Systematic review of knowledge, attitudes, and practices of dairy farmers and consumers towards bovine tuberculosis in low- and middle-income countries

Bovine Tuberculosis (bTB), caused by Mycobacterium bovis, is a neglected zoonotic disease primarily associated with cattle. The incidence of bTB is highest in low-income settings with high cattle density and unpasteurised dairy consumption. Smallholder dairy farming has steadily grown in low- and middle-income countries (LMICs) with limited professional support for adequate bTB surveillance and risk mitigation. Several studies have explored the knowledge, attitudes, and practices (KAP) of milk value chain stakeholders towards bTB in LMICs, but this evidence has not been collated and synthesised. We conducted a systematic review to determine what is known, believed, and done in relation to bTB among dairy producers and consumers in LMICs. We performed a systematic search of studies in OVID Medline, Scopus and CABI on 11 September 2023. KAP data were summarised using narrative synthesis and forest plots. We retrieved 2763 articles, retaining 51 for the review. Only studies from Africa (n = 38) and Asia (n = 13) met the eligibility criteria. Most populations reported awareness of human tuberculosis and knew it could be treated, but there was limited awareness of bTB and its zoonotic potential. Knowledge of bTB transmission routes and bTB mitigation varied across populations, and risky practices were also variable. Inconsistencies in study design and survey tools suggest some results may have a mid- to high-risk of bias. Awareness of bTB is surprisingly low among African and Asian populations with high bTB exposure risk, possibly due to the long-standing divide between animal and human health messages that has obscured the One Health implications of bTB. Addressing bTB in LMICs requires a structural One Health approach and standard KAP survey tools to adequately explore the socio-cultural, political, and economic processes and drivers favouring bTB spread and persistence.

The devil you know and the devil you don't: current status and challenges of bovine tuberculosis eradication in the United States

Having entered into its second century, the eradication program for bovine tuberculosis (bTB, caused by Mycobacterium bovis) in the United States of America occupies a position both enviable and daunting. Excepting four counties in Michigan comprising only 6109 km2 (0.06% of US land area) classified as Modified Accredited, as of April 2022 the entire country was considered Accredited Free of bTB by the US Department of Agriculture for cattle and bison. On the surface, the now well-described circumstances of endemic bTB in Michigan, where white-tailed deer (Odocoileus virginianus) serve as a free-ranging wildlife maintenance host, may appear to be the principal remaining barrier to national eradication. However, the situation there is unique in the U.S., and far-removed from the broader issues of bTB control in the remainder of the country. In Michigan, extensive surveillance for bTB in deer over the last quarter century, and regulatory measures to maximize the harvest of publicly-owned wildlife, have been implemented and sustained. Prevalence of bTB in deer has remained at a low level, although not sufficiently low to eliminate cattle herd infections. Public attitudes towards bTB, cattle and deer, and their relative importance, have been more influential in the management of the disease than any limitations of biological science. However, profound changes in the demographics and social attitudes of Michigan's human population are underway, changes which are likely to force a critical reevaluation of the bTB control strategies thus far considered integral. In the rest of the U.S. where bTB is not self-sustaining in wildlife, changes in the scale of cattle production, coupled with both technical and non-technical issues have created their own substantial challenges. It is against this diverse backdrop that the evolution of whole genome sequencing of M. bovis has revolutionized understanding of the history and ecology of bTB in Michigan, resolved previously undiscernible epidemiological puzzles, provided insights into zoonotic transmission, and unified eradication efforts across species and agencies. We describe the current status of bTB eradication in the U.S., how circumstances and management have changed, what has been learned, and what remains more elusive than ever.

