Field evaluation of the single intradermal cervical tuberculin test and the interferon-gamma assay for detection and eradication of bovine tuberculosis in Spain

Genome-Wide Association Study Reveals Quantitative Trait Loci and Candidate Genes Associated with High Interferon-gamma Production in Holstein Cattle Naturally Infected with Mycobacterium Bovis

Mycobacterium bovis (Mb) is the causative agent of bovine tuberculosis (bTb). Genetic selection aiming to identify less susceptible animals has been proposed as a complementary measure in ongoing programs toward controlling Mb infection. However, individual animal phenotypes for bTb based on interferon-gamma (IFNɣ) and its use in bovine selective breeding programs have not been explored. In the current study, IFNɣ production was measured using a specific IFNɣ ELISA kit in bovine purified protein derivative (bPPD)-stimulated blood samples collected from Holstein cattle. DNA isolated from the peripheral blood samples collected from the animals included in the study was genotyped with the EuroG Medium Density bead Chip, and the genotypes were imputed to whole-genome sequences. A genome-wide association analysis (GWAS) revealed that the IFNɣ in response to bPPD was associated with a specific genetic profile (heritability = 0.23) and allowed the identification of 163 SNPs, 72 quantitative trait loci (QTLs), 197 candidate genes, and 8 microRNAs (miRNAs) associated with this phenotype. No negative correlations between this phenotype and other phenotypes and traits included in the Spanish breeding program were observed. Taken together, our results define a heritable and distinct immunogenetic profile associated with strong production of IFNɣ in response to Mb.

Assessment of the sensitivity of the bovine tuberculosis eradication program in a high prevalence region of Spain using scenario tree modeling

In spite of the efforts invested to eradicate bovine tuberculosis (bTB) in cattle, the disease is still present in several developed countries, including Spain. Among the factors related with disease persistence in high prevalence areas, the lack of sensitivity of the screening test for detection of infected herds [single intradermal tuberculin (SIT) test] can play a major role. Here, a scenario tree model mimicking the diagnostic test scheme in place in the region of Castilla y Leon (Spain) was developed to estimate the probability of detecting bTB in an infected-non detected officially tuberculosis free (OTF) herd (herd sensitivity, HSe). In order to do so the probability of detecting at least one positive animal in the SIT test with/without post-mortem (detection of lesions and culture) confirmation in an infected herd was estimated using Monte Carlo simulation through @RISK (Palisade Co, NY, USA). Uncertainty on the accuracy of the diagnostic tests was introduced in the model using distributions based on the literature. The performance of the model was evaluated by comparing the predicted number of SIT/post-mortem positive animals in infected herds with those observed in newly detected bTB-infected herds in the region in 2011-2015. The estimated HSe of the SIT test was 76.2% (95% probability interval: 19.8-97.6). According to the model, bTB infection would be then confirmed through culture in 65.3% (95% PI: 50.0-82.3) of the herds detected through the SIT test, so that overall the proportion of infected-non detected OTF herds in which the infection could be confirmed after the initial SIT test was 49.6% (95% PI: 9.75-80.3). The predicted HSe of both SIT test and culture was directly correlated with herd size. Results from the model suggest a moderate but highly variable HSe of the current surveillance system in place for bTB detection in OTF herds located in high prevalence areas, that could be maximized by performing multiple tests within a year as indicated in the Spanish eradication program (with a median SIT HSe of 87% when two consecutive tests were considered). In addition, these results highlight the usefulness of performing subsequent SIT tests to rule out infection in SIT-positive herds even when the causative agent cannot be isolated.

