Factors associated with the clinical diagnosis of foot and mouth disease during the 2001 epidemic in the UK

The purpose of this investigation was to identify factors associated with the clinical diagnosis of foot and mouth disease during the 2001 epidemic in the United Kingdom. Using logistic regression, we compared: (1) reports of suspect disease that resulted in the declaration of FMD to reports that did not, and (2) laboratory-positive cases to laboratory-negative cases. From 6,801 reports of suspect disease, 2,026 cases of FMD were identified. Suspect cases were more likely to become clinical cases if: (1) the report originated from the disease control authorities ('active surveillance') rather than the public, usually farmers ('passive surveillance'); (2) cattle were the species suspected of disease, as opposed to sheep; (3) the report was filed during the peak of the epidemic; (4) the reporting premises was within 3 km of an FMD case detected within the previous 2 weeks; or (5) the report originated from certain local disease control centres. There were significant two-way interactions between: type of surveillance and species suspected of disease, type of surveillance and proximity of other infected premises, species suspected and time in the epidemic, and time in the epidemic and proximity of other infected premises. Clinical cases were more likely to be laboratory positive if: (1) they were found by passive versus active surveillance, (2) cattle were suspected of disease (versus sheep), (3) oldest lesions were less than 3 days, (4) the report was filed at any time other than the peak of the epidemic, or (5) the report originated from certain local disease control centres. Significant two-way interactions were found between: type of surveillance and species suspected of disease, and type of surveillance and time in the epidemic.     

Foot-and-mouth disease: an assessment of the risks facing New Zealand

Although New Zealand has never had a case of foot-and-mouth disease (FMD), the threat that this disease poses to the economy of this country has long been recognised. The unprecedented global spread of FMD caused by the type-O PanAsia strain, culminating in the outbreak that occurred in the United Kingdom in early 2001, has refocussed the concerns of biosecurity agencies worldwide. The 3 lines of defence against exotic disease incursions in this country are border controls, surveillance and incursion response capability. This article reviews the pathogenesis, virus survival, routes of infection and methods of spread of FMD virus, and in the light of recent international developments, presents a summary of the major risks of introduction and dissemination of FMD virus and the risk-management measures in place for this country.     

Vaccination against foot-and-mouth disease: the implications for Canada

Vaccination of susceptible animals against foot-and-mouth disease (FMD) is a well established strategy for helping to combat the disease. Traditionally, FMD vaccine has been used to control a disease incursion in countries where the disease has been endemic rather than in countries considered free of the disease. In 2001, the use of vaccine was considered but not implemented in the United Kingdom (1), whereas vaccine was used to help to control FMD in The Netherlands (2,3). Canadian contingency plans provide for the use of vaccine; Canada is a member of the North American Foot-and-Mouth Disease Vaccine Bank, which could supply vaccine if needed. This article explains why Canada might use FMD vaccine to combat an outbreak and the factors that are relevant to the disposal of vaccinated animals and their products. It concludes that vaccination is an important mechanism in Canada's preparedness for an outbreak of FMD and that products from vaccinated animals are safe for human consumption.     

Potential revenue impact of an outbreak of foot-and-mouth disease in the United States

OBJECTIVE: To estimate potential revenue impacts of an outbreak of foot-and-mouth disease (FMD) in the United States similar to the outbreak in the United Kingdom during 2001. DESIGN: Economic analysis successively incorporating quarantine and slaughter of animals, an export ban, and consumer fears about the disease were used to determine the combined impact. SAMPLE POPULATION: Secondary data for cattle, swine, lambs, poultry, and products of these animals. PROCEDURE: Data for 1999 were used to calibrate a model for the US agricultural sector. Removal of animals, similar to that observed in the United Kingdom, was introduced, along with a ban on exportation of livestock, red meat, and dairy products and a reduction and shift in consumption of red meat in the United States. RESULTS: The largest impacts on farm income of an FMD outbreak were from the loss of export markets and reductions in domestic demand arising from consumer fears, not from removal of infected animals. These elements could cause an estimated decrease of $14 billion (9.5%) in US farm income. Losses in gross revenue for each sector were estimated to be the following: live swine, -34%; pork, -24%; live cattle -17%; beef, -20%; milk, -16%; live lambs and sheep, -14%; lamb and sheep meat, -10%; forage, -15%; and soybean meal, -7%. CONCLUSIONS AND CLINICAL RELEVANCE: Procedures to contain an outbreak of FMD to specific regions and allow maintenance of FMD-free exports and efforts to educate consumers about health risks are critical to mitigating adverse economic impacts of an FMD outbreak.     

