Estimating the human health risk from possible BSE infection of the British sheep flock

Should infectious disease modelling research be subject to ethics review?

Should research projects involving epidemiological modelling be subject to ethical scrutiny and peer review prior to publication? Mathematical modelling had considerable impacts during the COVID-19 pandemic, leading to social distancing and lockdowns. Imperial College conducted research leading to the website publication of a paper, Report 9, on non-pharmaceutical interventions (NPIs) and COVID-19 mortality demand dated 16th March 2020, arguing for a Government policy of non-pharmaceutical interventions (e.g. lockdowns, social distancing, mask wearing, working from home, furlough, school closures, reduced family interaction etc.) to counter COVID 19. Enquiries and Freedom of Information requests to the institution indicate that there was no formal ethical committee review of this specific research, nor was there any peer review prior to their online publication of Report 9. This paper considers the duties placed upon researchers, institutions and research funders under the UK 'Concordat to Support Research Integrity' (CSRI), across various bioethical domains, and whether ethical committee scrutiny should be required for this research.

Non-human primates in prion diseases

The fascinating history of prion diseases is intimately linked to the use of nonhuman primates as experimental models, which brought so fundamental and founding information about transmissibility, pathogenesis, and resistance of prions. These models are still of crucial need for risk assessment of human health and may contribute to pave a new way towards the moving field of prion-like entities which now includes the main human neurodegenerative diseases (especially Alzheimer's and Parkinson's diseases).

Forecasting for COVID-19 has failed

Epidemic forecasting has a dubious track-record, and its failures became more prominent with COVID-19. Poor data input, wrong modeling assumptions, high sensitivity of estimates, lack of incorporation of epidemiological features, poor past evidence on effects of available interventions, lack of transparency, errors, lack of determinacy, consideration of only one or a few dimensions of the problem at hand, lack of expertise in crucial disciplines, groupthink and bandwagon effects, and selective reporting are some of the causes of these failures. Nevertheless, epidemic forecasting is unlikely to be abandoned. Some (but not all) of these problems can be fixed. Careful modeling of predictive distributions rather than focusing on point estimates, considering multiple dimensions of impact, and continuously reappraising models based on their validated performance may help. If extreme values are considered, extremes should be considered for the consequences of multiple dimensions of impact so as to continuously calibrate predictive insights and decision-making. When major decisions (e.g. draconian lockdowns) are based on forecasts, the harms (in terms of health, economy, and society at large) and the asymmetry of risks need to be approached in a holistic fashion, considering the totality of the evidence.

Scientific report on the analysis of the 2-year compulsory intensified monitoring of atypical scrapie

The European Commission asked EFSA whether the scientific data on the 2-year intensified monitoring in atypical scrapie (AS) outbreaks (2013-2020) provide any evidence on the contagiousness of AS, and whether they added any new knowledge on the epidemiology of AS. An ad hoc data set from intensified monitoring in 22 countries with index case/s of AS in sheep and/or goats (742 flocks from 20 countries, 76 herds from 11 countries) was analysed. No secondary cases were confirmed in goat herds, while 35 secondary cases were confirmed in 28 sheep flocks from eight countries. The results of the calculated design prevalence and of a model simulation indicated that the intensified monitoring had limited ability to detect AS, with no difference between countries with or without secondary cases. A regression model showed an increased, but not statistically significant, prevalence (adjusted by surveillance stream) of secondary cases in infected flocks compared with that of index cases in the non-infected flocks (general population). A simulation model of within-flock transmission, comparing a contagious (i.e. transmissible between animals under natural conditions) with a non-contagious scenario, produced a better fit of the observed data with the non-contagious scenario, in which each sheep in a flock had the same probability of developing AS in the first year of life. Based on the analyses performed, and considering uncertainties and data limitations, it was concluded that there is no new evidence that AS can be transmitted between animals under natural conditions, and it is considered more likely (subjective probability range 50-66%) that AS is a non-contagious, rather than a contagious disease. The analysis of the data of the EU intensified monitoring in atypical scrapie infected flocks/herds confirmed some of the known epidemiological features of AS but identified that major knowledge gaps still remain.

Sheep scab transmission: a spatially explicit dynamic metapopulation model

Psoroptic mange (sheep scab), caused by the parasitic mite, Psoroptes ovis, is an important disease of sheep worldwide. It causes chronic animal welfare issues and economic losses. Eradication of scab has proved impossible in many sheep-rearing areas and recent reports of resistance to macrocyclic lactones, a key class of parasiticide, highlight the importance of improving approaches to scab management. To allow this, the current study aimed to develop a stochastic spatial metapopulation model for sheep scab transmission which can be adapted for use in any geographical region, exhibited here using data for Great Britain. The model uses agricultural survey and sheep movement data to geo-reference farms and capture realistic movement patterns. Reported data on sheep scab outbreaks from 1973 to 1991 were used for model fitting with Sequential Monte Carlo Approximate Bayesian Computation methods. The outbreak incidence predicted by the model was from the same statistical distribution as the reported outbreak data (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\chi }^{2}$$\end{document}χ2 = 115.3, p = 1) and the spatial location of sheep scab outbreaks predicted was positively correlated with the observed outbreak data by county (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\tau$$\end{document}τ = 0.55, p < 0.001), confirming that the model developed is able to accurately capture the number of farms infected in a year, the seasonality of scab incidence and the spatial patterns seen in the data. This model gives insight into the transmission dynamics of sheep scab and will allow the exploration of more effective control strategies.

A Fluorescent Metal-Organic Framework for Food Real-Time Visual Monitoring

Due to increasing food-safety issues, exploiting efficient approaches for food quality assessment and instrumentation has attracted concerns worldwide. Herein, a smart evaluation system based on a fluorescent metal-organic framework (MOF) is developed for real-time visual monitoring of food freshness. Via post-synthetic modification, a ratiometric fluorescent MOF probe is constructed by covalently coupling fluorescein 5-isothiocyanate (5-FITC) with NH₂ -rich lanthanide MOF. The probes exhibit a dual-emissive-responsive to biogenic amine, resulting in an increase in FITC emission along with a decrease in Eu³⁺ emission accompanied by a clear distinguishable color transition from orange red to green. After doping the probes on a flexible substrate, the obtained MOF composite film can be integrated with a smartphone-based portable platform easily. It is proved that this smart evaluation system can be used for on-site inspection of the freshness of raw fish samples. This work develops a fluorescent MOF-based smart evaluation system as a novel platform for application in food monitoring, which not only has enormous economic value but also holds great public health significance.

