Case-control study of cases of bovine spongiform encephalopathy born after July 31, 1996 (BARB cases) in Great Britain

This paper reports the results of a case-control study of the bovine spongiform encephalopathy (BSE) cases born in Great Britain after the statutory reinforcement of the ban (BARB) on the feeding of mammalian-derived meat and bone meal on 31 July 1996. A total of 499 suspect clinical cases of BSE, born after 31 July 1996, and reported negative by July 31, 1996 and were compared with the set of 164 confirmed Great BARB cases in Great Britain detected by both passive and active surveillance. Animal-level risk factors (age and type of feed offered) and herd-level risk factors (herd size and type, number of prereinforced feed ban BSE cases born on the holding, the presence of other domestic species and waste management) were obtained for the analysis. BARB cases were 2.56 times (95 per cent CI 1.29 to 5.07) more likely to be exposed to homemix or a combination of homemix and proprietary feeds were 0.59 times (95 per cent CI 0.50 to 0.69) as less likely to be exposed to the unit increases in the number of prereinforced feed ban BSE cases diagnosed on the natal holding. A supplementary spatial analysis of these cases revealed three areas of excess BARB density: Northwest and Southwest of Wales and Northeast of Scotland.

Use of laboratory data to reduce the time taken to detect new diseases: VIDA to FarmFile

The analysis of laboratory data can provide information about the health of livestock populations; in Great Britain the Veterinary Investigation Diagnosis Analysis (VIDA) system has provided such data since 1975. However VIDA covers only known diagnoses, with limited epidemiological characterisation. The unexpected outbreak of bse showed that it was necessary to improve surveillance to detect new diseases, and a necessary update of the VIDA database for the millennium date change provided the opportunity. The information required to enhance the value of laboratory data was identified, a new form and database, 'FarmFile', were designed to record it, and they began to be used in 1999. The detection of new diseases depends on making comparisons with the expected or 'usual' levels of unexplained disease. The data are analysed quarterly to assess any changes in the levels of unexplained disease in different species, categorised in terms of clinical sign or body system, by comparison with previous years. No new diseases have been detected either through FarmFile or more traditional means since the new analyses started in earnest in 2004, but they have indicated that an unexplained event was not a new disease of concern, and developments continue to improve the system's sensitivity and specificity.

Modelling studies to estimate the prevalence of foot-and-mouth disease carriers after reactive vaccination

Foot-and-mouth disease (FMD) is a highly contagious and economically significant viral disease of cloven-hoofed animals. Vaccination can be used to help restrict the spread of the infection, but evidence must be provided to show that the infection has been eradicated in order to regain the FMD-free status. While serological tests have been developed, which can identify animals that have been infected regardless of vaccination status, it is vital to know the probable prevalence of herds with FMD carriers and the within-herd prevalence of those carriers in order to design efficient post-epidemic surveillance strategies that establish freedom from disease. Here, we present the results of a study to model the expected prevalence of carriers after application of emergency vaccination and the impact of this on the sensitivity of test systems for their detection. Results showed that the expected prevalence of carrier-containing herds after reactive vaccination is likely to be very low, approximately 0.2%, and there will only be a small number of carriers, most likely one, in the positive herds. Therefore, sensitivity for carrier detection can be optimized by adopting an individual-based testing regime in which all animals in all vaccinated herds are tested and positive animals rather than herds are culled.

Risk-based surveillance for H5N1 avian influenza virus in wild birds in Great Britain

Recent outbreaks of the H5N1 strain of avian influenza in Europe have highlighted the need for continuous surveillance and early detection to reduce the likelihood of a major outbreak in the commercial poultry industry. In Great Britain (gb), one possible route by which H5N1 could be introduced into domestic poultry is through migratory wild birds from Europe and Asia. Extensive monitoring data on the 24 wild bird species considered most likely to introduce the virus into GB, and analyses of local poultry populations, were used to develop a risk profile to identify the areas where H5N1 is most likely to enter and spread to commercial poultry. The results indicate that surveillance would be best focused on areas of Norfolk, Suffolk, Lancashire, Lincolnshire, south-west England and the Welsh borders, with areas of lower priority in Anglesey, south-west Wales, north-east Aberdeenshire and the Firth of Forth area of Scotland. These areas have significant poultry populations including a large number of free-range flocks, and a high abundance of the 24 wild bird species.

A model (BSurvE) for evaluating national surveillance programs for bovine spongiform encephalopathy

Our BSurvE spreadsheet model estimates the BSE prevalence in a national cattle population, and can be used to evaluate and compare alternative strategies for a national surveillance program. Each individual surveillance test has a point value (based on demographic and epidemiological information) that reflects the likelihood of detecting BSE in an animal of a given age leaving the population via the stated surveillance stream. A target sum point value for the country is calculated according to a user-defined design prevalence and confidence level, the number of cases detected in animals born after the selected starting date and the national adult-herd size. Surveillance tests carried out on different sub-populations of animals are ranked according to the number of points gained per unit cost, and the results can be used in designing alternative surveillance programs.