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.     

Description of recent foot and mouth disease outbreaks in nonendemic areas: exploring the relationship between early detection and epidemic size

The objective of this investigation was to describe the detection of foot and mouth disease (FMD) outbreaks in nonendemic areas, and to consider how events early in an epidemic influence the epidemic's course. We identified 24 epidemics that occurred between 1992 and 2003 in areas officially considered free of FMD. We obtained information about these epidemics from many sources, including the scientific literature, the grey (non peer-reviewed) literature, and individuals involved with the outbreaks. While most of the epidemics consisted of fewer than 150 infected premises, there were 4 extremely large epidemics, each consisting of more than 2000 infected premises. There was no direct relationship between the time to detection and either the total number of infected premises or the number of animals killed for disease control purposes. We believe that the movement of infected animals through markets was the most critical factor that contributed to the unusual magnitude of the very large epidemics.     

Early dissemination of foot-and-mouth disease virus through sheep marketing in February 2001

The results of epidemiological investigations suggest that livestock on up to 79 premises, spread widely throughout the British Isles, may have been exposed to infection by foot-and-mouth disease (FMD) virus by the movement of infected sheep before the first case of the disease was confirmed at an abattoir in Essex on February 20, 2001. A further 36 premises may have been infected by this route before the national livestock movement ban was imposed on February 23.     

Evaluation of risks of foot-and-mouth disease in Scotland to assist with decision making during the 2007 outbreak in the UK

An outbreak of foot-and-mouth disease (FMD) occurred in Surrey on August 3, 2007. A Great Britain-wide ban on livestock movements was implemented immediately. This coincided with the start of seasonal sheep movements off the hills in Scotland; the majority of these animals are sold via markets. The ban therefore posed severe economic and animal-welfare hardships if it was to last through September and beyond. The Scottish Government commissioned an analysis to assess the risk of re-opening markets given the uncertainty about whether FMD had entered Scotland. Tracing of livestock moved from within the risk zone in England between July 16 and August 3 identified contact chains to 12 Scottish premises; veterinary field inspections found a further three unrecorded movements. No signs of infection were found on these holdings. Under the conservative assumption that a single unknown Scottish holding was infected with FMD, an estimate of the time-dependent probability of Scotland being FMD free given no detection was made. Analyses indicated that if FMD was not detected by early to mid-September then it was highly probable that Scotland was FMD free. Risk maps were produced to visualise the potential spread of FMD across Scotland if it was to spread either locally or via market sales.     

Risk factors for transmission of foot-and-mouth disease during an outbreak in southern England in 2007

During an outbreak of foot-and-mouth disease (FMD) in southern England in 2007, a case-control study was conducted to identify risk factors for infection and to investigate the relative impact of risk factors on transmission between the infected farms. Seven of the eight case farms in the outbreak and 22 control farms participated. Data were collected via questionnaires and subjected to comparative statistical analysis. Case farms were further classified as primary or secondary according to the likely source of infection during the study. On primary case farms, it was plausible that infection had been introduced directly from the original source. On secondary case farms, FMD infection was more likely to have originated from another infected premises. Calving occurred more frequently on case farms than on control farms during the risk period, and the two primary case farms had a larger proportion of youngstock than the other farms. Secondary case farms (n=5) had a higher composite environmental risk score and a lower biosecurity score than control farms.     