Forecasting efforts from prior epidemics and COVID-19 predictions

Since the onset of the COVID-19 pandemic, countless disease prediction models have emerged, shaping the focus of news media, policymakers, and broader society. We reviewed the accuracy of forecasts made during prior twenty-first century epidemics, namely SARS, H1N1, and Ebola. We found that while disease prediction models were relatively nascent as a research focus during SARS and H1N1, for Ebola, numerous such forecasts were published. We found that forecasts of deaths for Ebola were often far from the eventual reality, with a strong tendency to over predict. Given the societal prominence of these models, it is crucial that their uncertainty be communicated. Otherwise, we will be unaware if we are being falsely lulled into complacency or unjustifiably shocked into action.

Genotype-dependent molecular evolution of sheep bovine spongiform encephalopathy (BSE) prions in vitro affects their zoonotic potential

Prion diseases are rare fatal neurological conditions of humans and animals, one of which (variant Creutzfeldt-Jakob disease) is known to be a zoonotic form of the cattle disease bovine spongiform encephalopathy (BSE). What makes one animal prion disease zoonotic and others not is poorly understood, but it appears to involve compatibility between the prion strain and the host prion protein sequence. Concerns have been raised that the United Kingdom sheep flock may have been exposed to BSE early in the cattle BSE epidemic and that serial BSE transmission in sheep might have resulted in adaptation of the agent, which may have come to phenotypically resemble scrapie while maintaining its pathogenicity for humans. We have modeled this scenario in vitro. Extrapolation from our results suggests that if BSE were to infect sheep in the field it may, with time and in some sheep genotypes, become scrapie-like at the molecular level. However, the results also suggest that if BSE in sheep were to come to resemble scrapie it would lose its ability to affect humans.

Increased susceptibility of transgenic mice expressing human PrP to experimental sheep bovine spongiform encephalopathy is not due to increased agent titre in sheep brain tissue

Bovine spongiform encephalopathy (BSE) in cattle and variant Creutzfeldt-Jakob disease in humans have previously been shown to be caused by the same strain of transmissible spongiform encephalopathy agent. It is hypothesized that the agent spread to humans following consumption of food products prepared from infected cattle. Despite evidence supporting zoonotic transmission, mouse models expressing human prion protein (HuTg) have consistently shown poor transmission rates when inoculated with cattle BSE. Higher rates of transmission have however been observed when these mice are exposed to BSE that has been experimentally transmitted through sheep or goats, indicating that humans may potentially be more susceptible to BSE from small ruminants. Here we demonstrate that increased transmissibility of small ruminant BSE to HuTg mice was not due to replication of higher levels of infectivity in sheep brain tissue, and is instead due to other specific changes in the infectious agent.

There is no safe dose of prions

Understanding the circumstances under which exposure to transmissible spongiform encephalopathies (TSEs) leads to infection is important for managing risks to public health. Based upon ideas in toxicology and radiology, it is plausible that exposure to harmful agents, including TSEs, is completely safe if the dose is low enough. However, the existence of a threshold, below which infection probability is zero has never been demonstrated experimentally. Here we explore this question by combining data and mathematical models that describe scrapie infections in mice following experimental challenge over a broad range of doses. We analyse data from 4338 mice inoculated at doses ranging over ten orders of magnitude. These data are compared to results from a within-host model in which prions accumulate according to a stochastic birth-death process. Crucially, this model assumes no threshold on the dose required for infection. Our data reveal that infection is possible at the very low dose of a 1000 fold dilution of the dose that infects half the challenged animals (ID50). Furthermore, the dose response curve closely matches that predicted by the model. These findings imply that there is no safe dose of prions and that assessments of the risk from low dose exposure are right to assume a linear relationship between dose and probability of infection. We also refine two common perceptions about TSE incubation periods: that their mean values decrease linearly with logarithmic decreases in dose and that they are highly reproducible between hosts. The model and data both show that the linear decrease in incubation period holds only for doses above the ID50. Furthermore, variability in incubation periods is greater than predicted by the model, not smaller. This result poses new questions about the sources of variability in prion incubation periods. It also provides insight into the limitations of the incubation period assay.

Detection and localisation of PrP(Sc) in the liver of sheep infected with scrapie and bovine spongiform encephalopathy

Prions are largely contained within the nervous and lymphoid tissue of transmissible spongiform encephalopathy (TSE) infected animals. However, following advances in diagnostic sensitivity, PrP(Sc), a marker for prion disease, can now be located in a wide range of viscera and body fluids including muscle, saliva, blood, urine and milk, raising concerns that exposure to these materials could contribute to the spread of disease in humans and animals. Previously we demonstrated low levels of infectivity in the liver of sheep experimentally challenged with bovine spongiform encephalopathy. In this study we show that PrP(Sc) accumulated in the liver of 89% of sheep naturally infected with scrapie and 100% of sheep challenged with BSE, at both clinical and preclinical stages of the disease. PrP(Sc) was demonstrated in the absence of obvious inflammatory foci and was restricted to isolated resident cells, most likely Kupffer cells.

Breeding with resistant rams leads to rapid control of classical scrapie in affected sheep flocks

Susceptibility to scrapie, a transmissible spongiform encephalopathy in sheep, is modulated by the genetic make-up of the sheep. Scrapie control policies, based on selecting animals of resistant genotype for breeding, have recently been adopted by the Netherlands and other European countries. Here we assess the effectiveness of a breeding programme based on selecting rams of resistant genotype to obtain outbreak control in classical scrapie-affected sheep flocks under field conditions. In six commercially-run flocks following this breeding strategy, we used genotyping to monitor the genotype distribution, and tonsil biopsies and post-mortem analyses to monitor the occurrence of scrapie infection. The farmers were not informed about the monitoring results until the end of the study period of six years. We used a mathematical model of scrapie transmission to analyze the monitoring data and found that where the breeding scheme was consistently applied, outbreak control was obtained after at most four years. Our results also show that classical scrapie control can be obtained before the frequency of non-resistant animals is reduced to zero in the flock. This suggests that control at the national scale can be obtained without a loss of genetic polymorphisms from any of the sheep breeds.