A model (BSurvE) for estimating the prevalence of bovine spongiform encephalopathy in a national herd

We developed the BSurvE spreadsheet model to estimate the true prevalence of bovine spongiform encephalopathy (BSE) in a national cattle population, and evaluate national BSE surveillance programs. BSurvE uses BSE surveillance data and demographic information about the national cattle population. The proportion of each cohort infected with BSE is found by equating the observed number of infected animals with the number expected, following a series of probability calculations and assuming a binomial distribution for the number of infected animals detected in each surveillance stream. BSurvE has been used in a series of international workshops, where analysis of national datasets demonstrated patterns of cohort infection that were consistent with infection-control activities within the country. The results also reflected the timing of known events that were high-risk for introduction of the infectious agent.

The importance of the PrP genotype in active surveillance for ovine scrapie

Surveillance activities for ovine scrapie have expanded in the 21st century, following concerns about the potential for a hidden epidemic of bovine spongiform encephalopathy in European sheep populations. Large-scale surveys have been used to estimate the prevalence of scrapie infection. In this study we analyse data from the surveys in Great Britain between 2002 and 2004. When we estimate genotype-specific prevalences for each of the two screening tests used a difference is observed. One test underestimates the number of positive cases in genotypes classically considered to be at a low relative risk of developing clinical disease (ARR- and AHQ-containing genotypes). By comparison, the other test underestimates the number of positive cases in genotypes classically considered to be at an increased relative risk of developing clinical disease (VRQ-containing genotypes). These findings have implications for surveillance, disease control, and diagnostic test evaluation.

Bovine spongiform encephalopathy: the effect of oral exposure dose on attack rate and incubation period in cattle

The dose–response of cattle exposed to the bovine spongiform encephalopathy (BSE) agent is an important component of modelling exposure risks for animals and humans and thereby, the modulation of surveillance and control strategies for BSE. In two experiments calves were dosed orally with a range of amounts of a pool of brainstems from BSE-affected cattle. Infectivity in the pool was determined by end-point titration in mice. Recipient cattle were monitored for clinical disease and, from the incidence of pathologically confirmed cases and their incubation periods (IPs), the attack rate and IP distribution according to dose were estimated. The dose at which 50 % of cattle would be clinically affected was estimated at 0.20 g brain material used in the experiment, with 95 % confidence intervals of 0.04–1.00 g. The IP was highly variable across all dose groups and followed a log-normal distribution, with decreasing mean as dose increased. There was no evidence of a threshold dose at which the probability of infection became vanishingly small, with 1/15 (7 %) of animals affected at the lowest dose (1 mg).

Analysis of data from the passive surveillance of scrapie in Great Britain between 1993 and 2002

Reports of clinical scrapie in Great Britain between January 1, 1993 and December 31, 2002 were reviewed. Scrapie was confirmed in 4142 sheep on 1099 holdings. The cumulative case and holding incidence risks decreased in 2001, probably owing to the outbreak of foot-and-mouth disease, although there were regional variations. Sheep aged between three and four years old constituted the largest affected group. In the period between 1998 and 2002, 51.3 per cent of the cases had the genotype ARQ/VRQ, 19.3 per cent were ARQ/ARQ and 18.9 per cent were VRQ/VRQ; Swaledale, Shetland and Welsh mountain sheep were the most common pure breeds reported. The areas at highest risk were the Shetland Islands, followed by the south and east of England.

Trends in age at detection in cases of bovine spongiform encephalopathy in Belgium: an indicator of the epidemic curve

There were 118 cases of bovine spongiform encephalopathy (BSE) in Belgium before January 1, 2004. Trends in their age at detection were analysed and attempts were made to use this parameter as a predictor of the current status of the BSE epidemic in the country. The following variables were considered: date of birth, breed, date of detection, mode of detection, and the number and age of animals slaughtered and rendered each month. Age at detection as a function of date of birth was a very poor epidemiological indicator. It was concluded that the increasing age of BSE cases when they were detected was due to the depletion of cases, as a result of there being no new infections, and that it is a reliable indicator of a decrease in the epidemic curve in Belgium. By means of a simulation it is shown how age distribution at the time of detection closely follows the epidemic curve and data from Great Britain are used to illustrate the point.

Descriptive spatial analysis of scrapie-affected flocks in Great Britain between January 1993 and December 2002

The spatial distribution of sheep flocks in Great Britain with confirmed clinical scrapie between January 1993 and December 2002 inclusive was investigated by using kernel density estimation and a cluster scan test statistic. Six statistically significant clusters were identified: three were lower risk, and were centred on the north-western coast of Scotland, the north-western coast of Wales and the South Yorkshire/Pennine region; three were of higher risk, and were centred in the central south, North Yorkshire and north Cumbria. General knowledge and the results of previous epidemiological studies were used to generate biologically plausible hypotheses that might explain these findings. They included aspects of flock management and disease transmission, and factors associated with the identification of cases, including their detection, recognition and, in particular, reporting levels, as well as diagnosis and animal movements.