Wild Animal Tuberculosis: Stakeholder Value Systems and Management of Disease

When human health is put at risk from the transmission of animal diseases, the options for intervention often require input from stakeholders whose differing values systems contribute to decisions on disease management. Animal tuberculosis (TB), caused principally by Mycobacterium bovis is an archetypical zoonotic pathogen in that it can be transmitted from animals to humans and vice versa. Although elimination of zoonotic transmission of TB to humans is frequently promoted as the raison d'être for TB management in livestock, in many countries the control strategies are more likely based on minimizing the impact of sustained infection on the agricultural industry. Where wild animals are implicated in the epidemiology of the disease, the options for control and eradication can require involvement of additional stakeholder groups. Conflict can arise when different monetary and/or societal values are assigned to the affected animals. This may impose practical and ethical dilemmas for decision makers where one or more species of wild animal is seen by some stakeholders to have a greater value than the affected livestock. Here we assess the role of stakeholder values in influencing TB eradication strategies in a number of countries including Ireland, the UK, the USA, Spain, France, Australia, New Zealand and South Africa. What it reveals is that the level of stakeholder involvement increases with the complexity of the epidemiology, and that similar groups of stakeholders may agree to a set of control and eradication measures in one region only to disagree with applying the same measures in another. The level of consensus depends on the considerations of the reservoir status of the infected host, the societal values assigned to each species, the type of interventions proposed, ethical issues raised by culling of sentient wild animals, and the economic cost benefit effectiveness of dealing with the problem in one or more species over a long time frame. While there is a societal benefit from controlling TB, the means to achieve this requires identification and long-term engagement with all key stakeholders in order to reach agreement on ethical frameworks that prioritize and justify control options, particularly where culling of wild animals is concerned.

Baiting and Feeding Revisited: Modeling Factors Influencing Transmission of Tuberculosis Among Deer and to Cattle

Although tuberculosis caused by Mycobacterium bovis (bTB) is endemic in white-tailed deer (Odocoileus virginianus) in northeastern Michigan, USA, baiting and feeding of deer continue despite a regulatory ban. Previous modeling suggests aggregation at bait sites slows the rates at which harvest and/or vaccination decrease bTB prevalence, prolongs time to eradication, and increases the likelihood that once eradicated, bTB will re-establish following an incursion. However, the extent to which specific factors such as food density, attractiveness to deer, and persistence on the landscape influence bTB transmission is unknown. We used an individual-based, spatially-explicit stochastic simulation model of bTB in deer and cattle to investigate effects of feed density, attractiveness, and spatial and temporal persistence on bTB prevalence in deer and the probability of breakdowns in adjacent cattle herds. Because hunter harvest remains key to controlling bTB in deer, and harvest rates are in long term decline, we modeled these feeding-associated factors at harvest rates prevailing both when the model was developed (2003-2007) and in 2018. Food placement at randomized locations vs. fixed sites had little effect on bTB prevalence in deer, whereas increasing the probability that deer move to food piles (attractiveness) had the greatest effect of factors studied on both prevalence and herd breakdowns. Reducing food pile density reduced prevalence, but decreased herd breakdowns only modestly. Consistent availability of food over longer periods of time, as would occur with supplemental winter feeding or persistent recreational feeding, increased both prevalence in deer and cattle herd breakdowns dramatically. Though perhaps implausible to the public, altering how bait and feed for deer are used can reduce cattle herd breakdowns. Baiting and feeding bans have contributed to declining bTB prevalence, but non-compliance and continued legal sales of feed impede eradication. Requiring hunters to move food piles is unlikely to mitigate effects on transmission and is not a useful management tool. Compared to baiting, winter supplemental feeding or extended recreational feeding is likely to magnify bTB transmission by prolonging temporal availability. Because attractiveness of feed is influenced both by type of feed and deer behavior, research to quantify factors influencing deer movement to food should be a priority.

Persistent Spillback of Bovine Tuberculosis From White-Tailed Deer to Cattle in Michigan, USA: Status, Strategies, and Needs