Molecular Identification of Mycobacterium Species of Public Health and Veterinary Importance from Cattle in the South State of México

Mycobacterium genus causes a variety of zoonotic diseases. The best known example is the zoonotic tuberculosis due to M. bovis. Much less is known about "nontuberculous mycobacteria (NTM)," which are also associated with infections in humans. The Mexican standard NOM-ZOO-031-1995 regulates the presence of M. bovis in cattle; however, no regulation exists for the NTM species. The objective of this study was to isolate and identify nontuberculous mycobacteria species from cattle of local herds in the south region of the State of Mexico through the identification and detection of the 100 bp molecular marker in the 23S rRNA gene with subsequent sequencing of the 16S rRNA gene. Milk samples (35) and nasal exudate samples (68) were collected. From the 108 strains isolated, 39 were selected for identification. Thirteen strains isolated from nasal exudates amplified the 100 bp molecular marker and were identified as M. neoaurum (six strains), M. parafortuitum (four strains), M. moriokaense (two strains), and M. confluentis (one strain). Except M. parafortuitum, the other species identified are of public health and veterinary concern because they are pathogenic to humans, especially those with underlying medical conditions.

Enemies and turncoats: bovine tuberculosis exposes pathogenic potential of Rift Valley fever virus in a common host, African buffalo (Syncerus caffer)

The ubiquity and importance of parasite co-infections in populations of free-living animals is beginning to be recognized, but few studies have demonstrated differential fitness effects of single infection versus co-infection in free-living populations. We investigated interactions between the emerging bacterial disease bovine tuberculosis (BTB) and the previously existing viral disease Rift Valley fever (RVF) in a competent reservoir host, African buffalo, combining data from a natural outbreak of RVF in captive buffalo at a buffalo breeding facility in 2008 with data collected from a neighbouring free-living herd of African buffalo in Kruger National Park. RVF infection was twice as likely in individual BTB+ buffalo as in BTB- buffalo, which, according to a mathematical model, may increase RVF outbreak size at the population level. In addition, co-infection was associated with a far higher rate of fetal abortion than other infection states. Immune interactions between BTB and RVF may underlie both of these interactions, since animals with BTB had decreased innate immunity and increased pro-inflammatory immune responses. This study is one of the first to demonstrate how the consequences of emerging infections extend beyond direct effects on host health, potentially altering the dynamics and fitness effects of infectious diseases that had previously existed in the ecosystem on free-ranging wildlife populations.

Assessment of the sensitivity of the gamma-interferon test and the single intradermal comparative cervical test for the diagnosis of bovine tuberculosis under field conditions

In some French départements, the eradication of bovine tuberculosis is incomplete and usual skin tests [single intradermal tuberculin test (SIT) and single intradermal comparative cervical test (SICCT)] have poor specificity due to cross-reactions with non-pathogenic mycobacteria, causing economic losses. In Côte d'Or (Burgundy, France), an experimental serial testing scheme based on the combination of SICCT and gamma-interferon (IFN-γ) tests has been initiated in order to shorten the interval between suspicion and its invalidation in herds with false-positive results to skin tests. Our aim was to assess the scheme's sensitivity and to compare it to the sensitivity of the screening scheme recommended by the European Commission. Our study included 1768 animals from Côte d'Or. The sensitivities of both schemes were estimated using a Bayesian approach. The individual sensitivity of the IFN-γ test [88·1%, 95% credibility interval (CrI) 72·8-97·5] was not significantly different from individual SICCT sensitivity (80·3%, 95% CrI 61·6-98·0) and individual SIT sensitivity (84·2%, 95% CrI 59·0-98·2). The individual specificity of the IFN-γ test was 62·3% (95% CrI 60·2-64·5). No significant difference could be demonstrated between the sensitivities of the serial testing scheme used in Côte d'Or (73·1%, 95% CrI 41·1-100) and the European Union serial testing scheme (70·1%, 95% CrI 31·5-100·0).