Bovine spongiform encephalopathy and related diseases: an epidemiological overview

Following the recognition of the novel disease bovine spongiform encephalopathy in Great Britain in 1986, epidemiological and other research studies were initiated. The initial results of these studies revealed that bovine spongiform encephalopathy was caused by a scrapie-like agent and the vehicle of infection was meat-and-bone meal incorporated into cattle feedstuffs as a protein source. The British cattle population became effectively exposed in 1981-82 and this was associated with a dramatic reduction in the use of hydrocarbon solvents for the extraction of fat in the production of meat-and-bone meal. The feeding of ruminant-derived protein to ruminants was statutorily banned in July 1988 to prevent further exposure from the food-borne source. This paper reviews the epidemiological aspects of bovine spongiform encephalopathy and the occurrence of transmissible spongiform encephalopathies in other species.

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.

Estimation of the age-dependent risk of infection to BSE of dairy cattle in Great Britain

An important aspect of the bovine spongiform encephalopathy (BSE) epidemic has been an apparent age-dependent risk of infection, with younger cattle being more likely to become infected than older cattle. Our objective was to determine the age-dependent risk of infection of dairy cattle. We first reviewed unpublished data on the feeding patterns of proprietary concentrates for dairy-replacement cattle. These data showed that autumn- and spring-born cattle would receive different feeding patterns of proprietary concentrates, and so age-dependent risk of infection profiles were obtained separately for autumn- and spring-born cattle. We used back-calculation methods to analyse BSE-epidemic data collected in Great Britain between 1984 and 1996. Dairy cattle were most at risk in the first 6 months of life; adult cattle were at relatively low risk of infection. Between 6 and 24 months of age, risk profiles reflected feeding patterns of proprietary concentrates in each of the autumn- and spring-born cohorts.

National survey for Salmonella in pigs, cattle and sheep at slaughter in Great Britain (1999-2000)

AIMS

The objective of these surveys was to estimate the prevalence of faecal carriage of Salmonella in healthy pigs, cattle and sheep at slaughter, and of pig carcase contamination with Salmonella. These data can be used as a baseline against which future change in Salmonella prevalence in these species at slaughter can be monitored.

METHODS AND RESULTS

In this first randomized National Survey for faecal carriage of Salmonella in slaughter pigs, cattle and sheep in Great Britain, 2509 pigs, 891 cattle and 973 sheep were sampled in 34 pig abattoirs and 117 red meat abattoirs in England, Scotland and Wales. Carriage of Salmonella in 25 g caecal contents was identified in 578 (23.0% pigs) but in only 134 (5.3%) of carcase swabs. The predominant Salmonella serovars found in both types of sample were S. Typhimurium (11.1% caeca, 2.1% carcases) and S. Derby (6.3% caeca, 1.6% carcases). The main definitive phage types (DT) of S. Typhimurium found were DT104 (21.9% of caecal S. Typhimurium isolates), DT193 (18.7%), untypable strains (17.6%), DT208 (13.3%) and U302 (13.3%). Three isolates of S. Enteritidis (PTs 13A and 4) and one enrofloxacin-resistant S. Choleraesuis were also isolated. A positive 'meat-juice ELISA' was obtained from 15.2% of pigs at 40% optical density (O.D.) cut-off level and 35.7% at 10% cut-off. There was poor correlation between positive ELISA results or carcase contamination and the caecal carriage of Salmonella. The ratio of carcase contamination to caecal carriage rates was highest in abattoirs from the midland region of England and in smaller abattoirs. In cattle and sheep 1 g samples of rectal faeces were tested. Two isolates (i.e. 0.2%) were recovered from cattle, one each of S. Typhimurium, DT193 and DT12. One sheep sample (0.1%) contained a Salmonella, S. Typhimurium DT41. In a small subsidiary validation exercise using 25 g of rectal faeces from 174 cattle samples, three (1.7%) isolates of Salmonella (S. Typhimurium DT104, S. Agama, S. Derby) were found.

CONCLUSIONS

The carriage rate of Salmonella in prime slaughter cattle and sheep in Great Britain was very low compared with pigs. This suggests that future control measures should be focused on reduction of Salmonella infection on pig farms and minimizing contamination of carcases at slaughter.

SIGNIFICANCE AND IMPACT OF THE STUDY

This work has set baseline figures for Salmonella carriage in these species slaughtered for human consumption in Great Britain. These figures were collected in a representative way, which enables them to be used for monitoring trends and setting control targets.

Frequencies of prion protein (PrP) genotypes and distribution of ages in 15 scrapieaffected flocks in Great Britain

The frequencies of prion protein (PrP) genotypes were investigated in 15 scrapie-affected flocks in Great Britain. The flocks were heterogeneous in the frequencies of different genotypes and alleles, and in their age distributions. The median flock frequency of animals with VRQ-containing genotypes was 21 per cent (range 2 to 82 per cent, mean 25 per cent). The VRQ-containing and other non-ARR genotypes made up 11 to 82 per cent of a flock (median 46 per cent, mean 48 per cent). In comparison with data from the general population the scrapie-affected population had a lower frequency of the ARR/ARR genotype, and so of the ARR allele, and had a higher frequency of VRQ/non-ARR heterozygote genotypes, and thus of the VRQ allele.