Free-ranging white-tailed deer (Odocoileus virginianus) are believed to be a self-sustaining reservoir for bovine tuberculosis (bTB) in northeastern Lower Michigan, USA. Although a comprehensive control program is in place and on-farm mitigation strategies to curtail bTB transmission between cattle and deer have been implemented for over a decade, cattle and deer continue to become infected with the disease. Thus, renewed motivation to eradicate bTB is needed if that is truly the goal. Recurrent detection of bTB in cattle in the region is of mounting concern for state and federal agricultural agencies, producers, and wildlife managers. Current on-farm mitigation efforts include fencing and refined cattle feeding and watering practices. Liberal removal of antlerless deer through hunter harvest and disease control permits (DCPs) issued to cattle producers and agency sharp shooters have also been ongoing. Although these strategies have merit and efforts to reduce prevalence in deer and occurrence of positive farms are elevated, additional actions are needed. Heightened management actions to combat bTB in deer could include deer vaccination programs, strategic habitat manipulations to redistribute deer from farms, and precision removal of deer in proximity to high-risk farms. Foundational research to address development and delivery of vaccine to free-ranging deer is complete. Strategic management and habitat manipulation could reduce and disperse local concentrations of deer while better meeting wildlife, forestry, and agricultural goals. The responses of local deer populations to targeted removal of individuals are generally understood and there is potential to reduce deer activity around agricultural operations while allowing them to persist nearby on natural foods. We summarize the history and progress to date, discuss the realized merit of novel management strategies, and suggest options to rid deer and cattle in Michigan of bTB.

The importance of communication in promoting voluntary participation in an experimental trial: A qualitative study based on the assessment of the gamma-interferon test for the diagnosis of bovine tuberculosis in France

Understanding the factors leading each stakeholder to participate in an experimental trial is a key element for improving trial set-up and for identifying selection bias in statistical analyses. An experimental protocol, validated by the European Commission, was developed in France to assess the ability of the gamma-interferon test in terms of accuracy to replace the second intradermal skin test in cases of suspected bovine tuberculosis. Implemented between 2013 and 2015, this experimental trial was based on voluntary participation. To determine and understand the motivation or reluctance of farmers to take part in this trial, we carried out a sociological survey in France. Our study was based on semi-structured interviews with the farmers and other stakeholders involved. The analysis of findings demonstrated that shortening the lock-up period during tuberculosis suspicion, following the use of a gamma-interferon test, was an important aim and a genuine challenge for the animal health stakeholders. However, some farmers did not wish to continue the trial because it could potentially have drastic consequences for them. Moreover, misunderstandings and confusion concerning the objectives and consequences of the trial led stakeholders to reject it forcefully. Based on our results, we offer some recommendations: clear and appropriate communication tools should be prepared to explain the protocol and its aims. In addition, these types of animal health trials should be designed with the stakeholders’ interests in mind. This study provides a better understanding of farmer motivations and stakeholder influences on trial participation and outcomes. The findings can be used to help design trials so that they promote participation by farmers and by all animal health stakeholders in general.

Management of on-farm risk to livestock from bovine tuberculosis in Michigan, USA, white-tailed deer: Predictions from a spatially-explicit stochastic model

The eradication of bovine tuberculosis (bTB), caused by Mycobacterium bovis, from cattle in many locations worldwide is complicated by endemic foci of the disease in free-ranging wildlife. Recent simulation modeling of the bTB outbreak in white-tailed deer (WTD) in Michigan, USA, suggests current management is unlikely to eradicate bTB from the core outbreak area (DMU 452) within the next three decades. However, some level of control short of eradication might sufficiently reduce transmission from deer to cattle to a point at which the negative effects of bTB on the cattle industry could be reduced or eliminated, while minimizing the negative consequences of reducing deer numbers. We extended our existing spatially-explicit, individual-based stochastic simulation model of bTB transmission in WTD to incorporate transmission to cattle, to characterize the effects of vaccination and increased harvest of WTD on cattle herd breakdown rates, to examine the effects of localized culling or vaccination of WTD in the vicinity of cattle farms, to assess the effects of concurrent deer baiting, and to determine the effect of progressive restriction of deer/cattle contact on herd breakdowns. A spatially-explicit "cattle layer" was constructed describing the spatial locations, farm size and cattle density of all farms within and directly adjacent to DMU452. Increased hunter harvest or vaccination of deer, or a combination, would likely decrease the number of cattle herd breakdowns to <1 per year in less than 15 years. Concurrent deer baiting variably increased the time necessary to achieve zero breakdowns. The prevalence of bTB in deer needed to fall below ∼0.5% before ≤1 herd breakdown per year could be expected, and below 0.1% before zero breakdowns were likely. Locally applied post-harvest deer culling or vaccination also rapidly reduced herd breakdowns. On farm biosecurity measures needed to reduce deer to cattle contact by >95% in order to reliably reduce herd breakdowns, and did not achieve zero breakdowns in the absence of other deer controls.