A comparison of predictions made by three simulation models of foot-and-mouth disease

AIMS: To describe results of a relative validation exercise using the three simulation models of foot-and-mouth disease (FMD) in use by the quadrilateral countries (QUADS; Australia, Canada, New Zealand, and United States of America; USA). METHODS: A hypothetical population of farms was constructed and, following the introduction of an FMD-like disease into a single farm, spread of disease was simulated using each of the three FMD simulation models used by the QUADS countries. A series of 11 scenarios was developed to systematically evaluate the key processes of disease transmission and control used by each of the three models. The predicted number of infected units and the size of predicted outbreak areas for each scenario and each model were compared using the Kruskal-Wallis test. Agreement among the three models in terms of geographical areas predicted to become infected were quantified using Fleiss' Kappa statistic. RESULTS: Although there were statistically significant differences in model outputs in terms of the numbers of units predicted to become infected, the temporal onset of infection throughout the simulation period, and the spatial distribution of infected units, these differences were generally small and would have resulted in the same (or similar) management decisions being adopted in each case. CONCLUSIONS: Agreement among the three models in terms of the numbers of premises predicted to become infected, the temporal onset of infection throughout the simulation period, and the spatial distribution of infected premises provides evidence that each of the model developers are consistent in their approach to simulating the spread of disease throughout a population of susceptible individuals. This consistency implies that the assumptions taken by each development team are appropriate, which in turn serves to increase end-user confidence in model predictions. CLINICAL RELEVANCE: Relative validation is one of a number of steps that can be undertaken to increase end-user confidence in predictions made by infectious disease models.     

Temporal and geographical distribution of cases of foot-and-mouth disease during the early weeks of the 2001 epidemic in Great Britain

Estimates of the likely dates of infection of the early cases of the 2001 foot-and-mouth disease (FMD) epidemic indicate that at least 57 premises in 16 counties in Great Britain were infected before the first case was disclosed. Nationwide animal movement controls were imposed within three days of the first case being confirmed on February 20, when FMD was only known to be in two counties, and these controls limited its geographical spread. After the first few cases were confirmed, new cases were rapidly discovered, and the epidemic curve for the daily number of confirmed cases peaked five weeks later, 11 days later than the peak of the curve based on the estimated dates of infection. In the peak week, both curves showed an average daily number of 43 new cases. The estimated dates of infection are believed to be relatively unbiased for the early cases, for which they were derived from a known contact with infection. However, for the later cases they were estimated mainly from the age of the clinical signs of the disease, and were biased by species and other factors, a bias which would probably have made the estimated dates later than was in fact the case.     

Procedures for preventing the transmission of foot-and-mouth disease virus to pigs and sheep by personnel in contact with infected pigs

The most effective method of containing an outbreak of foot-and-mouth disease (FMD) is by the culling of livestock. However, qualified people must diagnose the disease before the culling can begin, and they must avoid susceptible animals after having been in contact with infected premises, to prevent them from transmitting the virus. To test the effectiveness of biosecurity procedures in preventing the transmission of FMD virus (O/UK/35/2001) investigators contacted and sampled pigs inoculated with FMD virus for approximately 45 minutes and then contacted and sampled sentinel pigs and sheep after either using no biosecurity procedures, or washing their hands and donning clean outerwear, or showering and donning clean outerwear. The virus was detected in the nasal secretions of one investigator immediately after the postmortem investigation of the inoculated pigs but was not detected in samples collected between approximately 12 and 84 hours later. After the contaminated personnel had showered and changed into clean outerwear they did not transmit the strain of FMD virus to susceptible pigs and sheep.     

A comparison of predictions made by three simulation models of foot-and-mouth disease

AIMS: To describe results of a relative validation exercise using the three simulation models of foot-and-mouth disease (FMD) in use by the quadrilateral countries (QUADS; Australia, Canada, New Zealand, and United States of America; USA).