Discontinuity patterns in stages of the precaution adoption process model: Meat consumption during a livestock epidemic

OBJECTIVES

Patterns of changes in social-cognitive variables were investigated in order to test selected stages of the precaution adoption process model (PAPM). It was hypothesized that non-linear trends (discontinuity patterns) in perceived vulnerability, positive and negative outcome expectancies, procrastination, and self-efficacy might be observed across the stages.

DESIGN

Cross-sectional data from 808 respondents were employed.

METHOD

Questionnaire data were collected in an on-line study on meat consumption during a livestock epidemic in Germany. Polynomial trends and analyses of variance with post-hoc-contrasts were used to examine the patterns of change.

RESULTS

Discontinuity patterns were found for perceived vulnerability, negative outcome expectancies, and procrastination. The data provided partial support for discontinuity patterns in self-efficacy. Continuity patterns were found for positive outcome expectancies.

CONCLUSIONS

Results provide support for a stage model rather than a pseudo-stage model.

Scrapie prevalence in sheep of susceptible genotype is declining in a population subject to breeding for resistance

Background

Susceptibility of sheep to scrapie infection is known to be modulated by the PrP genotype of the animal. In the Netherlands an ambitious scrapie control programme was started in 1998, based on genetic selection of animals for breeding. From 2002 onwards EU regulations required intensive active scrapie surveillance as well as certain control measures in affected flocks.

Here we analyze the data on genotype frequencies and scrapie prevalence in the Dutch sheep population obtained from both surveillance and affected flocks, to identify temporal trends. We also estimate the genotype-specific relative risks to become a detected scrapie case.

Results

We find that the breeding programme has produced a steady increase in the level of genetic scrapie resistance in the Dutch sheep population. We also find that a significant decline in the prevalence of scrapie in tested animals has occurred a number of years after the start of the breeding programme. Most importantly, the estimated scrapie prevalence level per head of susceptible genotype is also declining significantly, indicating that selective breeding causes a population effect.

Conclusions

The Dutch scrapie control programme has produced a steady rise in genetic resistance levels in recent years. A recent decline in the scrapie prevalence per tested sheep of susceptible prion protein genotype indicates that selective breeding causes the desired population effect.

Surveillance and simulation of bovine spongiform encephalopathy and scrapie in small ruminants in Switzerland

BACKGROUND

After bovine spongiform encephalopathy (BSE) emerged in European cattle livestock in 1986 a fundamental question was whether the agent established also in the small ruminants' population. In Switzerland transmissible spongiform encephalopathies (TSEs) in small ruminants have been monitored since 1990. While in the most recent TSE cases a BSE infection could be excluded, for historical cases techniques to discriminate scrapie from BSE had not been available at the time of diagnosis and thus their status remained unclear. We herein applied state-of-the-art techniques to retrospectively classify these animals and to re-analyze the affected flocks for secondary cases. These results were the basis for models, simulating the course of TSEs over a period of 70 years. The aim was to come to a statistically based overall assessment of the TSE situation in the domestic small ruminant population in Switzerland.

RESULTS

In sum 16 TSE cases were identified in small ruminants in Switzerland since 1981, of which eight were atypical and six were classical scrapie. In two animals retrospective analysis did not allow any further classification due to the lack of appropriate tissue samples. We found no evidence for an infection with the BSE agent in the cases under investigation. In none of the affected flocks, secondary cases were identified. A Bayesian prevalence calculation resulted in most likely estimates of one case of BSE, five cases of classical scrapie and 21 cases of atypical scrapie per 100'000 small ruminants. According to our models none of the TSEs is considered to cause a broader epidemic in Switzerland. In a closed population, they are rather expected to fade out in the next decades or, in case of a sporadic origin, may remain at a very low level.

CONCLUSIONS

In summary, these data indicate that despite a significant epidemic of BSE in cattle, there is no evidence that BSE established in the small ruminant population in Switzerland. Classical and atypical scrapie both occur at a very low level and are not expected to escalate into an epidemic. In this situation the extent of TSE surveillance in small ruminants requires reevaluation based on cost-benefit analysis.

The role of mathematical modelling in understanding the epidemiology and control of sheep transmissible spongiform encephalopathies: a review

To deal with the incompleteness of observations and disentangle the complexities of transmission much use has been made of mathematical modelling when investigating the epidemiology of sheep transmissible spongiform encephalopathies (TSE) and, in particular, scrapie. Importantly, these modelling approaches allow the incidence of clinical disease to be related to the underlying prevalence of infection, thereby overcoming one of the major difficulties when studying these diseases. Models have been used to investigate the epidemiology of scrapie within individual flocks and at a regional level; to assess the efficacy of different control strategies, especially selective breeding programmes based on prion protein (PrP) genotype; to interpret the results of scrapie surveillance; and to inform the design of surveillance programmes. Furthermore, mathematical modelling has played an important role when assessing the risk to human health posed by the possible presence of bovine spongiform encephalopathy in sheep. Here, we review the various approaches that have been taken when developing and analysing mathematical models for the epidemiology and control of sheep TSE and assess their impact on our understanding of these diseases. We also identify areas that require further work, discuss future challenges and identify data gaps.

Protective effect of the T112 PrP variant in sheep challenged with bovine spongiform encephalopathy

Sheep with an ARQ/ARQ PRNP genotype at codon positions 136/154/171 are highly susceptible to experimental infection with bovine spongiform encephalopathy (BSE). However, a number of sheep challenged orally or intracerebrally with BSE were clinically asymptomatic and found to survive or were diagnosed as BSE-negative when culled. Sequencing of the full PRNP gene open reading frame of BSE-susceptible and -resistant sheep indicated that, in the majority of Suffolk sheep, resistance was associated with an M112T PRNP variant (TARQ allele). A high proportion (47 of 49; 96%) of BSE-challenged wild-type (MARQ/MARQ) Suffolk sheep were BSE-infected, whereas none of the 20 sheep with at least one TARQ allele succumbed to BSE. Thirteen TARQ-carrying sheep challenged with BSE are still alive and some have survival periods equivalent to, or greater than, reported incubation periods of BSE in ARR/ARR and VRQ/VRQ sheep.

