Veterinary Public Health, State Veterinary Medicine - Risk and Disease Surveillance Notes
Introduction to Veterinary Public Health, State Veterinary Medicine - Risk and Disease surveillance
Lesson Learning Outcomes
By the end of these sessions, students will be able to:
Identify UK and international organizations involved in Veterinary State Medicine and Public Health design and application in the UK.
Identify key statutory instruments underpinning Animal Health, Animal Welfare, and Food Safety legislation in the UK.
Describe Animal Health Surveillance principles in the UK and their applications for companion and farm animals.
Discuss the role of international organizations and trade in setting animal health surveillance principles.
Identify the legal framework that underlies statutory surveillance.
Identify diseases notifiable under UK legislation and their control systems.
What is State Veterinary Medicine (SVM)?
State Veterinary Medicine encompasses:
Protection of public health
Protection of animal health
Protection of animal welfare
Protection of international trade
Who is Involved in SVM and Veterinary Public Health (VPH)?
Organizations involved operate at international, national, and local levels.
Risk Analysis
Risk analysis is a structured approach to handling hazards and risks.
Definitions of risk vary depending on context (sociological, mathematical, colloquial).
Hazard
A hazard is something potentially harmful to humans, animals, plants, or the environment.
Example: A speeding car.
Hazard identification involves identifying all potential hazards in a given situation.
Risk Assessment
Risk assessment is evaluating the risk(s) resulting from a hazard.
A risk assessor or team is responsible for conducting the evaluation due to the diverse expertise required.
Risk Management
Risk management uses risk assessment results and the risk manager’s judgment to balance potential benefits against assessed risks.
The goal is to make decisions on acceptable risk and formulate policy.
Cost-benefit and/or risk-benefit analyses may be included.
Risk management should be a structured process:
Putting the identified ‘risk issue’ into context.
Information gathering.
Identifying possible management options.
Making decisions on safeguards (risk-reduction measures).
Ensuring decisions are turned into actions, and monitoring outcomes.
Evaluating the outcomes of the decisions and actions.
Re-evaluating the problem and its context based on the actions taken.
International Organizations
Governmental
European Union (European Commission)
Food and Veterinary Office (FVO)
European Food Safety Authority (EFSA)
European Centre for Disease Control (ECDC)
Non-Governmental
World Animal Health Organisation (OIE)
United Nations (UN)
World Health Organisation (WHO)
Food and Agricultural Organisation (FAO)
Codex Alimentarius
Committee on Food Hygiene
Committee on Food Additives
Provides advice, codes of practice, and standards
World Trade Organisation (WTO)
International Standards Organisation (ISO)
World Organisation for Animal Health (OIE)
Formed in 1924 as the Office International des Epizooties.
Intergovernmental organization with 182 member states, coordinating and promoting animal disease control.
Recognized reference organization by the WTO.
Core mandate: improve animal health worldwide.
In 2002, became the key international organization on animal welfare and committed to preventing zoonoses effects on veterinary public health, including food safety.
World Trade Organisation (WTO)
Formed in 1995.
Intergovernmental organization with 164 member states coordinating, regulating, and facilitating international trade.
The process of becoming a WTO member is unique, dependent on economic development and current trade regime.
World Health Organisation (WHO - United Nations)
An agency of the United Nations responsible for international Public Health.
Formed in 1948, all UN members (193 member states) are members of the WHO.
Leads global efforts to expand universal health coverage, coordinates responses to health emergencies, and promotes healthier lives.
Food and Agricultural Organization (FAO - United Nations)
A specialized agency of the UN that leads international efforts to defeat hunger and improve nutrition and food security.
Formed in 1945, all UN members (193 member states) are members of the FAO.
Mandate: assist governments and development agencies in coordinating activities to improve and develop agriculture, forestry, fisheries, and land/water resources.
Codex Alimentarius (FAO, United Nations)
A collection of internationally recognized standards, codes of practice, guidelines, and recommendations related to food, food production, food labeling, and food safety.
Formed in 1963, currently has 189 members.
International Standards Organisation (ISO)
Independent, non-governmental international organization with 164 national standards bodies.
The UK’s representative body is the British Standards Institution (BSI).
Formed in 1947.
Mandate: organization, development, and publishing of worldwide technical, industrial, and commercial standards.
OIE Mandate
WTO's Sanitary and Phytosanitary Agreement recognizes OIE as the reference organization for international animal health and zoonoses standards.