METHODS: A hypothetical population of farms was constructed and, following the introduction of an FMD-like disease into a single farm, spread of disease was simulated using each of the three FMD simulation models used by the QUADS countries. A series of 11 scenarios was developed to systematically evaluate the key processes of disease transmission and control used by each of the three models. The predicted number of infected units and the size of predicted outbreak areas for each scenario and each model were compared using the Kruskal-Wallis test. Agreement among the three models in terms of geographical areas predicted to become infected were quantified using Fleiss' Kappa statistic.

RESULTS: Although there were statistically significant differences in model outputs in terms of the numbers of units predicted to become infected, the temporal onset of infection throughout the simulation period, and the spatial distribution of infected units, these differences were generally small and would have resulted in the same (or similar) management decisions being adopted in each case.

CONCLUSIONS: Agreement among the three models in terms of the numbers of premises predicted to become infected, the temporal onset of infection throughout the simulation period, and the spatial distribution of infected premises provides evidence that each of the model developers are consistent in their approach to simulating the spread of disease throughout a population of susceptible individuals. This consistency implies that the assumptions taken by each development team are appropriate, which in turn serves to increase end-user confidence in model predictions.

CLINICAL RELEVANCE: Relative validation is one of a number of steps that can be undertaken to increase end-user confidence in predictions made by infectious disease models.     

Space-time interaction as an indicator of local spread during the 2001 FMD outbreak in the UK

During the 2001 FMD outbreak in the UK, decisions on the level of implementation of control measures were supported by predictive models. Models were mainly used as macro-level tools to predict the behaviour of the disease in the whole country rather than at the local level. Here we explore the use of the magnitude and characteristics of the space-time interaction as an indicator of local spread and, indirectly, of the effectiveness of control measures aimed at reducing short-range transmission during the course of a major livestock disease epidemic. The spatiotemporal evolution patterns are described in the four main clusters that were observed during the outbreak by means of the hazard rate and space-time K-function (K(s,t)). For each local outbreak, the relative measure D(0)(s,t), derived from K(s,t), which represents the excess risk attributable to the space-time interaction was calculated for consecutive 20-day temporal windows to represent the dynamics of the space-time interaction. The dynamics of the spatiotemporal interaction were very different among the four local clusters, suggesting that the intensity of local spread, and therefore the effectiveness of control measures, markedly differed between local outbreaks. The large heterogeneity observed in the relative impact of being close in time and space to an infected premises suggests that the decision making in relation to control of the outbreak would have benefited from indicators of local spread which could be used to complement global predictive modelling results. Despite its limitations, our results suggest that the real-time analysis of the space-time interaction can be a valuable decision support tool during the course of a livestock disease epidemic.     

How do resources influence control measures during a simulated outbreak of foot and mouth disease in Australia?

An outbreak of foot and mouth disease (FMD) could seriously impact Australia's livestock sector and economy. As an FMD-free country, an outbreak would trigger a major disease control and eradication program that would include the culling of infected and at risk animals (‘stamping out’), movement restrictions and zoo-sanitary measures. Additional control measures may also include pre-emptive culling or vaccination. However, it is unclear what disease strategy would be most effective under Australian conditions and different resource levels. Using a stochastic simulation model that describes FMD transmission between farms in a livestock dense region of Australia, our results suggest that using current estimates of human resource capacity for surveillance, infected premises operations and vaccination, outbreaks were effectively controlled under a stamping out strategy. However, under more constrained resource allocations, ring vaccination was more likely to achieve eradication faster than stamping out or pre-emptive culling strategies.     

Maintaining a vigilance for foreign animal diseases.

The incursion of foot-and-mouth disease (FMD) into the United Kingdom in February 2001 served as a wakeup call for North American agriculture. As the livestock health crisis in the United Kingdom progressed, it became increasingly evident that the United States, Canada, and Mexico were also susceptible to an incursion of a foreign animal disease. The terrorist attacks of September 11, 2001, and the subsequent anthrax mailings reaffirmed the fact that the United States is vulnerable to an infectious assault, regardless of whether it is intentional or accidental.     