Linkages between animal and human health sentinel data

INTRODUCTION

In order to identify priorities for building integrated surveillance systems that effectively model and predict human risk of zoonotic diseases, there is a need for improved understanding of the practical options for linking surveillance data of animals and humans. We conducted an analysis of the literature and characterized the linkage between animal and human health data. We discuss the findings in relation to zoonotic surveillance and the linkage of human and animal data.

METHODS

The Canary Database, an online bibliographic database of animal-sentinel studies was searched and articles were classified according to four linkage categories.

RESULTS

465 studies were identified and assigned to linkage categories involving: descriptive, analytic, molecular, or no human outcomes of human and animal health. Descriptive linkage was the most common, whereby both animal and human health outcomes were presented, but without quantitative linkage between the two. Rarely, analytic linkage was utilized in which animal data was used to quantitatively predict human risk. The other two categories included molecular linkage, and no human outcomes, which present health outcomes in animals but not humans.

DISCUSSION

We found limited use of animal data to quantitatively predict human risk and listed the methods from the literature that performed analytic linkage. The lack of analytic linkage in the literature might not be solely related to technological barriers including access to electronic database, statistical software packages, and Geographical Information System (GIS). Rather, the problem might be from a lack of understanding by researchers of the importance of animal data as a 'sentinel' for human health. Researchers performing zoonotic surveillance should be aware of the value of animal-sentinel approaches for predicting human risk and consider analytic methods for linking animal and human data. Qualitative work needs to be done in order to examine researchers' decisions in linkage strategies between animal and human data.

Prevalence of sheep infected with classical scrapie in Great Britain, 1993–2007

Extensive surveillance for classical scrapie has been carried out in Great Britain since 1993, the results of which can be used for monitoring the effect of control measures introduced since 2001. A back-calculation approach was used to estimate the prevalence of sheep infected with classical scrapie, which integrates data on reported clinical cases (1993–2007) and the results of fallen stock and abattoir surveys (2002–2007). The prevalence of classical scrapie in GB was fairly constant until 2003, although the estimates depended on assumptions made about the performance of diagnostic tests used in the surveys. If infected animals could be detected in the final quarter of the incubation period, the estimated prevalence was 0·6–0·7%, while if they could be detected in the final half of the incubation period, it was 0·3–0·4%. Between 2003 and 2007 the prevalence declined by around 40%, and the magnitude of the reduction was independent of assumptions made about the diagnostic tests.

Field performance of two rapid screening tests in active surveillance of transmissible spongiform encephalopathies in small ruminants

Recently, screening tests for monitoring the prevalence of transmissible spongiform encephalopathies specifically in sheep and goats became available. Although most countries require comprehensive test validation prior to approval, little is known about their performance under normal operating conditions. Switzerland was one of the first countries to implement 2 of these tests, an enzyme-linked immunosorbent assay (ELISA) and a Western blot, in a 1-year active surveillance program. Slaughtered animals (n = 32,777) were analyzed in either of the 2 tests with immunohistochemistry for confirmation of initial reactive results, and fallen stock samples (n = 3,193) were subjected to both screening tests and immunohistochemistry in parallel. Initial reactive and false-positive rates were recorded over time. Both tests revealed an excellent diagnostic specificity (>99.5%). However, initial reactive rates were elevated at the beginning of the program but dropped to levels below 1% with routine and enhanced staff training. Only those in the ELISA increased again in the second half of the program and correlated with the degree of tissue autolysis in the fallen stock samples. It is noteworthy that the Western blot missed 1 of the 3 atypical scrapie cases in the fallen stock, indicating potential differences in the diagnostic sensitivities between the 2 screening tests. However, an estimation of the diagnostic sensitivity for both tests on field samples remained difficult due to the low disease prevalence. Taken together, these results highlight the importance of staff training, sample quality, and interlaboratory comparison trials when such screening tests are implemented in the field.

Within-holding prevalence of sheep classical scrapie in Great Britain

Background

Data from the Compulsory Scrapie Flocks Scheme (CSFS), part of the compulsory eradication measures for the control of scrapie in the EU, have been used to estimate the within-holding prevalence of classical scrapie in Great Britain (GB). Specifically data from one of the testing routes within the CSFS have been used; the initial cull (IC), whereby two options can be applied: the whole flock cull option by which the entire flock is depopulated, and the genotyping and cull of certain genotypes.

Results

Between April 2005 and September 2007, 25,316 suitable samples, submitted from 411 flocks in 213 scrapie-affected holdings in Great Britain, were tested for scrapie. The predicted within-holding prevalence for the initial cull was 0.65% (95% CI: 0.55–0.75). For the whole cull option was 0.47% (95% CI: 0.32–0.68) and for the genotype and cull or mixed option (both options applied in different flocks of the same holding), the predicted within-holding prevalence was 0.7% (95% CI: 0.6–0.83). There were no significant differences in the within-flock prevalence between countries (England, Scotland and Wales) or between CSFS holdings by the surveillance stream that detected the index case. The number of CSFS flocks on a holding did not affect the overall within-holding prevalence of classical scrapie.

Conclusion

These estimates are important in the discussion of the epidemiological implications of the current EU testing programme of scrapie-affected flocks and to inform epidemiological and mathematical models. Furthermore, these estimates may provide baseline data to assist the design of future surveillance activities and control policies with the aim to increase their efficiency.

Transmission dynamics and mechanisms of endemicity of scrapie in the UK sheep population

SUMMARYScrapie is a fatal neurological disease of sheep which is endemic in the United Kingdom. It is one of the family of transmissible spongiform encephalopathies (TSEs) that includes BSE. In this paper, we developed a micro-simulation model for scrapie in the UK sheep population, incorporating the genetic and structural diversity of the population and infectious contact between flocks through trading. The simulation was fitted to epidemiological data from a range of sources. We found a detection/reporting probability of 16% (95% CI 12-17) for animals dying of scrapie. Prevalence of infected animals in the population was about 0.15%. Infected individuals were found in 9% of flocks overall, rising to 60% in Shetland and 75% in Swaledale flocks. Mean values of R0 for flocks varied with breed from 2.43 (Shetland) to 0.21 (Suffolk). We also examined the possible long-term persistence of scrapie in the UK flock in the absence of any intervention.