Spatio-temporal epidemiology of foot-and-mouth disease in two counties of Great Britain in 2001

The spatial, temporal, and spatio-temporal features of the 2001 British foot-and-mouth disease epidemic in selected areas within the counties of Cumbria and Devon, which experienced the greatest incidence of disease, are described using hazard functions, extraction mapping and the space-time K-function. In Cumbria, the hazard of foot-and-mouth disease infection peaked at 2.8% in the week commencing 8 March 2001 and farm holdings in this area continued to be identified with disease to 12 September 2001. In contrast, peak infection hazard in Devon was 0.7% in the week commencing 15 March 2001 and eradication of the disease was achieved in this area by 31 May 2001. Persistence of the disease in Cumbria was consistent with: (1) many cattle holdings infected early in the epidemic (creating a high environmental viral load), and (2) a relatively large amount of medium-to-long-distance spread of the virus associated with seasonal farming activities-compounded to some extent by the movement of people and vehicles between disaggregated farm land parcels. The interaction of disease risk in Cumbria showed that premises remained infectious for longer throughout May, June and July, consistent with delays in disease detection during this period.

Prevalence of faecal excretion of verocytotoxigenic Escherichia coli 0157 in cattle in England and Wales

During the decade to 1999, the incidence of human infections with the zoonotic pathogen verocytotoxin-producing Escherichia coli O157 (VTEC O157) increased in England and Wales. This paper describes the results of a survey of 75 farms to determine the prevalence of faecal excretion of VTEC O157 by cattle, its primary reservoir host, in England and Wales. Faecal samples were collected from 4663 cattle between June and December 1999. The prevalence of excretion by individual cattle was 4.2 per cent (95 per cent confidence interval [CI] 2.0 to 6.4) and 10.3 per cent (95 per cent CI 5.8 to 14.8) among animals in infected herds. The within-herd prevalence on positive farms ranged from 1.1 to 51.4 per cent. At least one positive animal was identified on 29 (38.7 per cent; 95 per cent CI 28.1 to 50.4) of the farms, including dairy, suckler and fattening herds. The prevalence of excretion was least in the calves under two months of age, peaked in the calves aged between two and six months and declined thereafter. The phage types identified most widely were 4, 34 and 2, which were each found on six of the 29 positive farms.

Decision-support tools for foot and mouth disease control

Recent experience with foot and mouth disease (FMD) has shown that large and very costly epidemics can occur in countries considered extremely unlikely to experience the disease. The consequences of an introduction are much more severe than in the past and effective control is more difficult to achieve. Few countries have developed effective risk management strategies and information-based response systems to respond to these developments. The authors describe the tools which can be employed to minimise the impact of a disease incursion, using the example of FMD. To make such systems effective, the development of a national farms database in advance, including geo-referencing, is highly desirable. This greatly enhances the power of the decision-support tools, which can then be applied as soon as a serious disease incursion has been detected. These tools include procedures to detect infected farms promptly, to protect as yet uninfected farms against exposure to virus and to manage control policies. Epidemiological evaluation and prediction tools have advanced particularly rapidly and can guide the choice of control policies during an outbreak. Integrated decision-support systems offer the best method of managing FMD outbreaks to minimise the cost and size of the epidemics.

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

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

Faecal carriage of verocytotoxin-producing Escherichia coli O157 in cattle and sheep at slaughter in Great Britain

A 12-month abattoir survey was conducted between January 1999 and January 2000, to determine the prevalence of faecal carriage of verocytotoxin-producing Escherichia coli O157 (VTEC O157) in cattle and sheep slaughtered for human consumption in Great Britain. Samples of rectum containing faeces were collected from 3939 cattle and 4171 sheep at 118 abattoirs, in numbers proportional to the throughput of the premises. The annual prevalence of faecal carriage of VTEC O157 was 4.7 per cent (95 per cent confidence interval 4.1 to 5.4) for cattle and 1.7 per cent (1.3 to 2.1) for sheep, values which were statistically significantly different from each other (P < 0.001). The organisms were recovered from both cattle and sheep slaughtered throughout the year and at abattoirs in all regions of the country, but the highest prevalence was in the summer. The most frequency recovered VTEC O157 isolates were phage types 2, 8 and 21/28 in cattle and 4 and 32 in sheep, the five most frequently isolated phage types associated with illness in people in Great Britain during the same period.

Descriptive epidemiology of the 2001 foot-and-mouth disease epidemic in Great Britain: the first five months

In February 2001, foot-and-mouth disease (FMD) was confirmed in Great Britain. A major epidemic developed, which peaked around 50 cases a day in late March, declining to under 10 a day by May. By mid-July, 1849 cases had been detected. The main control measures employed were livestock movement restrictions and the rapid slaughter of infected and exposed livestock. The first detected case was in south-east England; infection was traced to a farm in north-east England to which all other cases were linked. The epidemic was large as a result of a combination of events, including a delay in the diagnosis of the index case, the movement of infected sheep to market before FMD was first diagnosed, and the time of year. Virus was introduced at a time when there were many sheep movements around the country and weather conditions supported survival of the virus. The consequence was multiple, effectively primary, introductions of FMD virus into major sheep-keeping areas. Subsequent local spread from these introductions accounted for the majority of cases. The largest local epidemics were in areas with dense sheep populations and livestock dealers who were active during the key period. Most affected farms kept both sheep and cattle. At the time of writing the epidemic was still ongoing; however, this paper provides a basis for scientific discussion of the first five months.

