Focusing on Syndromic Surveillance, BSE, and Echinococcosis

| 18 Comments

Depending on the material discussed on lecture, please comment on the 3 most poignant points raised during the lecture today and ask 1 question you may have had during today's lecture.

18 Comments

I'm impressed by how hard it would be to eradicate Echinococcus in a rural environment. Even to have to deworm dogs every 45-60 days seems burdensome to me.

I found it interesting that Contagious Bovine Pleuropheumonia was eradicated without any lab test or scientific study. Just common sense epidemiology.

I would have liked some comparison of human Rabies deaths around the world. Again, when I was growing up, we were scared of aggressive dogs because they were supposed to be rabid. I don't think today's DVM students have that same experience or background.

Question: I'm wondering how many diseases have been eradicated in MN in the past 30 years? When I started in practice several of these disease were not yet eradicated. But surveillance efforts were successful in achieving eradication.

-I think that today's lecture highlighted the importance of syndromic surveillance in the eradication of disease, as our example with Pleuropneumonia illustrated. Perhaps we spend too much time determining what is causing a disease rather than tracking it and culling affected animals. Or perhaps we need to develop side by side work in identification and syndromic surveillance to eradicate disease.

-BSE presents unique surveillance issues as it is not detectable in the live animals, and has a long incubation period. I think that more work needs to be done determining how to most cost effectively look for this disease within our cattle populations.

-Surveillance and eradication of Echinococcosis appears to be a very difficult issue because of the amount of time that would need to be spent deworming all of the affected dogs. I think that the new plan outlined in lecture today will help in the work done in Uruguay, especially since it incorporates education for the people.

Question: What determines if the CDC/USDA or some other health agency will attempt to eradicate a disease? What are some inherent factors of disease that make this easier or harder to accomplish?

Comments:
-It's amazing how people don't trust educators or veterinarians, especially if they aren't from the same area. Wouldn't everyone want to be safe and listen on how to prevent being infected w/echinococcosis?
-It's interesting to learn that echinococcosis has been around, and recognized for many hundreds of years. I wonder if people thought it was caused by dogs.
-I thought it was interesting that BSE's spread to many different countries from the UK was so widespread.

Question:
If feeding meat and bone meal has been discontinued from many countries, how is that we're still seeing BSE, even when we're past it's incubation time?

-It is a tough situation to try to eradicate or even control a disease when the local population is unwilling to help. I find it frustrating that one tries diligently to control a disease and locals can not see the good one is trying to achieve
-So much money is dumped into trying to find bovine TB and eradicate it that its almost impossible to fully get rid of it due to intermingling of wildlife animals who carry TB
-Targeting surveillance is sometimes a much more cost effective way of controlling diseases and eradicating them.

Question: Since rabies is a serious disease, why aren't the laws and regulations on rabies vaccination of domestic animals universal through all the states?

Interesting comment Naomi, I would guess to say that we still see BSE because of the spontaneous form of BSE. But that is totally a guess

1. I had not quite thought of this but sometimes simple surveillance systems such as slaughter surveillance with a good back tracking system could fair much better than a more technical test like the ELISA (due to false positives).

2.The possible link between infected workers and bovine tuberculosis makes the control and especially eradication a lofty goal to achieve. Given the political undertones that may go along with targeting specific groups for TB testing.

3.I was impressed by how effective targeted surveillance can be- case in point the BSE surveillance in the US. Effective and affordable.

Question:

a. Cattle under 48 months may not exhibit clinical signs, but could they be 'infective' . Does BSE have a form of latency stage?

1. I was very interested to learn that Minnesota has no state requirement for rabies vaccination in dogs and cats. Given the prevalence of rabies compared to other states which have laws requiring rabies vaccination, it seems strange that Minnesota does not have a state wide law.

2. The discussion of workers on dairy farms infecting cows with TB and vice versa is very interesting topic. I can see how there can be very sensitive issues surrounding legal status in the US and ethnicity.

3. Ecchinococcus is a neglected disease that often affects populations that are socioeconomically poor and rural. It was interesting to hear about the recent peri-urban populations that have brought the disease to the urban environment and the unique measures that are being used to help reduce the disease.