Control of scrapie in the UK sheep population

Scrapie is a fatal transmissible spongiform encephalopathy (TSE) of sheep, endemic in the UK for centuries. Interest in the disease has been heightened over the last decade by the possibility of the related BSE being transmissible to and between sheep and a range of control interventions has been proposed and implemented. In this paper, we examined the effect of these policies and their components on observed case rate, susceptible allele frequency and R0 within the framework of a large simulation model of the British sheep population and its breeding and trading structure. We compared interventions with the natural fade-out of scrapie in the population through loss of susceptible genotypes in the absence of control. We compare the results of interventions with the natural course of the scrapie epidemic. Our model suggested that scrapie will persist in the national flock for 300-400 years with the impact on gene frequencies confined largely to high case-rate breeds, such as Shetland and Swaledale. We found the National Scrapie Plan (NSP) to be the most effective in terms of the removal of both susceptible genotypes and scrapie from the population. Complete eradication of scrapie can be achieved within 32 years (95% CI 23-43 years). The Compulsory Scrapie Flock Scheme (CSFS) is as effective as the NSP in reducing the observed case rate but has a limited impact on the frequencies of susceptible genotypes in the population overall. In combination with the NSP, eradication of scrapie is achieved >10 years faster. Of the components of the CSFS, the breeding and culling aspects are each almost as effective as the full policy, with trading restrictions contributing little. We have speculated on the impact of control measures on the possibility BSE infection within the national flock by examining their effect on flock R0 for BSE across different breeds.

A descriptive study of the prevalence of atypical and classical scrapie in sheep in 20 European countries

Background

The development of active surveillance programmes for transmissible spongiform encephalopathies of small ruminants across Europe has led to the recent identification of a previously undetected form of ovine prion disease, 'atypical' scrapie. Knowledge of the epidemiology of this disease is still limited, as is whether it represents a risk for animal and/or public health.

The detection of atypical scrapie has been related to the use of only some of the EU agreed rapid tests. Information about the rapid tests used is not, as yet, available from public reports on the surveillance of transmissible spongiform encephalopathies in small ruminants. We collected detailed results of active surveillance from European countries to estimate and to compare the prevalence of atypical scrapie and classical scrapie in sheep for each country stratified by each surveillance stream; healthy slaughtered and found dead adult sheep.

Results

From the 20 participating countries, it appeared that atypical scrapie was detected in Europe wherever the conditions necessary for its diagnosis were present. In most countries, atypical scrapie and classical scrapie occurred at low prevalence level. The classical scrapie prevalence estimates were more variable than those for atypical scrapie, which appeared remarkably homogeneous across countries, surveillance streams and calendar years of surveillance. Differences were observed in the age and genotype of atypical scrapie and classical scrapie cases that are consistent with previous published findings.

Conclusion

This work suggests that atypical scrapie is not rare compared to classical scrapie. The homogeneity of its prevalence, whatever the country, stream of surveillance or year of detection, contrasts with the epidemiological pattern of classical scrapie. This suggests that the aetiology of atypical scrapie differs from that of classical scrapie.

Quantifying the risk from ovine BSE and the impact of control strategies

Although no naturally infected sheep with bovine spongiform encephalopathy (BSE) has ever been discovered, it remains possible that BSE once infected the UK sheep population, has been transmitted between sheep, and is still present today. We constructed a mathematical model to assess the current maximum theoretical exposure to consumers from BSE-infected ovine material and to estimate the risk reduction that could be achieved by abattoir-based control options if BSE-infected sheep were ever found in the national flock. We predict that, if present, the exposure to consumers from a single BSE-infected sheep would be high: one sheep, close to the end of its incubation period, is likely to contribute 10-1000 times more infectious material than a fully infectious cow. Furthermore, 30% of this exposure comes from infectivity residing in lymphatic and peripheral tissue that cannot be completely removed from a carcass. We are 95% confident that throughout Great Britain, no more than four sheep flocks currently harbour an ongoing BSE epidemic. However, since the exposure from a single infected sheep is high, the annual human exposure from four 'typical' BSE-infected flocks could be considerable. Small reductions in exposure could be achieved by strategies based on tissue testing, a 12-month age restriction or expanded definitions of high-risk tissues. A six-month age restriction is likely to be more effective and genotype-based strategies the most effective.

Exposure assessment of TSEs from the landspreading of meat and bone meal

Recent changes in European legislation have meant that certain processed abattoir waste, which has been appropriately heat treated and ground to a specified particle size, can be spread on nonpasture agricultural land. This has opened the way for the potential landspreading of mammalian meat and bone meal (mMBM) derived from animals slaughtered for human consumption. This article reports on two separate case studies (Study 1 carried out in Great Britain (GB) and Study 2 carried out in Ireland) on the potential exposure to TSE infectivity following the spreading of abattoir waste (derived from animals slaughtered for human consumption) on nonpasture agricultural land. For Study 1, the average TSE infectivity on nonpasture agricultural land per year from sheep with scrapie was found to be higher (five orders of magnitude) than that estimated for BSE in cattle (3.9 x 10(-3) Ovine Oral ID(50)/ton of soil compared to 3.3 x 10(-8) Bovine Oral ID(50)/ton of soil). The mean estimate for BSE in sheep was 8.1 x 10(-6) Ovine Oral ID(50)/ton of soil. The mean level of infectivity in mMBM was assessed to be 1.2 x 10(-5) and 2.36 x 10(-5) ID(50)/ton of mMBM for Study 1 and 2, respectively. For Study 2 the spreading of mMBM was estimated to result in infectivity on nonpasture land of 1.62 x 10(-8) Bovine Oral ID(50)/m(3). The mean simulated probability of infection per year per bovine animal was 1.11 x 10(-9). Given the low infectivity density and corresponding low risks to bovines the spreading of mMBM could be considered a viable alternative for the utilization of mMBM.

An overview of transmissible spongiform encephalopathies

Transmissible spongiform encephalopathies (TSEs) are fatal neurodegenerative disorders of humans and animals associated with an accumulation of abnormal isoforms of prion protein (PrP) in nerve cells. The pathogenesis of TSEs involves conformational conversions of normal cellular PrP (PrPc) to abnormal isoforms of PrP (PrPSc). While the protein-only hypothesis has been widely accepted as a causal mechanism of prion diseases, evidence from more recent research suggests a possible involvement of other cellular component(s) or as yet undefined infectious agent(s) in PrP pathogenesis. Although the underlying mechanisms of PrP strain variation and the determinants of interspecies transmissibility have not been fully elucidated, biochemical and molecular findings indicate that bovine spongiform encephalopathy in cattle and new-variant Creutzfeldt–Jakob disease in humans are caused by indistinguishable etiological agent(s). Cumulative evidence suggests that there may be risks of humans acquiring TSEs via a variety of exposures to infected material. The development of highly precise ligands is warranted to detect and differentiate strains, allelic variants and infectious isoforms of these PrPs. This article describes the general features of TSEs and PrP, the current understanding of their pathogenesis, recent advances in prion disease diagnostics, and PrP inactivation.