Extent of Mycobacterium bovis infection in dairy cattle herds subject to partial culling as determined by an interferon-gamma assay

The interferon-gamma (IFN-γ) assay is employed as a complementary diagnostic test for bovine tuberculosis (BTB) in many countries. To simplify this assay, we established a 96-well plate format using the ESAT-6 and CFP-10 antigens and then employed it to determine the extent of Mycobacterium (M.) bovis infection in dairy herds with a history of BTB outbreaks in a country where only selective culling is practiced. The sensitivity and specificity of this IFN-γ assay were 85.9% and 100%, respectively, based on comparison with the conventional single intradermal tuberculin test (SIDT). The IFN-γ assay was also positive in 30.4% and 36.8% of SIDT-negative animals from herds with recent and remote BTB outbreaks, respectively. Of 14 SIDT-negative, IFN-γ positive cattle, five (35.7%) were culture positive and an additional six were positive based on a polymerase chain reaction-based test for M. bovis. Therefore, the IFN-γ assay has the potential to serve as a specific and sensitive test for M. bovis infection in dairy cattle. Further, the results indicated that a substantial portion of SIDT-negative animals in herds with previous BTB outbreaks were actually infected with M. bovis. Accordingly, the present selective-culling strategy may require modifications to include this more sensitive assay.

Towards risk-based test protocols: estimating the contribution of intensive testing to the UK bovine tuberculosis problem

Eradicating disease from livestock populations involves the balancing act of removing sufficient numbers of diseased animals without removing too many healthy individuals in the process. As ever more tests for bovine tuberculosis (BTB) are carried out on the UK cattle herd, and each positive herd test triggers more testing, the question arises whether ‘false positive’ results contribute significantly to the measured BTB prevalence. Here, this question is explored using simple probabilistic models of test behaviour. When the screening test is applied to the average UK herd, the estimated proportion of test-associated false positive new outbreaks is highly sensitive to small fluctuations in screening test specificity. Estimations of this parameter should be updated as a priority. Once outbreaks have been confirmed in screening-test positive herds, the following rounds of intensive testing with more sensitive, albeit less specific, tests are highly likely to remove large numbers of false positive animals from herds. Despite this, it is unlikely that significantly more truly infected animals are removed. BTB test protocols should become based on quantified risk in order to prevent the needless slaughter of large numbers of healthy animals.

Parameter estimation and use of gamma interferon assay for the diagnosis of bovine tuberculosis in Brazil

This study aimed to evaluate the interference of tuberculin test on the gamma-interferon (INFg) assay, to estimate the sensitivity and specificity of the INFg assay in Brazilian conditions, and to simulate multiple testing using the comparative tuberculin test and the INFg assay. Three hundred-fifty cattle from two TB-free and two TB-infected herds were submitted to the comparative tuberculin test and the INFg assay. The comparative tuberculin test was performed using avian and bovine PPD. The INFg assay was performed by the BovigamTM kit (CSL Veterinary, Australia), according to the manufacturer's specifications. Sensitivity and specificity of the INFg assay were assessed by a Bayesian latent class model. These diagnostic parameters were also estimate for multiple testing. The results of INFg assay on D0 and D3 after the comparative tuberculin test were compared by the McNemar's test and kappa statistics. Results of mean optical density from INFg assay on both days were similar. Sensitivity and specificity of the INFg assay showed results varying (95% confidence intervals) from 72 to 100% and 74 to 100% respectively. Sensitivity of parallel testing was over 97.5%, while specificity of serial testing was over 99.7%. The INFg assay proved to be a very useful diagnostic method.

Eurasian wild boar response to skin-testing with mycobacterial and non-mycobacterial antigens