A stochastic model to estimate the prevalence of scrapie in Great Britain using the results of an abattoir-based survey

In 1997/1998, an abattoir survey was conducted to determine the likely exposure of the human population to transmissible spongiform encephalopathy (TSE) infection in sheep submitted for slaughter in Great Britain. The survey examined brain material from 2809 sheep processed through British abattoirs. Sampling was targeted by age: 45% of animals tested were > or =15 months old. All samples of adequate quality (98%) were tested for signs of scrapie infection using histopathology and scrapie-associated fibril (SAF) detection and 500 were tested using immunohistochemistry (IHC). No conclusive positive animals were found using either histology or IHC. Ten animals were positive by SAF. Standard statistical analyses suggest (with 95% confidence) that the prevalence of detectable (by histopathology) infection in the slaughter population was < or =0.11%. However, the incubation period of scrapie is long (usually around 2-3 years) and none of the tests used in the survey is capable of detecting scrapie infection in the early stages of infection. We present an age-structured stochastic model incorporating parameters for the incubation period of scrapie, prevalence of infection by age and test sensitivity. Using the model, we demonstrate that the negative results obtained for all samples using IHC and histopathology are consistent with a true prevalence of infection in the slaughter population of up to 11%. This suggests that up to 300 of the animals tested might have been infected but the infection was not sufficiently advanced in these animals to be detectable by IHC or histopathology. The survey was designed to detect a prevalence of 1% with a precision of +/-0.5% and a confidence level of 95% in each age group assuming that diagnostic tests were 100% specific and sensitive from a known stage in the incubation period. The results of the model demonstrate that to estimate a true prevalence of scrapie infection of 1% with an accuracy of +/-0.5% would have required a far larger sample size. An accurate estimate of the required sample size is complicated by uncertainty about test sensitivity and the underlying infection dynamics of scrapie. A pre-requisite for any future abattoir survey is validation of the diagnostic tests used in relation to both stage of incubation and genotype. Sampling in the <15-month age group was of no value in this survey because the diagnostic tests used were thought to be ineffective in most of the animals in this age group.

Predictive spatial modelling of alternative control strategies for the foot-and-mouth disease epidemic in Great Britain, 2001

A spatial simulation model of foot-and-mouth disease was used in March and early April 2001 to evaluate alternative control policies for the 2001 epidemic in Great Britain. Control policies were those in operation from March 20, 2001, and comprised a ban on all animal movements from February 23, 2001, and a stamping-out policy. Each simulation commenced with the known population of infected farms on April 10, 2001, and ran for 200 days. For the control policy which best approximated that actually implemented from late March, the model predicted an epidemic of approximately 1800 to 1900 affected farms, and estimated that the epidemic would be eradicated between July and October 2001, with a low probability of continuing beyond October 2001. This policy included the slaughter-out of infected farms within 24 hours, slaughter of about 1.3 of the surrounding farms per infected farm within a further 48 hours, and minimal interfarm movements of susceptible animals. Delays in the slaughter of animals on infected farms beyond 24 hours after diagnosis slightly increased the epidemic size, and failure to achieve pre-emptive slaughter on an adequate number of at-risk farms substantially increased the expected size of the epidemic. Vaccination of up to three of the most outbreak-dense areas carried out in conjunction with the adopted control policy reduced the predicted size of the epidemic by less than 100 farms. Vaccination of buffer zones (designed to apply available vaccine and manpower as effectively as possible) carried out in place of the adopted control policy allowed the disease to spread out of control, producing an epidemic involving over 6000 farms by October 2001, with no prospect of immediate eradication.

Histological observations on the brains of symptomless 7-year-old cattle

The histological changes in the brains of 506 clinically normal 7-year-old cattle, which were part of a cohort study on maternal transmission of bovine spongiform encephalopathy, are described. Vacuolation of the white matter, of unknown aetiology, located particularly in the substantia nigra, was a frequent finding. Vacuolated neurons were commonly observed in the red nucleus (64.3% of the animals) and in the habenular nucleus (50.1%). Spheroids were found in 10.8% of the brains, most frequently in the vestibular nuclei. Cellular inflammatory infiltrates in association with blood vessels occurred in 30% of the animals at various locations in the brain; their aetiology remains uncertain, but they may have reflected subclinical or latent infections. Mineralization of the wall of blood vessels, with proliferation of the intima, was observed frequently in vessels of the internal capsule and was probably associated with ageing. The description of histological findings in the brain of symptomless adult cattle in the present study provides a useful background for diagnostic bovine neuropathology.

Descriptive spatial analysis of the epidemic of bovine spongiform encephalopathy in Great Britain to June 1997

This was a spatial analysis of the epidemic of bovine spongiform encephalopathy (BSE) in Great Britain, based on agricultural census data collected between 1986 and 1996 and BSE case data collected up to June 1997. Kernel smoothing techniques were used to plot the distribution of BSE-positive cattle holdings per 100 holdings per square kilometre and the distribution of confirmed BSE cases per 100 head of cattle per square kilometre. In the early stages of the epidemic reported BSE cases were scattered widely throughout Great Britain, with no clearly identifiable focus. By June 1997, a statistically significant cluster of BSE-positive holdings was identifiable in the eastern part of the South west region of England. During the epidemic the highest densities of confirmed BSE cases per 100 cattle per square kilometre occurred in the greater part of the South west region of England and within Dyfed in the south west of Wales. In Wales, a small number of holdings experienced large numbers of confirmed BSE cases. In the South west region of England a large number of holdings experienced small numbers of confirmed cases. By June 1997, the distribution of BSE-positive holdings across Great Britain was largely determined by factors that influenced the amount of recycled infectious material they were exposed to.