WILDLIFE HEALTH AND PUBLIC TRUST RESPONSIBILITIES FOR WILDLIFE RESOURCES

A significant development in wildlife management is the mounting concern of wildlife professionals and the public about wildlife health and diseases. Concurrently, the wildlife profession is reexamining implications of managing wildlife populations as a public trust and the concomitant obligation to ensure the quality (i.e., health) and sustainability of wildlife. It is an opportune time to emphasize the importance of wildlife health, specifically to advocate for comprehensive and consistent integration of wildlife health in wildlife management. We summarize application of public trust ideas in wildlife population management in the US. We argue that wildlife health is essential to fulfilling public trust administration responsibilities with respect to wildlife, due to the central responsibility of trustees for ensuring the well-being of wildlife species (i.e., the core resources of the trust). Because both health of wildlife and risk perceptions regarding threats posed by wildlife disease to humans and domestic animals are issues of growing concern, managing wildlife disease and risk communication vis-à-vis wildlife health is critical to wildlife trust administration. We conclude that wildlife health professionals play a critical role in protecting the wildlife trust and that current conditions provide opportunities for important contributions by wildlife health professionals in wildlife management.

Wildlife disease and risk perception

Risk perception has an important influence on wildlife management and is particularly relevant to issues that present health risks, such as those associated with wildlife disease management. Knowledge of risk perceptions is useful to wildlife health professionals in developing communication messages that enhance public understanding of wildlife disease risks and that aim to increase public support for disease management. To promote knowledge of public understanding of disease risks in the context of wildlife disease management, we used a self-administered questionnaire mailed to a stratified random sample (n = 901) across the continental United States to accomplish three objectives: 1) assess zoonotic disease risk perceptions; 2) identify sociodemographic and social psychologic factors underlying these risk perceptions; and 3) examine the relationship between risk perception and agreement with wildlife disease management practices. Diseases we assessed in the surveys were rabies, plague, and West Nile virus. Risk perception, as measured by an index consisting of severity, susceptibility, and dread, was greatest for rabies and West Nile virus disease (x = 2.62 and 2.59, respectively, on a scale of 1 to 4 and least for plague (x = 2.39). The four most important variables associated with disease risk perception were gender, education, prior exposure to the disease, and concern for health effects. We found that stronger risk perception was associated with greater agreement with wildlife disease management. We found particular concern for the vulnerability of wildlife to zoonotic disease and for protection of wildlife health, indicating that stakeholders may be receptive to messages emphasizing the potential harm to wildlife from disease and to messages promoting One Health (i.e., those that emphasize the interdependence of human, domestic animal, wildlife, and ecosystem health).

Impacts of wildlife baiting and supplemental feeding on infectious disease transmission risk: a synthesis of knowledge

Baiting and supplemental feeding of wildlife are widespread, yet highly controversial management practices, with important implications for ecosystems, livestock production, and potentially human health. An often underappreciated threat of such feeding practices is the potential to facilitate intra- and inter-specific disease transmission. We provide a comprehensive review of the scientific evidence of baiting and supplemental feeding on disease transmission risk in wildlife, with an emphasis on large herbivores in North America. While the objectives of supplemental feeding and baiting typically differ, the effects on disease transmission of these practices are largely the same. Both feeding and baiting provide wildlife with natural or non-natural food at specific locations in the environment, which can result in large congregations of individuals and species in a small area and increased local densities. Feeding can lead to increased potential for disease transmission either directly (via direct animal contact) or indirectly (via feed functioning as a fomite, spreading disease into the adjacent environment and to other animals). We identified numerous diseases that currently pose a significant concern to the health of individuals and species of large wild mammals across North America, the spread of which are either clearly facilitated or most likely facilitated by the application of supplemental feeding or baiting. Wildlife diseases also have important threats to human and livestock health. Although the risk of intra- and inter-species disease transmission likely increases when animals concentrate at feeding stations, only in a few cases was disease prevalence and transmission measured and compared between populations. Mostly these were experimental situations under controlled conditions, limiting direct scientific evidence that feeding practices exacerbates disease occurrence, exposure, transmission, and spread in the environment. Vaccination programs utilizing baits have received variable levels of success. Although important gaps in the scientific literature exist, current information is sufficient to conclude that providing food to wildlife through supplemental feeding or baiting has great potential to negatively impact species health and represents a non-natural arena for disease transmission and preservation. Ultimately, this undermines the initial purpose of feeding practices and represents a serious risk to the maintenance of biodiversity, ecosystem functioning, human health, and livestock production. Managers should consider disease transmission as a real and serious concern in their decision to implement or eliminate feeding programs. Disease surveillance should be a crucial element within the long-term monitoring of any feeding program in combination with other available preventive measures to limit disease transmission and spread.