Eurasian wild boar (Sus scrofa) are able to maintain bovine tuberculosis (bTB) in the wild and are most probably able to transmit the disease to other species, thus acting as a true wildlife reservoir. Translocation of wild boar is a common practice in European countries. Therefore, identifying effective tools for bTB diagnosis in living wild boar is crucial for the implementation of control measures. We describe for the first time the sex and origin related differences in the skin-test response to mycobacterial antigens (bPPD and aPPD) and to a non-mycobacterial antigen (PHA, a plant derived mitogen) in wild and farmed wild boar, and used a small sample of known M. bovis infected wild boar to establish whether skin-testing is an option for bTB diagnosis in living wild boar. The highest skinfold increase response was detected at the PHA injection site, evidencing that the PHA test could be useful in monitoring cell mediated immunity (CMI) in wild boar populations. A clear age-increasing trend of the PHA response indicated that age should be taken into account when measuring CMI in wild boar. Origin related differences in the response against mycobacterial antigens could reflect differential exposure to mycobacterial antigens. Skin testing in BCG immunized wild boar showed low sensitivity (43-57%), while the sensitivity was good in the culture positive controls (75-100%), depending on the reading criterion. Specificity improved when the criterion was a response to bPPD larger than 2 mm and bPPD response larger than aPPD response (77%). Although a limited sample, our results indicated the potential of skin test as a bTB diagnostic tool in Eurasian wild boar. However, handling of wild boar is dangerous, specificity is low, and more effort is needed in order to define the sensitivity of this technique.

TESTE DE TUBERCULIZAÇÃO EM OVINOS (OVIS ARIES) EXPERIMENTALMENTE SENSIBILIZADOS

RESUMO Esta pesquisa visou estabelecer valores de referência para a interpretação da reação tuberculínica em ovinos experimentalmente inoculados com cepas padrões de Mycobacterium bovis AN5 e Mycobacterium avium D4, além de avaliar possíveis reações clínicas provocadas pela resposta imuno-alérgica intradérmica à tuberculina. Utilizou-se 30 ovinos, distribuídos por 3 grupos de 10 animais cada, a saber: A sensibilizados M. avium; B sensibilizados M. bovis e C – não sensibilizado (controle) – que receberam injeção de solução fisiológica. Após 45 dias da sensibilização, realizou-se o Teste Cervical Comparativo (TCC) com reação medida pela variação da espessura da pele com cutímetro de mola, nos seguintes momentos: antes da aplicação das tuberculinas (PPDs -derivado protéico purificado), 12h, 24h, 48h, 72h e 96h após a aplicação. Em relação à reação ao PPD bovino, no Teste Cervical Simples (TCS), lido às 72h (± 6 horas) pós-tuberculinização (p. t.), considerou-se uma reação positiva, quando o aumento da espessura da pele foi igual ou maior que 2,40 mm; como inconclusiva, com aumento entre 1,00 e 2,40 mm, e como reação negativa, aumentos da espessura da pele inferiores a 1 mm. A análise dos resultados da leitura do TCC, realizada às 72h p. t., permitiu concluir que o animal poderá ser considerado com resposta: positiva, quando a reação ao PPD bovino superar aquela ao aviário em pelo menos 2 mm; inconclusiva, quando a reação ao PPD bovino for maior que aquela ao aviário, com diferença entre 1 e 1,90 mm, e negativa quando a reação bovina for menor que a aviária ou maior em até 0,90 mm. Estes valores obtidos para o TCS e TCC são propostos como padrão de interpretação desses testes em ovinos.

The immunology of bovine tuberculosis and progression toward improved disease control strategies

Failure to remove cattle diseased with Mycobacterium bovis has immense financial implications for disease control, animal health and agricultural trade as well as the zoonotic risk to human health. Current disease control strategies based on DTH skin testing fail to detect all diseased cattle and additional measures are urgently needed to improve detection of disease and to prevent naïve animals becoming exposed to infection. Experimental models of bovine TB traditionally based on intra-nasal instillation, intra-tracheal inoculation or placed in-contact with infected cattle, have been further developed using aerosolised bacteria delivered to the respiratory tract, allowing field-like bovine TB to be recreated under controlled, experimental conditions. Experimental infection models have already been used to improve diagnostic tests. Specificity of DTH skin testing can be improved under experimental conditions, using recombinant ESAT-6, while laboratory assays such as IFN-gamma release have benefited from the use of defined proteins to improve assay specificity. In combination, antigen cocktails may also improve test sensitivity. There is a concerted international effort to evaluate vaccines for use in cattle populations and to define vaccination strategies which will eliminate disease from infected herds. DNA, protein and genetically modified vaccines inoculated in a single dose, given as prime-boost or injected concurrently, will elicit significant protection against challenge with M. bovis under controlled conditions. However, vaccines and vaccination strategies require evaluation under field conditions. Furthermore, complementary strategies are under development to differentiate immune responses that follow vaccination from those following disease. This paper describes those recent advances which may lead to the introduction of improved disease control strategies.