Temporal aspects of the epidemic of bovine spongiform encephalopathy in Great Britain: individual animal-associated risk factors for the disease

The objectives of this study were first to determine the cumulative incidence of bovine spongiform encephalopathy (BSE) in the British cattle population from July 1986 to June 1997, secondly, to identify individual animal-associated risk factors that influenced the age of onset of clinical signs in confirmed BSE cases, and, thirdly, to assess the effectiveness of the measures introduced to control BSE during the epidemic. The analyses were based on the population of British cattle at risk, derived from agricultural census data collected between 1986 and 1996, and BSE case data collected up to June 30, 1997. The unit of interest was individual adult cattle recorded on annual agricultural censuses between June 1986 and June 1996. Univariate and multivariate survival analysis techniques were used to characterise the age of onset of clinical signs. In total 167,366 cases of BSE were diagnosed in Great Britain up to June 30, 1997. The cumulative incidence of BSE between July 1986 and June 1997 was 1.10 (95 per cent confidence interval [CI] 1.09 to 1.10) cases per 100 adult cattle at risk. Cattle from the South east, South west and Eastern regions of England had 4.26 to 5.96 (95 per cent CI 4.15 to 6.14) times as great a monthly hazard of being confirmed with BSE as cattle from Scotland. Compared with cattle born before June 1985, those born between July 1987 and June 1988 had 22.5 (95 per cent CI 22.1 to 22.8) times the monthly hazard of being confirmed with BSE, whereas those born in the 12 months after July 1988 had only 7.39 (95 per cent CI 7.24 to 7.54) times the monthly hazard of being confirmed with BSE. This reduction in hazard was directly attributable to the ban on the use of ruminant protein as a feed instituted in July 1988. Successive cohorts from 1989 to 1991 experienced further reductions in the hazard of experiencing BSE. The additional decrease in hazard observed for the 1990 cohort may be attributed to the effect of the Specified Bovine Offal ban instituted in September 1990.

Temporal aspects of the epidemic of bovine spongiform encephalopathy in Great Britain: holding-associated risk factors for the disease

The objectives of this study were first to describe the pattern of the epidemic of bovine spongiform encephalopathy (BSE) in Great Britain in terms of the temporal change in the proportion of all cattle holdings that had experienced at least one confirmed case of BSE to June 30, 1997, and secondly to identify risk factors that influenced the date of onset of a holding's first confirmed BSE case. The analyses were based on the population of British cattle at risk, derived from agricultural census data collected between 1986 and 1996, and the BSE case data collected up to June 30, 1997. The unit of interest was the cattle holding and included all those recorded at least once on annual agricultural censuses conducted between June 30, 1986, and June 30, 1996. The outcome of interest was the date on which clinical signs were recorded in a holding's first confirmed case of BSE, termed the BSE onset date. Univariate and multivariate survival analysis techniques were used to describe the temporal pattern of the epidemic. The BSE epidemic in Great Britain started in November 1986, with the majority of affected holdings having their BSE onset date after February 1992. After adjusting for the effect of the size and type of holding, holdings in the south of England (specifically those in the Eastern, South east and South west regions) had 2.22 to 2.43 (95 per cent confidence interval [CI] 2.07 to 2.58) times as great a monthly hazard of having a BSE index case as holdings in Scotland. After adjusting for the effect of region and type of holding, holdings with more than 53 adult cattle had 5.91 (95 per cent CI 5.62 to 6.21) times as great a monthly hazard of having a BSE index case as holdings with seven to 21 adult cattle. Dairy holdings had 3.06 (95 per cent CI 2.96 to 3.16) times as great a monthly hazard of having a BSE index case as beef suckler holdings. These analyses show that there were different rates of onset in different regions and in holdings of different sizes and types, that the epidemic was propagated most strongly in the south of the country, and that the growth of the epidemic followed essentially the same pattern in each region of the country, with modest temporal lags between them. The control measures imposed in 1988 and 1990 brought the expansion of the epidemic under control, although the rate of progress was slowed by those regions where the effectiveness of the control methods took some time to take full effect.

Scrapie surveillance in Great Britain: results of an abattoir survey, 1997/98

A randomised sample of 2,809 apparently healthy sheep, 55 per cent of them less than 15 months of age, which were slaughtered for human consumption at abattoirs in Great Britain in 1997/98, was taken to establish the prevalence of scrapie infection. The medulla oblongata of each sheep was examined histopathologically at the level of the obex, and fresh brain tissue was examined for scrapie-associated fibrils (SAF) to establish whether there was evidence of scrapie. In addition, histological sections of the medulla from 500 of the sheep were immunostained with an antiserum to PrP, and the same technique was also applied to any animal found positive or inconclusive by the histological or SAF examinations. Any sheep which was positive by any of these diagnostic methods was also examined by Western immunoblotting, for the detection of the disease-specific protein PrP(Sc). A total of 2,798 sheep (99.6 per cent) were negative by all the methods applied. Ten animals were SAF-positive but negative by all the other methods, and in one animal there was immunohistochemical staining which could not be interpreted unequivocally as disease-specific. A mathematical model was used to estimate the prevalence of scrapie infection in the national slaughtered sheep population which would be consistent with these results. By this model, the absence of unequivocally substantiated cases of scrapie in the sample was consistent with a prevalence of infection in the slaughter population of up to 11 per cent.

