generated by the Fmd epidemic in Europe in 2001 provides many lessons to be learned for the US and highlights the need for creative thinking in research and teaching within colleges of veterinary medicine to more effectively address the threat of epidemic diseases under the "new world order." There is general agreement that the veterinary profession in the US plays a unique role in protecting the nation against epidemic livestock diseases, whether caused naturally or through bioterrorism. The profession also has a significant role in protecting the public's health, since several epidemic diseases of animals, such as rift valley fever, are zoonotic. However, improved financial support at the federal and state levels is urgently needed to support epidemic-diseases research and teaching in colleges of veterinary medicine.     

Experiences of University of Liverpool veterinary students during the 2001 epidemic of foot-and-mouth disease

The 2001 epidemic of foot-and-mouth disease disrupted the teaching of practical farm animal work for much of that year. Many students in their clinical years in the Faculty of Veterinary Science at the University of Liverpool, went to help to control the disease, both in place of some normal term-time activities and as part of their extramural studies out of term time. This paper, which is based on a questionnaire survey of the students, describes their experiences, the types of work they did, the skills they acquired and their views on the effects of the epidemic on their studies. The vast majority of students felt they had benefited from their experiences and had contributed to combating the epidemic.     

Post-traumatic stress disorder in participants of foot-and-mouth disease epidemic control in Miyazaki,Japan, in 2010

Foot-and-mouth disease (FMD) occurred in Miyazaki, Japan, in 2010, and 290,000 animals were culled. This paper describes the mental distress of the volunteers who had been dispatched to Miyazaki for disease control two years after the epidemic. It also assesses risk factors for post-traumatic stress disorder (PTSD). A participatory appraisal and self-administered questionnaire survey were conducted in 2012 for those who were dispatched to Miyazaki in 2010. The Impact of Event Scale-Revised (IES-R) was used as an indicator of PTSD, and univariate and multivariable analyses were performed. Of the 875 respondents, 1.3% had higher IES-R scores than the cut-off point (25), which is suggestive of PTSD. Mental stresses during and soon after FMD control and after two years were described. Four risk factors associated with high IES-R scores were found: transporting culled animals (P<0.01), stress during FMD control (P<0.01) and at the time of the survey (P<0.01), and lack of someone to talk to about FMD-associated stress at the time of the survey (P<0.01). Veterinarians, livestock technicians and clerical officers involved in FMD control still suffer from mental stress two years later. Public services should provide an opportunity for them to consult with mental health specialists. These findings should be used to better prepare workers who deal with infectious diseases of animals, especially when they must be culled. The establishment of a collaborative framework between veterinary and mental health services is recommended.     

Control of a foot-and-mouth disease epidemic in Argentina

A major epidemic of foot-and-mouth disease affected Argentina during 2001. The epidemic was controlled by mass-vaccination of the national herd and movement restrictions. The median herd disease reproduction ratio (R_H) decreased significantly from 2.4 (before the epidemic was officially recognized) to 1.2 during the mass-vaccination campaign and <1 following the mass-vaccination campaign. The largest distance between two outbreaks was similar during (1905 km) and after (1890 km) the mass-vaccination. However, after mass-vaccination was completed, the proportion of herd outbreaks clustered decreased from 70.4% to 66.8%, respectively. Although a combination of vaccination and livestock-movement restrictions was effective in controlling the epidemic, 112 herd outbreaks occurred up to 6 months after the end of the mass-vaccination campaign. Mass-vaccination and movement restrictions might be an effective strategy to control FMD; however, the time taken to end large, national epidemics might be >1 year.     

Airborne transmission of foot-and-mouth disease virus from Burnside Farm,Heddon-on-the-Wall,Northumberland, during the 2001 epidemic in the United Kingdom

The results of a detailed assessment of the atmospheric conditions when foot-and-mouth disease (FMD) virus was released from Burnside Farm, Heddon-on-the-Wall, Northumberland at the start of the 2001 epidemic in the UK are consistent with the hypothesis that the disease was spread to seven of the 12 farms in the immediate vicinity of the source by airborne virus, and airborne infection could not be ruled out for three other premises; the remaining two premises were unlikely to have been infected by airborne virus. The distances involved ranged from less than 1 km up to 9 km. One of the farms which was most probably infected by airborne virus from Burnside Farm was Prestwick Hall Farm, which is believed to have been key to the rapid spread of the disease throughout the country. In contrast, the results of detailed atmospheric modelling, based on a combination of clinical evidence from the field and laboratory experiments have shown that by assuming a relationship between the 24-hour average virus concentrations and subsequent infection, threshold infection levels were seldom reached at the farms close to Burnside Farm. However, significant short-term fluctuations in the concentration of virus can occur, and short-lived high concentrations may have increased the probability of infection and explain this discrepancy.     

Clinical and laboratory investigations of five outbreaks of foot-and-mouth disease during the 2001 epidemic in the United Kingdom

Clinical and laboratory investigations of five outbreaks of foot-and-mouth disease (FMD) were made during the early stages of the 2001 epidemic in the UK. The first outbreak, confirmed on February 20, was at an abattoir in Essex which specialised in the processing of culled sows and boars. On February 23, the disease was confirmed at a pig farm in Northumberland which held cull sows and boars fed on waste food; the findings indicated that it was the first of the five premises to be infected. The disease had probably been present since early February, and it was the most likely origin of the epidemic. The other premises investigated were a waste food-fed cull sow/boar pig unit in Essex, approximately 30 km from the abattoir, which was probably infected at the same time or before the abattoir, a sheep and cattle farm approximately 6 km from the Northumberland pig farm, which was probably infected by airborne virus from it in the period immediately before February 13, and a sheep and cattle farm in Devon which had clinical disease from February 20 and was probably infected by sheep transported from Northumberland on February 13 which arrived on February 15.     

Factors associated with the early detection of foot-and-mouth disease during the 2001 epidemic in the United Kingdom

An essential objective of an effective foot-and-mouth disease (FMD) eradication campaign is to shorten the infectious period by rapidly detecting and destroying cases of disease. The purpose of our investigation was to identify factors associated with the early detection of clinical FMD during the 2001 outbreak in the United Kingdom. We performed a logistic regression analysis, using early versus late detection of disease as the outcome of interest.During the 2001 FMD outbreak in the United Kingdom, infected premises were more likely to be detected early under the following circumstances: 1) cattle (particularly dairy) were infected rather than sheep; 2) a recently confirmed infected premises was within 3 km of the new case; and 3) the case was initially reported by the farmer, rather than a Local Disease Control Centre-initiated surveillance activity (patrol, tracing, pre-emptive cull). Our findings suggest that reporting by farmers and initiatives that increase farmer education and awareness should be encouraged.