Challenges to quality testing for bovine tuberculosis in Ireland; perspectives from major stakeholders

Within the national bovine tuberculosis (bTB) eradication programme in Ireland, concern has been expressed about the quality of testing by veterinarians. However, there is little published evidence supporting this concern, or the challenges that undermine quality testing. Qualitative research methods were used to gather the perspectives of major stakeholders in the bTB eradication (BTE) scheme on the challenges to quality testing for bovine tuberculosis in Ireland. These stakeholders included private veterinarians, government veterinarians, senior managers and herd owners, on the quality of bTB testing and the barriers to improvement. Results are grouped into challenges that exist in the testing environment (ie, at a farm level), and challenges associated with the skills environment (ie, professional skills involved with conducting the test). Challenges in the testing environment include inadequate on-farm testing conditions; lack of clarity on responsibility to ensure adequate testing environment; and the influence of the veterinarian-client relationship. Challenges in the skills environment include deficiencies in the development and supervision of testing skills among trainees and newly qualified veterinarians; and deficiencies in testing standards at a practice level. Regular supervision of testing is necessary to ensure standards. The importance of a continued understanding of the disease (and its eradication) supported by a partnership, cooperative approach between all stakeholders, is emphasised.

Live-trapping and bovine tuberculosis testing of free-ranging white-tailed deer for targeted removal

Context Significant efforts have been made in Michigan, USA, to reduce the prevalence of bovine tuberculosis (TB) in free-ranging white-tailed deer (Odocoileus virginianus) over the past 15 years. Since 2002, however, prevalence has changed little, prompting the need for new control strategies. Aims In January–March of 2007 and 2008, a trap–test–cull project was conducted on an 11 000-ha property in the north-eastern Lower Peninsula of Michigan. The objectives were to assess the feasibility of live-trapping and testing white-tailed deer for TB as a means for targeted removal and estimate the cost of this effort. Methods Live-trapped deer were ear-tagged and a blood sample was drawn for use with the CervidTB STAT-PAK (commonly called Rapid Test) for TB diagnosis in the field. Deer testing negative were released, whereas deer testing positive were euthanised to confirm blood-test results via bacterial culture. Key results In all, 762 (741 with known sex and age) individual deer were captured and tested for TB. Adults comprised 59% (437 of 741) of the captures. Eight (1.8%) adults were positive on the blood test; six of eight (1.4% of adults) were confirmed TB positive via bacterial culture. Estimated TB prevalence in the present study was 2.5% (adjusted for Rapid Test sensitivity of 56%), being lower than what would be expected on the basis of routine hunter-harvest surveillance for this site which has yielded prevalence rates from 3.4% to 4.8%. Results demonstrated the ability to trap and test a substantial number of deer given high deer densities (16–20 deer per km2), availability of traps and abundant workers. The 2-year project cost a total of ~US$228 000, or US$38 000 per culture-positive animal. Conclusions Because of the cost and effort involved, a project such as the present one applied to Michigan’s larger TB-management area (148 018 ha) is not feasible. Implications If the efficiency and effectiveness of a trap–test–cull project could be improved by vaccinating test-negative animals, should a vaccine be approved for use in free-ranging white-tailed deer, a trap–test–cull project applied on a scale similar to the present study may prove beneficial by possibly reducing disease transmission, in addition to removing TB-positive animals.