Surveillance of BSE

The current method used to identify suspect BSE cases is based on reporting cattle displaying clinical signs compatible with BSE. The reporting of such cases is dependent on the ability of farmers and veterinarians to recognise the disease symptoms and on the willingness to report such cases. Furthermore, it depends on the stage of the disease, because early clinical signs of BSE are not always typical. Histology and immunohistochemistry are established and reliable to confirm BSE in cattle, but the procedure is cumbersome, time consuming and therefore not suited for mass testing of animals. A targeted surveillance system using the Prionics-Western-Blot Test was initiated in Switzerland in 1999. Prionics-positive results are confirmed by histology or immunohistochemistry by the BSE-reference laboratory. This surveillance scheme has confirmed fallen stock and cows subjected to emergency slaughter as the major risk groups. Currently all cattle from these two categories are tested. As a further measure a random sample of cows from regular slaughtering is tested. This enables to determine the BSE status independent of the inaccuracies of a clinical case reporting system. This approach may be helpful to reliably assess the BSE situation in countries with low incidence in order to verify their BSE status and in countries which want to prove their BSE-free status.

Bovine tuberculosis in Northern Ireland: a case-control study of herd risk factors

This paper presents the results of the first formal epidemiological study in Northern Ireland of risk factors for bovine tuberculosis (TB) associated with farm boundaries, neighbours and wildlife. The study was designed as a case-control study and 427 dairy herds were investigated between December 1993 and January 1995. The case herds had more than 30 cattle, and herds in which the source of infection had been ascribed to purchased cattle were avoided. Data on the Department of Agriculture Animal Health Computer were used in conjunction with data collected through a questionnaire to examine a range of possible risk factors, including the number and nature of the farm boundaries, the number of neighbours and their TB history, the number of hedgerows, the presence of badger setts, whether badger carcases had been found on the land, and the possible presence of deer. A follow-up telephone survey was conducted to minimise bias. The results highlighted two main associations with TB breakdowns, the presence of badgers, and contiguous neighbours who had had confirmed TB breakdowns. The estimated aetiological fraction for both associations was approximately 40 per cent, suggesting that although infected cattle may have a significant role in the transmission of TB their importance relative to the badger may have been over-estimated in the Northern Ireland TB scheme. The contribution of the badger is possibly one of several main reasons for the lack of significant progress in TB eradication despite strenuous efforts associated with all aspects of the scheme.

Geographical distribution of variant CJD in the UK (excluding Northern Ireland)

BACKGROUND

The agent that causes variant Creutzfeldt-Jakob disease (variant CJD) is indistinguishable from the causative agent of bovine spongiform encephalopathy (BSE). The transmission route by which human beings are infected has not been established. One hypothesis is that cases of variant CJD have resulted from exposure to the BSE agent via rendering plants involved in the production of meat and bone meal, the main vehicle of the BSE epidemic.

METHODS

We identified cases of variant CJD through the National CJD Surveillance Unit, and obtained lifetime residential histories of cases by interviewing a relative. The addresses of all rendering plants in the UK (excluding Northern Ireland) in production in 1988 were available from a survey done in that year. We calculated the distance between each case's place of residence on Jan 1, 1988, and the nearest rendering plant from postcode data, and used data from the 1991 UK census to estimate the population living within various distances of rendering plants. We compared the observed number of cases of variant CJD within a particular distance of a rendering plant with the number expected if there is no association between residential proximity to a rendering plant and the risk of developing variant CJD.

FINDINGS

Up to Aug 31, 1998, 26 cases of variant CJD with onset in the UK (Northern Ireland not included) had been identified. The observed and expected numbers of variant CJD cases living within a specified distance of any rendering plant up to 50 km were almost the same. Two plants in the county of Kent each had four cases within 50 km in 1988, significantly more cases than expected (plant A, 1.04 expected; plant B, 0.74 expected). Multiple significance tests were done, so some tests would be expected to appear significant by chance alone. Computer simulations suggested that the observation of four cases of variant CJD living in an area with a population of 1.5 million (the size of Kent) is not unexpected.

INTERPRETATION

There is no evidence that people with variant CJD tended to live closer than the population as a whole to rendering plants in the 1980s. The reported cluster of variant CJD cases in Kent is most probably a chance finding.

Analysis of dam-calf pairs of BSE cases: confirmation of a maternal risk enhancement

We investigate whether a calf born to a dam that develops bovine spongiform encephalopathy (BSE) (prior or subsequent to the birth) is itself at an enhanced risk of developing BSE. Analyses utilize the main database on reported BSE cases in the British cattle herd maintained by the Central Veterinary Laboratory in Weybridge to trace the dams of BSE-affected animals born following the ruminant feed ban in July 1988. The data reveal a significantly enhanced risk of disease in calves born to BSE-affected dams, with the risk being greatest when birth occurs after the onset of clinical signs of disease in the dam. The dependence of the maternally enhanced risk on the maternal incubation stage at birth argues for a significant component of direct maternal transmission of the aetiological agent of BSE, and offers little support for the hypothesis of genetic predisposition. Using a statistical likelihood model, we obtain estimates of the rate of direct maternal transmission by maternal incubation stage; however, biases in the available data make these values minimum estimates.