Question:
I wonder if there are any diagnostics tests being researched that could detect BSE at an earlier age of onset?

1) Syndromic surveillance is used to monitor diseases based on clinical signs; with the objective to identify sick animals early before confirmation of diagnoses and reporting to a state/federal government agency.
2) Bats, skunks and raccoons are the main rabies vectors/reservoirs in the United States, and state governments are using baits to vaccinate wildlife.
3) The state of Minnesota does not require dogs and cats to be vaccinated against rabies; it is up to each municipality or county to determine their own regulations regarding rabies vaccination requirements for dogs and cats.
Question:
In regards to the TB tests used in cattle, what does it cost a cattle producer to have a veterinarian perform a Caudal Fold Tuberculin (CFT) Test and a Comparative Cervical Tuberculin (CCT) Test.

1)BSE is a very fascinating disease to me, and one that I do not understand very well (in terms of its development). I understand that obtaining vCJD is a frightening and very debilitating disease to receive, but I wonder if the world is overreacting and spending too much money on a disease that has an extremely small prevalence. Should that money be spent on other pathogens that kill millions of people each year, such as diarrhoeal diseases?

2)Echinococcosis is a difficult parasite to control. I think in many ways dealing with the stray dog population is key. In the United States there is not enough money to deal with the stray dog population, so I could only imagine how difficult it can be for a country that is not as well off economically as we are.

3)Syndromic surveillance is the best system to use for BSE considering that those with clinical signs have a greater chance of showing classical lesions on histology.

Question:
What is the surveillance program for echinococcosis in the United States?

1)Syndromic surveillance is an idea that is catching on in human medicine because of the threat of things like bioterrorism and foodborne illness outbreaks. It has not caught on as much in animals.
2)BSE surveillance is expensive and very specifically targeted at high risk animals even though the prevalence of BSE infection is incredibly low.
3)Because of the varying sensitivites and specificities of the echinococcus tests, the tests result in different apparent prevalences that may not be reflective of the true prevalence of the disease.

Question: We talked about the fact that Uruguay tests all of their dairy herds for TB every year. Do they test any beef herds even though TB hasn't been found in beef as of yet?

1) I realized today I had an assumption about rabies vaccination policies which was wrong - it is interesting that Minnesota doesn't have the same laws as so many other states.

2) After working through the exercise, I think it really solidified how targeted surveillance is useful in creating a program that is effective and financially feasible.

3) I seem to always forget and then always be surprised that we know so little about TSEs compared to how much time and money we have spent investigating them.

?) I am interested in learning more about the possibility of human --> animal transmission of disease. I think it is definitely something I don't normally think of as being a concern, but is totally worth consideration.

* I was heartened to learn that some diseases have been completely eradicated from areas of the globe. It’s incentive to keep moving forward.

* Distrust of government programs is a reality in the United States as well. While it is sometimes justifiable, as with the fallout from the infamous Tuskegee syphilis experiments, it can also have devastating consequences. For example studies show that up to 50% of African Americans believe that HIV is a manmade virus and 15% believe that its purpose is genocide against blacks. These beliefs are probably part of the reason that African Americans have the highest rate of HIV in the US. Distrust is very difficult to overcome.

* The currently very low human mortality rate from rabies would not seem to make additional prevention programs fundable. It will be interesting to see if the current cuts to public health infrastructure result in the resurgence of certain diseases in the US.

? Could the current cases of BSE be a result of vertical transmission?

3 Points

CBPP is a good example of successful syndromic surveillance. Clinical signs were used to identify suspect cases and then were culled which eradicated the disease in the US prior to discovery of the etiologic agent or development of advanced diagnostic screening.

Surveillance of high risk populations for BSE may increase sensitivity of screening, data quality, stability and cost-effectiveness. However due to a prolonged incubation period, timeliness of current screening methods is also prolonged.

Many rural places may have acceptability with surveillance programs (ex. Echinococcus/TB) if those executing them are not trusted in the community. This can create low compliance, representativeness of the population and sensitivity of testing.