Assessment of diagnostic tools for eradication of bovine tuberculosis in cattle co-infected withMycobacterium bovisandM. aviumsubsp.paratuberculosis

The intradermal tuberculin (IDTB) test and the interferon-gamma (IFN-gamma) assay are used worldwide for detection of bovine tuberculosis in cattle, but little is known about the effect of co-infecting agents on the performance of these diagnostic tests. This report describes a field trial conducted in a cattle herd with dual infection (bovine tuberculosis and paratuberculosis) during 3.5 years. It has been based on a strategic approach encompassing serial parallel testing (comparative IDTB test, the IFN-gamma assay and serology of paratuberculosis) that was repeated 8 times over the period, and segregation of animals into two herds. The IDTB test detected 65.2% and the IFN-gamma test detected 69.6% of the Mycobacterium bovis culture-positive cattle. However, the IDTB test performed better during the first part of the trial, while the IFN-gamma test was the only method that detected infected animals during the following three samplings. The number of false positive reactors with the IDTB and/or the IFN-gamma tests was remarkably high compared to other reports, and could be caused by cross-reactivity with M. avium subsp. paratuberculosis. Also, the M. bovis isolates from cattle and wildlife from the same property were characterised using molecular techniques to disclose an epidemiological link. The IDTB test may not be appropriate to eradicate bovine tuberculosis in herds with dual mycobacterial infections. This report highlights the need to use several diagnostic techniques for the accurate detection of M. bovis infected animals in these herds.

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

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

Diagnosis of Mycobacterium bovis infection in cattle by use of the gamma-interferon (Bovigam®) assay

The strategic use of the gamma-interferon (IFN-gamma) assay (Bovigam) can provide a means for the early identification of Mycobacterium bovis infected cattle, thus ensuring their removal from an infected herd. When used in parallel with the tuberculin test, it is capable of identifying infected cattle, which might otherwise not be detected until later, if at all. The early detection and removal of these animals reduces the risk that they will become a source of infection for other cattle. When targeted in herds of high prevalence the benefits to the herd owner directly concerned can be considerable as the assay provides a means of shortening the period of restriction for such herds. This serves to generate confidence among herd owners and other stakeholders that effective schemes, based on sound scientific principles, can be developed to eradicate tuberculosis from infected cattle populations.

Evaluation of surveillance strategies for bovine tuberculosis (Mycobacterium bovis) using an individual based epidemiological model