A note on parameter estimation for variant Creutzfeldt–Jakob disease epidemic models

A recent series of papers has raised issues regarding estimation of the key epidemiological parameters of variant Creutzfeldt-Jakob disease (vCJD) from fitting survival models to case data. In particular, it was stated that the scale of the epidemic cannot be estimated and must be fixed in any analysis. We show that this problem is an artefact of the approximate likelihood used in these papers to facilitate model-fitting, and is not a concern if estimation is based on the full likelihood. We also address comments in these papers regarding the choice of incubation period distribution.

BSE inoculation to prion diseases-resistant sheep reveals tricky silent carriers

The possible transmission of bovine spongiform encephalopathy (BSE) agent to sheep contributed to select genetically sheep considered as resistant to prion diseases i.e., with PrP ARR/ARR genotype. Here, we report the infection of two PrP ARR/ARR genotype sheep using the cattle BSE agent inoculated by peripheral routes. Disease-associated prion protein (PrP(d)) was detected in the brain for one case (at 2191 days post-infection (dpi)) and only in the nervous enteric system for the other one (at 673dpi). The electrophoretic pattern of PrP(d) from the obex region in this BSE challenged sheep was shown to be closer from that found in naturally scrapie-affected sheep with regard to the apparent molecular mass of the unglycosylated PrP(d). Importantly, the absence of any clinical symptoms up to 6 years following experimental challenge suggests that silent carriers of the BSE agent may exist among ARR homozygous sheep.

Projections of the future course of the primary vCJD epidemic in the UK: inclusion of subclinical infection and the possibility of wider genetic susceptibility

The incidence of variant Creutzfeldt-Jakob disease (vCJD) in the United Kingdom appears to be in decline, with only four deaths reported this year (to 6 September 2004). However, results of a survey of lymphoreticular tissues have suggested a substantially higher prevalence of vCJD than expected from the clinical data alone. There are two plausible explanations for this discrepancy: first, a proportion of those infected will not develop clinical disease (subclinical infection); and second, the genetic group in which no clinical cases of vCJD have yet occurred is susceptible. Using mathematical models for the primary transmission of bovine spongiform encephalopathy to humans, we explore the impact of these hypotheses on case predictions. Under the first hypothesis, the results suggest relatively few future cases will arise via primary transmission, but that these cases are a small proportion of those infected, with most having subclinical infection. Under the second hypothesis, results suggest a maximum fivefold increase in cases, but this hypothesis is unable to account for the discrepancy between clinical cases and the estimated prevalence. Predictions of future cases of vCJD therefore remain uncertain, particularly given the recent identification of additional cases infected via blood transfusion.

Monitoring for bovine spongiform encephalopathy in sheep in Great Britain, 1998–2004

Bovine spongiform encephalopathy (BSE) may have been transmitted to British sheep via contaminated feed in the 1980s. Strain-typing techniques based on immunohistochemical (IHC) detection of abnormal protein (PrPd) and the molecular analysis of proteinase-resistant protein (PrPres) by Western blotting (WB) can discriminate between natural or experimental scrapie and experimental BSE in sheep. Between 1 January 1998 and 31 October 2001, 1247 sheep, clinically suspected of scrapie, were found to be positive by statutory tests in Great Britain. Archived brain tissue from these cases was retested by using these discriminatory methods. Twelve brain samples showed PrPres WB patterns that were unlike those found in natural or experimental scrapie. Prospective screening of fresh tissue from a further 1121 scrapie cases was also carried out between 1 November 2001 and 31 May 2004. Two samples gave WB results with similarities to the results found for experimental BSE in sheep. When all 14 unusual cases were tested by IHC, no match to experimental BSE in sheep was found. There were uncertainties within the retrospective study, where some equivocal results were obtained due to poor tissue quality or the unavailability of the optimum brain region. However, for the samples where tissue condition was optimum, our results provide no evidence for the presence of BSE in sheep. Epidemiological interpretation of the 450 flocks sampled indicates that the maximum proportion of sheep transmissible spongiform encephalopathy cases that could be BSE is 0.66 %. This estimate is lower than calculated previously (5 %), when the analysis was based on the results of strain typing in mice.

Epidemiological analysis of data for scrapie in Great Britain

In recent years, the control or eradication of scrapie and any other transmissible spongiform encephalopathies (TSEs) possibly circulating in the sheep population has become a priority in Britain and elsewhere in Europe. A better understanding of the epidemiology of scrapie would greatly aid the development and evaluation of control and eradication strategies. Here we bound the range of key epidemiological parameters using a combination of relatively detailed pathogenesis and demography data, more limited data on susceptibility and incubation times, and recent survey data on scrapie incidence in Great Britain. These data are simultaneously analysed using mathematical models describing scrapie transmission between sheep and between flocks. Our analysis suggests that occurrence of scrapie in a flock typically provokes changes in flock management that promote termination of the outbreak, such as the adoption of selective breeding, and that a large fraction of cases (possibly over 80%) goes undetected. We show that the data analysed are consistent with the within-flock reproduction number of scrapie lying in the range 1.5-6, consistent with previous epidemiological studies.