Question

If canine Rabies was brought in from another country (ex. Infected puppies imported from the airport) would Minnesota’s rabies surveillance be executed with adequate timeliness before other animals/human cases are observed (since there may be variable acceptability of rabies vaccination/testing in Minnesota)? Would cases be more likely to spread since there is no mandatory laws on vaccinations of pets in some jurisdictions of Minnesota?

1. I did not realize how few cases of bovine TB were found positive in Uruguay (10/45,000 farms). As well as how many more dairy cattle compared to beef cattle tested positive. This is a problem because of zoonotic risks with drinking unpasteurized milk.
2. I learned that cooking kills echinococcis. This can be a huge preventative measure since one of the main causes of spread is feeding offal (uncooked organs to dogs).
3. I did not know that Contagious bovine pleuropneumonia was eradicated so early in US history. This really exemplifies the value of surveillance focused on clinical disease signs.
Q. We learned some of the animals that can be infected with echinococcis. I was wondering what other animals may be infected (I have observed a hydatid cyst in a chinchilla). I was wondering if there if they can infect camelids since there is a large population of them in South America.

1 - I thought an important distinction was made today weighing the pros and cons of screening based on statistical probability (i.e. a small percentage of total cattle tested in USA for BSE) and screening based on public confidence (i.e. all cattle tested in Finland).

2 - It seems that distrust in the government is a universal sentiment (go figure). I've always thought that the most successful projects work hard to build a base of support with the public. That said, I think "acceptability" is one of the most challenging aspects of surveillance to do well.

3 - I learned that, apparently, state and other government veterinarians have seniority over "regular" vets when it comes to performing a few extra steps with a screening test. I understand that the CCT is more complicated than a CFT, but I'm not convinced it should be an exclusive club (as mentioned in class, this might actually hinder surveillance).

Q - I know Andrés has stated that there are no deer in Uruguay to harbor TB, but surely there must be some wildlife capable of being reservoirs, especially on the northern border with Brazil? Why hasn't this issue been addressed more (both in Uruguay and the US)?

Three Key Points:
1)It is possible to create a surveillance system and eradicate a disease without knowing the disease cause and using only clinical signs (vs diagnostic testing), as seen with contagious bovine pleuropneumonia.
2)The long incubation period and limited testing ability complicate surveillance of BSE and various countries utilize different methods (e.g. targeted surveillance) for different reasons.
3)Putting together a surveillance system for echinococcus highlights the complexity of such a task and the many factors that must be addressed to make the system successful.

Question: What are the common factors of a disease that elicit the creation of a surveillance system?

1. It was interesting to learn about the BSE surveillance system in the US which I think is very cost efficient. I think people in Finland don’t expect to find any new BSE cases in the future. At least all the veterinarians I’ve met at slaughter plants think testing all cattle over 48 months is crazy and huge waste of money but it’s not Finland to decide because it’s ruled by the European Union.

2. I think that planning the surveillance systems for different cases was really educational. When you have to consider things actively they’ll be much easier to remember afterwards.

3. Requirement of all dogs and cats to be vaccinated against rabies in the whole country would probably help to lower the prevalence but you could also use other ways like the oral bait vaccines for wild animals and maybe some controlling for dogs and cats which come from an another country. For example testing antibody levels before the animals can enter the country.

Question: If the cervical tuberculin test can only be done by state veterinarians couldn’t you educate all veterinarians to do the test so there wouldn’t be a problem with too little people being able to do the test?

1. It was interesting to learn about the BSE surveillance system in the US which I think is very cost efficient. I think people in Finland don’t expect to find any new BSE cases in the future. At least all the veterinarians I’ve met at slaughter plants think testing all cattle over 48 months is crazy and huge waste of money but it’s not Finland to decide because it’s ruled by the European Union.

2. I think that planning the surveillance systems for different cases was really educational. When you have to consider things actively they’ll be much easier to remember afterwards.

3. Requirement of all dogs and cats to be vaccinated against rabies in the whole country would probably help to lower the prevalence but you could also use other ways like the bait vaccines for wild animals and maybe some controlling for dogs and cats which come from an another country. For example testing that vaccine antibody levels are high enough before the animals can enter the country.

Question: If the cervical tuberculin test can only be done by state veterinarians couldn’t you educate all veterinarian to do the test so there wouldn’t be a problem with too little people being able to do the test?

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