The Netherlands holds the bovine tuberculosis-free (BTB-free) status according to European Union standards, but in recent years small outbreaks of the infection have occurred. After the last outbreak in 1999 with 10 infected herds the question raised if the current surveillance system, visual inspection of carcasses at the slaughterhouse, is efficient enough to detect infected cattle in time and to maintain the official BTB-free status. Through epidemiological modelling, the risk of a major outbreak is quantified, using one of six surveillance strategies. These are the currently used visual inspection of carcasses at the slaughterhouse (SL), the ELISA test on blood samples of carcasses at the slaughterhouse (ELISA-B), the gamma-interferon test on blood samples of carcasses at the slaughterhouse (GAMMA-B), comparative tuberculination of the herd (CT), the combined method of single and comparative tuberculination of the herd (ST+CT) and the ELISA test on samples of bulk milk (ELISA-M). Test frequency of the last three methods was varied as well. A stochastic individual based model (IBM) was developed to simulate a chain of infected herds, where each individual animal is followed in time. The model mimics the nation-wide situation after the introduction of one infected animal into one herd. BTB-transmission is simulated with an S-E(1)-E(2)-I state transition model. Output is time until detection of the infection, prevalence in the detected herd and the number of infected herds at the time of detection. For the assessment 500 simulations were used, representing 500 BTB-introductions. Model robustness to parameter values was analysed with Monte Carlo elasticity analysis, for which 1000 simulations were used. Results of median time until detection and median number of infected farms at detection for SL (302 weeks and seven farms) were in agreement with estimates from an outbreak in the Netherlands in 1999. ELISA-B and GAMMA-B performed better than SL with a much lower median time until detection (189 and 97 weeks, respectively). The results for the tuberculination methods (ST+CT and CT) and ELISA-M depended heavily on the frequency in which the tests were performed. The tuberculination methods ST+CT and CT yield comparable results and detect the infection sooner than SL, also at the lowest tested frequency of once in 5 years. ELISA-M is comparable with SL at frequencies of once in 4 or 5 years, and this test works well at frequencies of once a year or higher. Our study results are used for an economical optimisation analysis of the six surveillance strategies.

IFN-gamma diagnostic tests in the context of bovine mycobacterial infections in Belgium

In countries where cattle tuberculosis caused by Mycobacterium bovis (Mbov) and paratuberculosis caused by Mycobacterium avium subsp. paratuberculosis (Mptb) are present, testing strategies for the Mbov eradication have to discriminate between these two infections. Present indirect tests are based on the analysis of the specific cellular immune response (DTH, IFN-gamma) against crude mycobacterial antigens (avian and bovine PPD). In this study, we compared the evolution of the IFN-gamma responses of animals experimentally infected with Mbov, Mptb, or inoculated with Mycobacterium phlei. Mbov inoculation induced a strong IFN-gamma response that allows rapid classification of the status of the animals following interpretation criteria set up by us. Experimental inoculation with M. phlei induced sensitisation to mycobacterial antigens as detected by the IFN-gamma test but these reactions were of short duration, therefore, repeated testing allows us to define these animals as aspecific reactors. IFN-gamma response induced after oral inoculation of calves with Mptb was of low intensity and ratio of responses measured against avian versus bovine PPD did not allow a clear diagnostic at least for the six first month of infection.

BOVIGAM: an in vitro cellular diagnostic test for bovine tuberculosis

BOVIGAM which is based on the detection of gamma interferon (IFN- gamma) is a rapid, laboratory assay of a cell mediated immune response that may be used for the detection of tuberculosis (TB) infection in animals. Whole blood is first incubated overnight with bovine PPD, avian PPD or negative control antigens, and IFN- gamma in the supernatant plasma is then measured by EIA. TB infection is indicated by a predominant IFN- gamma response to bovine PPD. Since 1988, BOVIGAM has been extensively trialed on more than 200 000 cattle in Australia, Brazil, Ireland, Northern Ireland, Italy, New Zealand, Romania, Spain and the USA. Sensitivity has varied between 81.8% and 100% for culture-confirmed bovine TB and specificity between 94% and 100%. The IFN- gamma assay detects M. bovis infection earlier than the skin test and in New Zealand is applied to detect skin-test negative cattle with TB, where after slaughter a significant number of IFN- gamma reactors have TB. BOVIGAM is also approved in New Zealand for serial testing skin test positive cattle when non-specificity is suspected. Cattle are tested 7-30 days after a positive caudal fold test. The boosting effect of the skin test on T-cell activity allows blood to be cultured with PPD up to 30 h after collection without effecting accuracy. The BOVIGAM results are not affected by poor nutritional condition and are only mildly and briefly affected by dexamethasone treatment and parturition. IFN- gamma responses of cattle vaccinated with BCG are dose-dependent and short-lived. The BOVIGAM kit is now used routinely in many countries for the detection of M. bovis infected cattle, buffalo and goats.

Cattle-to-cattle transmission of Mycobacterium bovis

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