Breeding programmes for TSE resistance in British sheep. I. Assessing the impact on prion protein (PrP) genotype frequencies

From April 2005, member states of the European Union were required to implement a compulsory breeding programme for resistance to transmissible spongiform encephalopathies (TSEs) in sheep as part of measures to eradicate TSEs from national flocks. In this paper, we assessed the impact of four different breeding strategies on prion protein (PrP) genotype frequencies using a mathematical model which describes in detail gene flow in the British sheep flock. These strategies ranged from the minimum requirements laid down in by EU legislation to compulsory implementation of the current National Scrapie Plan for Great Britain (NSP) ram genotyping scheme. All four strategies were predicted to substantially reduce the frequency of the VRQ allele, which is associated with the highest risk of scrapie, although schemes with more stringent requirements produced a larger reduction. However, there were marked differences in the impact of the strategies on the frequency of other PrP alleles. In particular, restrictions beyond those required by EU legislation were necessary to change the frequency of other PrP alleles substantially. Consequently, a breeding programme which aims to reduce the risk to human health by reducing the frequency of the ARQ allele (associated with the highest risk of BSE in sheep) must place restrictions on ARQ-bearing animals. Similarly, a programme which seeks to increase the frequency of the ARR allele (associated with the lowest risk of TSE) must favour ARR-bearing animals.

Breeding programmes for TSE resistance in British sheep. II. Assessing the impact on the prevalence and incidence of scrapie

By establishing a breeding programme for transmissible spongiform encephalopathie (TSE) resistance, there are plans to eradicate sheep TSEs from member states of the European Union (EU). In this paper, we used a simple age- and genotype-structured model to assess the impact of four breeding strategies on the prevalence and incidence of scrapie in the British sheep flock. The strategies ranged from the minimum EU requirements to compulsory implementation of the current National Scrapie Plan for Great Britain (NSP). All four strategies were predicted to reduce the prevalence and incidence of disease, though there was likely to be a delay of several years between the implementation of a breeding programme and the reduction in incidence. There were differences in the efficacy of the strategies, with the most stringent resulting in the greatest reduction in prevalence and incidence. However, the magnitude of the differences was not great, largely because all four strategies eliminated the VRQ allele, which is associated with a markedly higher risk of disease than any of the other alleles. Sensitivity analyses indicated that the model results were robust to selection bias when estimating the risk of infection; and that the efficacy of a breeding programme was unlikely to be compromised, unless the risk of infection is substantially underestimated by data on clinical disease.

Transmissible spongiform encephalopathy risk assessment: the UK experience

Transmissible spongiform encephalopathy (TSE) risk assessments undertaken in the United Kingdom have mainly had the objective of determining the risks posed to humans from exposure to the causal agents associated with bovine spongiform encephalopathy (BSE) and variant Creutzfeld-Jakob disease (vCJD). In this article, I examine 19 of these risk assessments published to date and consider how their results might be influenced by underlying model assumptions and methodology. Three separate aspects common to all the assessments are infective load estimation, exposure pathway identification, and risk estimation. These are each discussed in detail.

A modelling framework to describe the spread of scrapie between sheep flocks in Great Britain

My aim was to develop a stochastic, spatial model describing the spread of scrapie between sheep flocks in Great Britain; I wanted a model, which could subsequently be used to assess the efficacy of different control strategies. The structure of the model reflects the demography of the British sheep flock, including a description of the contact structure between flocks. The dynamics of scrapie were incorporated through two probabilities associated with each flock: of acquiring infection and of experiencing a within-flock outbreak following exposure. The acquisition of infection depends on whether or not a flock buys-in sheep and, if it does, whether or not it trades with an affected flock. Once a flock is exposed, the probability of a within-flock outbreak occurring and its duration depend on the basic reproductive number, the prion-protein (PrP) genotype profile and the flock size. The model was validated using regional data from two postal surveys conducted in 1998 and 2002, which demonstrated that the model captures the spatial dynamics of scrapie (at least at a regional level). Moreover, the predicted distribution for the duration of a within-flock outbreak reflects the duration of outbreaks reported in the literature. Using the model to predict long-term trends in the proportion of affected flocks suggested that, even without control measures beyond the removal of animals with clinical signs, scrapie ultimately will disappear from the national flock, though it is likely to be decades before the disease is eliminated. However, there were scenarios consistent with the available data which suggested that scrapie could remain endemic within the British sheep flock. Consequently, it is essential to take this uncertainty in the long-term dynamics of scrapie into account when considering the efficacy of control strategies. Although control strategies were not explicitly examined, the model suggests two aspects important for control: larger flocks remain affected for longer and provide infection for other, smaller flocks and animal movements must be traceable.

Uncertainty due to model choice in variant Creutzfeldt-Jakob disease projections

For some statistical applications, uncertainty due to unverifiable assumptions can be much greater than that arising from the random variability that is quantified by conventional confidence intervals. The case of projecting possible maximum numbers of eventual deaths due to variant Creutzfeldt-Jakob disease in the United Kingdom provides an extreme example of this phenomenon. The need for parametric extrapolation of the incubation distribution, along with non-identifiability of the number of infected persons, makes assumptions very influential. Several publications in leading science journals gave upper bounds that were 100-fold to 20 000-fold lower than projections from other plausible models given here that fit the data about as well. The crucial assumption for projections is how the risk of death increases with time since infection, and exponential growth is an obvious choice for pessimistic models. Parametric extrapolation from the generalized lambda, generalized F, or lognormal distributions produced upper bounds much lower than exponential extrapolation (i.e. assuming a Gompertz distribution, which fit the data up to early 2002 quite well). Had the publications considered such possibilities, they would have reached much weaker conclusions and been less suitable for leading general science journals. The scientific publication process may have inherent disincentives for thorough assessment of uncertainty.

Frequencies of PrP genotypes in 38 breeds of sheep sampled in the National Scrapie Plan for Great Britain

Between October 2001 and January 2003 the prion protein (PrP) genotypes of over 250,000 sheep were determined through the operation of the National Scrapie Plan (NSP); the results for 38 breeds were analysed to provide an estimate of the underlying PrP genotype distribution of the British sheep population. Although there was marked variability among the genotype profiles of the different breeds, several trends emerged. A comparison of the allele frequencies demonstrated that the breeds could be grouped into three categories: breeds dominated by ARR and ARQ in which the frequency of ARR exceeded the frequency of ARQ; breeds dominated by ARR and ARQ in which the frequency of ARQ exceeded the frequency of ARR; and breeds with significant levels of either AHQ, ARH or VRQ. Hill breeds were more likely to have a lower proportion of animals at low risk of scrapie (NSP type 1) and a higher proportion of animals at an intermediate risk of scrapie (NSP type 3) than other breeds. Most breeds had a small proportion of animals at high risk of scrapie (NSP type 5). The frequency of ARR/VRQ (NSP type 4) was variable.