Descriptive epidemiology of bovine tuberculosis in michigan (1975-2010): lessons learned

Despite ongoing eradication efforts, bovine tuberculosis (BTB) remains a challenge in Michigan livestock and wildlife. The objectives of this study were to (1) review the epidemiology of BTB in Michigan cattle, privately owned cervids, and wildlife between 1975 and 2010 and (2) identify important lessons learned from the review and eradication strategies. BTB information was accessed from the Michigan BTB Eradication Project agencies. Cattle herds (49), privately owned deer herds (4), and wild white-tailed deer (668) were found infected with BTB during the review period. BTB has occurred primarily in counties located at the northern portion of the state's Lower Peninsula. Currently used BTB eradication strategies have successfully controlled BTB spread. However additional changes in BTB surveillance, prevention, and eradication strategies could improve eradication efforts.

Public acceptance as a determinant of management strategies for bovine tuberculosis in free-ranging U.S. wildlife

When bovine tuberculosis (bTB) is detected in free-ranging wildlife populations, preventing geographic spread and the establishment of a wildlife reservoir requires rapid, often aggressive response. Public tolerance can exert a significant effect on potential control measures available to managers, and thus on the success of disease management efforts. Separate outbreaks of bTB in free-ranging white-tailed deer (Odocoileus virginianus) in two midwestern states provide a case study. In Minnesota, bTB was first discovered in cattle in 2005 and subsequently in deer. To date, 12 beef cattle farms and 26 white-tailed deer have been found infected with the disease. From 2005 to 2008, disease prevalence in deer has decreased from 0.4% (SE=0.2%) to <0.1% and remained confined to a small (<425 km(2)) geographic area. Deer population reduction through liberalized hunting and targeted culling by ground sharpshooting and aerial gunning, combined with a prohibition on baiting and recreational feeding, have likely been major drivers preventing disease spread thus far. Without support from cattle producers, deer hunters and the general public, as well as politicians, implementation of these aggressive strategies by state and federal authorities would not have been possible. In contrast, Michigan first discovered bovine bTB in free-ranging deer in 1975, and disease management efforts were not instituted until 1995. The first infected cattle herd was diagnosed in 1998. Since 1995, disease prevalence in free-ranging deer has decreased from 4.9% to 1.8% in the ∼ 1500 km(2) core outbreak area. Culture positive deer have been found as far as 188 km from the core area. Liberalized harvest and restrictions on baiting and feeding have facilitated substantial reductions in prevalence. However, there has been little support on the part of hunters, farmers or the general public for more aggressive population reduction measures such as culling, and compliance with baiting and feeding restrictions has been variable and often problematic. We compare and contrast the Minnesota and Michigan outbreaks with respect to temporal, social, economic, and logistical factors that shape public attitudes toward aggressive disease control strategies, the limitations these factors place on management, and the implications for bTB eradication from wildlife reservoirs in the U.S.

Vaccination strategies for managing brucellosis in Yellowstone bison

Concerns over migratory bison (Bison bison) at Yellowstone National Park transmitting brucellosis (Brucella abortus) to cattle herds on adjacent lands led to proposals for bison vaccination. We developed an individual-based model to evaluate how brucellosis infection might respond under alternate vaccination strategies, including: (1) vaccination of female calves and yearlings captured at the park boundary when bison move outside the primary conservation area; (2) combining boundary vaccination with the remote delivery of vaccine to female calves and yearlings distributed throughout the park; and (3) vaccinating all female bison (including adults) during boundary capture and throughout the park using remote delivery of vaccine. Simulations suggested Alternative 3 would be most effective, with brucellosis seroprevalence decreasing by 66% (from 0.47 to 0.16) over a 30-year period resulting from 29% of the population receiving protection through vaccination. Under this alternative, bison would receive multiple vaccinations that extend the duration of vaccine protection and defend against recurring infection in latently infected animals. The initial decrease in population seroprevalence will likely be slow due to high initial seroprevalence (40-60%), long-lived antibodies, and the culling of some vaccinated bison that were subsequently exposed to field strain Brucella and reacted positively on serologic tests. Vaccination is unlikely to eradicate B. abortus from Yellowstone bison, but could be an effective tool for reducing the level of infection. Our approach and findings have applicability world-wide for managers dealing with intractable wildlife diseases that cross wildlife-livestock and wildlife-human interfaces and affect public health or economic well-being.