Identification of case clusters and counties with high infective connectivity in the 2001 epidemic of foot-and-mouth disease in Uruguay

OBJECTIVE: To evaluate the influence of individual spatial units (ie, counties) on the epidemic spread of foot-and-mouth disease (FMD) virus. SAMPLE POPULATION: 163 counties in Uruguay where there was an outbreak of FMD between April 23 and July 11, 2001. PROCEDURE: A geographically referenced database was created, and the distance between counties (13,203 county pairs), road density of counties (163 counties), and time when cases were reported in those counties (11 weeks of the epidemic) were considered to assess global spatial and spatial-temporal autocorrelation, determine the contribution of links connecting pairs of counties with infected animals, and allow us to hypothesize the influence for spread during the epidemic for counties with greater than the mean infective link contributions. RESULTS: Case clusters were indicated by the Moran Iand Mantel tests during the first 6 weeks of the epidemic. Spatial lags between pairs of counties with infected animals revealed case clustering before and after vaccination was implemented. Temporal lags predicted autocorrelation for up to 3 weeks. Link indices identified counties expected to facilitate epidemic spread. If control measures had been implemented in counties with a high index link (identifiable as early as week 1 of the epidemic), they could have prevented (by week 11 of the epidemic) at least 2.5 times as many cases per square kilometer than the same measures implemented in counties with average link indices. CONCLUSIONS AND CLINICAL RELEVANCE: Analysis of spatial autocorrelation and infective link indices may identify network conditions that facilitate (or prevent) disease spread.     

Spatiotemporal patterns and risks of herd breakdowns in pigs with postweaning multisystemic wasting syndrome

A retrospective cohort study of 116 British pig farms was undertaken to investigate the epidemiological risk factors associated with herd breakdowns with postweaning multisystemic wasting syndrome (PMWS). Farmers reported the PMWS status of their herd (case definition 1) and, where applicable, when the disease was first suspected and what they observed; they described a prolonged increase in mortality in six to 16-week-old pigs that was not attributable to any disease known to be on their farm. There was over 90 per cent agreement on the farmers' PMWS status between the farmers and their veterinarians. Approximately 70 per cent of the breakdowns were confirmed at the laboratory (case definition 2) except during the outbreak of foot-and-mouth disease (FMD) in 2001 when it was reduced to 30 per cent. Porcine circovirus type 2 antigen was detected in pigs examined postmortem (case definition 3) in approximately 90 per cent of the farms with increased mortality. The breakdowns occurred initially in the south of England and spread west and north, as well as locally in a radial pattern from the affected farms, and there was strong statistical evidence that there was non-random space-time clustering. The risk of herd breakdowns with PMWS was not constant; therefore, for each case definition, three survival models were developed with outcome variable time to breakdown of between January 2000 and January 2001, February 2001 to September 2001 (during FMD) or October 2001 to December 2003. Exposures with a bivariable significance of P<0.20 were tested in three multivariable Cox proportional hazard models. From January 2000 to January 2001 the risk of a herd breakdown with PMWS for definitions 1, 2 and 3 was greater for farms with 600 or more breeding sows, and for definitions 1 and 3 there was an increased risk associated with the purchase of replacement gilts rather than using homebred replacements. For definitions 1 and 3 the farms where the nearest pig farm had no breeding pigs were at greater risk of a breakdown than those where the nearest farm had breeding stock, as were the farms where visitors were not requested to avoid pigs for more than three days before visiting the farm during the FMD outbreak. From October 2001, the associated risks were identical for all three case definitions; farms were at greater risk when they had 600 or more breeding sows, if visitors had not avoided contact with pigs for more than three days before visiting the farm, and when there was a farm with PMWS less than five miles away. The affected farms were more likely to have disease associated with porcine parvovirus, porcine reproduction and respiratory syndrome virus, erysipelas, Escherichia coli and salmonella. These exposures were positively associated with large herds and the farm being close to other pig farms, but did not remain in the final models for breakdown with PMWS, indicating that such farms may be at greater risk of many infectious diseases.