Simulation of the options for a national control programme to eradicate scrapie from Great Britain

Because of the risk to public health posed by the potential presence of bovine spongiform encephalopathy (BSE) in sheep, there are plans to eradicate transmissible spongiform encephalopathies (TSEs) from the British sheep population. We used a mathematical model for the spread of scrapie between sheep flocks to assess the efficacy of five control strategies at eradicating the infection from the national flock. These range from ram-genotyping schemes through whole-flock genotyping with selective culling to whole-flock slaughter. The impact of control was considered under three scenarios for the long-term dynamics of scrapie in GB: two in which scrapie is ultimately eliminated (with different median extinction times) and one in which scrapie remains endemic. Results suggested that it is feasible to eradicate scrapie from the British sheep flock, but that any national control programme will take decades to eliminate the disease and be costly. The most-effective strategy, measured in terms of the probability of eradication and time taken for eradication, was predicted to be whole-flock culling, which was effective under all three scenarios for the long-term dynamics of scrapie. Strategies involving whole-flock genotyping with selective culling were also effective, though they were predicted to take longer to eradicate scrapie than whole-flock culling. Ram-genotyping schemes were effective in some instances, but not for the scenario where scrapie remained endemic in the national flock. At low levels of reporting of clinical disease (< 20%) the probability of eradication within 100 years was predicted to be < 100% and, consequently, low levels of reporting could compromise the effectiveness of a control programme. Moreover, the predicted time taken to eradicate scrapie would increase markedly if the reporting compliance decreased.

Area-level risks for BSE in British cattle before and after the July 1988 meat and bone meal feed ban

In this paper we investigate area-level risk factors for BSE for the cattle population present in Great Britain between 1986 and 1997. By dividing this population into two birth cohorts, those born before the July 1988 ban on feeding ruminant-derived meat and bone meal to ruminants and those born after, second-order regional influences are distinguished from the strong first-order south-to-north gradient of area-level BSE risk using Bayesian hierarchical models that account for structured (spatially correlated) and unstructured heterogeneity in the data. For both cohorts area-level risk of BSE was increased by a more southerly location and greater numbers of dairy cattle, relative to non-dairy cattle. For the cohort of cattle born after the July 1988 ban on feeding ruminant-derived meat and bone meal area-level BSE risk was additionally associated with greater numbers of pigs, relative to cattle. These findings support the role of low level cross-contamination of cattle feed by pig feed as an influence on BSE incidence risk as the epidemic evolved. Prior to the 1988 meat and bone meal ban unexplained BSE risk was relatively uniformly distributed across the country whereas after the ban there were spatially aggregated areas of unexplained risk in the northern and eastern regions of England suggesting that local influences allowed BSE control measures to be less-successfully applied in these areas, compared with the rest of the country. We conclude that spatially localised influences were operating in divergent ways during the two phases of the epidemic.

Proceedings of a consensus conference: the screening of blood donors for variant CJD

Since the identification, in 1996, of the first case of variant Creutzfeldt-Jakob disease (vCJD) in humans various approaches have been implemented and/or proposed to prevent this disease from being transfusion transmitted. In addition, a variety of possible laboratory-based approaches have been developed and will continue to be developed for the vCJD screening of blood donors. Various issues related to the implementation of such vCJD testing is likely to assume greater importance as diagnostic tests for vCJD becomes available for the potential screening of blood donors. The purpose of this Consensus Conference was to bring together international experts in an effort to determine which principles should guide the introduction of such testing. These experts provided the scientific and biological background of bovine spongiform encephalopathy (BSE) and vCJD, an understanding of their current epidemiology, as well as the ethical and legal issues that would impact on the implementation of a screening test for preventing the transfusion transmission of vCJD. This contentious issue is of potential considerable importance to transfusion medicine personnel worldwide, as well as to future recipients of allogeneic blood components.

PrPSc accumulation in myocytes from sheep incubating natural scrapie

Because variant Creutzfeldt-Jakob disease (vCJD) in humans probably results from consumption of products contaminated with tissue from animals with bovine spongiform encephalopathy, whether infectious prion protein is present in ruminant muscles is a crucial question. Here we show that experimentally and naturally scrapie-affected sheep accumulate the prion protein PrP(Sc) in a myocyte subset. In naturally infected sheep, PrP(Sc) is detectable in muscle several months before clinical disease onset. The relative amounts of PrP(Sc) suggest a 5,000-fold lower infectivity for muscle as compared to brain.

Age and variant Creutzfeldt-Jakob disease

The young and stable median age of those who die of variant Creutzfeldt-Jakob disease has been attributed to age-dependent infection rates. This analysis shows that an influence of age on risk for death after infection better explains age patterns, suggesting that biologic factors peaking in the third decade of life may hasten disease.

Detection of polymorphisms in the prion protein gene in the Belgian sheep population: Some preliminary data

The development of clinical signs of TSE/scrapie in sheep has been linked to polymorphisms in the prion protein (PRNP) gene. The most important polymorphisms appear to be at codons 136, 154, and 171. The objective of this study was to investigate the polymorphisms at these codons in the Belgian sheep population, including clinical healthy animals, healthy animals at the slaughterhouse and animals in TSE/scrapie positive farms (including a Nor98 farm).

Epidemiological implications of the susceptibility to BSE of putatively resistant sheep

The experimental infection of sheep with bovine spongiform encephalopathy (BSE) by the oral route and the likelihood that sheep were fed BSE-infected meat and bone meal has led to extensive speculation as to whether or not sheep are naturally infected with BSE. In response, the UK government has initiated the National Scrapie Plan (NSP), an ambitious £120 million per year project to create a BSE- and scrapie-resistant national sheep flock, by selectively breeding for a genotype of sheep believed to be resistant to both diseases. This genotype has recently been shown to be susceptible to BSE by intracerebral (i.c.) inoculation. Should these sheep be sufficiently susceptible to BSE via natural transmission, the NSP might fail. Here we estimate the susceptibility of this genotype to horizontal (sheep-to-sheep) transmission of BSE by comparison with more extensive oral and i.c. exposure data for other sheep genotypes. We show that a previous estimate of the risk of BSE transmission to sheep via the feedborne route remains robust. However, using a mathematical model for the within-flock transmission of BSE, we show that, while the best estimate indicates that the NSP should be successful, current data cannot exclude the failure of the NSP.