Comparison of histology with maternal and fetal serology for the diagnosis of abortion due to bovine neosporosis

An indirect fluorescent antibody test was applied to sera from normally calving and aborting cows and to samples of pleural fluid from their aborted calves, and the antibody titres were compared with histology and immunocytochemistry for the diagnosis of Neospora-associated abortion. Two groups of aborting cows and a third group of cows which had calved normally were used; group A consisted of 36 cows which aborted calves showing characteristic non-suppurative inflammatory lesions in which Neospora was demonstrated by immunocytochemistry, group B consisted of 100 cows which aborted calves without histological evidence of neosporosis, and group C consisted of 128 normally calved cows which were sampled within one month of calving. Serology on the maternal sera and fetal fluids was highly specific and sensitive for Neospora infection although 5 per cent of the cows which aborted Neospora-negative calves and 4.7 per cent of the normally calved cows were also seropositive. Anti-Neospora antibodies were also detected in 7 per cent of the samples of fetal fluid from Neospora-negative abortions.

A cohort study to examine maternally-associated risk factors for bovine spongiform encephalopathy

This long-term cohort study, initiated in July 1989, was designed to examine maternally-associated risk factors for bovine spongiform encephalopathy (BSE), forming part of the epidemiological research programme to assess the risks of non-feedborne transmission of BSE. In this study, the incidence of BSE in offspring of cows which developed clinical signs of BSE is compared with that in offspring, born in the same calving season and herd, of cows which had reached at least six years of age and had not developed BSE. All offspring were allowed to live to seven years of age. The results indicate a statistically significant risk difference between the two cohorts of 9.7 per cent and a relative risk of 3.2 for offspring of cows which developed clinical BSE. However, there is some evidence that this enhanced risk for offspring of BSE cases declined the later the offspring was born, but was increased the later the offspring was born in relation to the stage of the incubation period of the dam. The results presented cannot distinguish between a genetic component and true maternal transmission or a combination of both risks, but they do not indicate either that the BSE epidemic will be unduly prolonged or that the future incidence of BSE in Great Britain will increase significantly.

Risk of BSE from the import of cattle from the United Kingdom into countries of the European Union

This study assesses quantitatively the risk that other countries, in particular those within the European Union, have incurred by importing cattle from the United Kingdom during the period before or shortly after the ban on the import of live breeding stock was introduced in 1989. It does this by assessing the probability that animals imported from the UK in a certain year would have become a detected BSE case, had they not been exported. Using the annual incidence rates available for separate birth cohorts and a given culling rate, a cumulative incidence for each birth cohort was calculated. These figures were then combined with the numbers of live breeding cattle imported from the UK into the other countries of the EU, to give an import-related risk index for each country, assuming that their culling rates were similar to that in Great Britain. The countries could thus be categorised in terms of the number of cases of BSE they might have expected.

Sporadic Creutzfeldt-Jakob disease in the United Kingdom: analysis of epidemiological surveillance data for 1970-96

OBJECTIVE

To identify changes in the occurrence of Creutzfeldt-Jakob disease that might be related to the epidemic of bovine spongiform encephalopathy.

DESIGN

Epidemiological surveillance of the United Kingdom population for Creutzfeldt-Jakob disease based on (a) referral of suspected cases by neurologists, neuropathologists, and neurophysiologists and (b) death certificates.

SETTING

England and Wales during 1970-84, and whole of the United Kingdom during 1985-96.

SUBJECTS

All 662 patients identified as sporadic cases of Creutzfeldt-Jakob disease.

MAIN OUTCOME MEASURES

Age distribution of patients, age specific time trends of disease, occupational exposure to cattle, potential exposure to causative agent of bovine spongiform encephalopathy.

RESULTS

During 1970-96 there was an increase in the number of sporadic cases of Creutzfeldt-Jakob disease recorded yearly in England and Wales. The greatest increase was among people aged over 70. There was a statistically significant excess of cases among dairy farm workers and their spouses and among people at increased risk of contact with live cattle infected with bovine spongiform encephalopathy. During 1994-6 there were six deaths from sporadic Creutzfeldt-Jakob disease in the United Kingdom in patients aged under 30.

CONCLUSIONS

The increase in the incidence of sporadic Creutzfeldt-Jakob disease and the high incidence in dairy farmers in the United Kingdom may be unrelated to bovine spongiform encephalopathy. The most striking change in the pattern of Creutzfeldt-Jakob disease in the United Kingdom after the epidemic of bovine spongiform encephalopathy is provided by the incidence in a group of exceptionally young patients with a consistent and unusual neuropathological profile. The outcome of mouse transmission studies and the future incidence of the disease in the United Kingdom and elsewhere, will be important in judging whether the agent causing bovine spongiform encephalopathy has infected humans.