OIE establishes health requirements for safe international trade of animals and animal products, avoiding unjustified sanitary barriers.
OIE has a mandate in animal food production food safety to reduce food-borne risks to human health.
Guidelines and recommendations protect animal production and human population against hazards arising from animals.
Governmental International Organizations
Food and Veterinary Office (European Commission)
Mission: to check compliance with EU food safety and quality, animal health and welfare, and plant health legislation within the EU and in third countries exporting to the EU.
Contribute to the development of European Community policy.
Contribute to the development and implementation of effective control systems and inform stakeholders of audit and inspection outcomes.
European Food Safety Authority (EFSA)
A scientific agency of the EU.
Provides independent scientific advice and communicates on existing and emerging risks associated with the food chain (antimicrobial use, chemical toxicity, zoonotic disease etc.).
Advice is given to the European Commission and may be enacted into legislation.
European Centre for Disease Control (ECDC)
An agency of the EU with the mission to strengthen Europe's defenses against infectious diseases.
Reports to the European Commission on surveillance and disease data, threats, outbreaks, and public health matters.
Advice may be transcribed into legislation.
National Organizations: United Kingdom Government
Central Government
UK Parliament Westminster
Welsh Assembly
Scottish Parliament
Northern Ireland Assembly
Legal Hierarchy
Act – Primary Legislation
Regulations or Orders – Secondary Legislation
Codes – guidelines that meet Act requirements.
Other National Organizations
Food Standards Agency
Department of Health
DEFRA
Devolved administrations
Health and Safety Executive
CO (Civil Contingencies Secretariat)
No 10 Department For International Development
Foreign and Commonwealth Office
Department for International Trade
Communities and Local Government
Home Office
Office of Science and Technology
Trading Standards
Food Standards Agency (FSA)
A non-ministerial government department responsible for protecting public health in relation to food in England, Wales, and Northern Ireland.
Led by a board appointed to act in the public interest.
Food Standards Scotland is its Scottish counterpart.
DEFRA
Government department responsible for environmental protection, food production and standards, agriculture, fisheries, and rural communities across the UK.
APHA
Executive agency within DEFRA.
Main task: protect animal and public health and welfare from disease.
Conducts work across Great Britain on behalf of Defra, the Scottish Government, and the Welsh Government.
UKHSA
Executive agency within the Department of Health and Social Care (DHSC).
Formed in April 2021, fully replaced PHE in October 2021.
Responsible for protecting every community member from infectious diseases, chemical, biological, radiological, and nuclear incidents, and other health threats.
Provides scientific and operational leadership at national, local, and global levels.
Collaborates with Public Health Scotland, Public Health Wales, and Northern Ireland's Public Health Agency.
VMD
Regulation and authorization of veterinary medicines (safety, quality, and efficacy).
Adverse reaction reporting and post-authorization surveillance.
Surveillance for residues in animal products and antimicrobial resistance.
Enforcement of Legislation
Nationally:
APHA
Public Health England/Wales/Scotland / HSC Public Health NI
FSA operations
Local government:
Environmental Health
Trading Standards
Local Authorities
Environmental Health Officers (EHOs) were created in the 1970s, evolving from Public Health Officers and Inspectors of Nuisances.
Their responsibilities include housing, pollution, pest control, and food law enforcement.
EHOs have training in hygiene and microbiology and monitor the hygienic operation of food businesses and investigate/control food poisoning outbreaks.
Most EHOs have a degree in Environmental Health and are members of the Chartered Institute of Environmental Health (CIEH).
Local Government Role
In the UK, local authorities have a primary role in enforcing food safety and consumer protection legislation, mainly undertaken by Environmental Health Officers and Trading Standards Officers.
Local authorities play an essential service-level role and depend on appropriate national and European policies for coordination and consistency of enforcement.
Responsibilities include waste control, food premises licensing and inspection, pest control, animal welfare, housing, and nuisance management.
Notifiable Diseases and Surveillance
What are Notifiable Diseases?
In a UK context, notifiable diseases are animal diseases that you’re legally obliged to report to the Animal and Plant Health Agency (APHA), even if you only suspect that an animal may be affected.
DEFRA definition
A disease named in section 88 of the Animal Health Act 1981
Includes Cattle Plague, Pleuro-pneumonia, Foot and Mouth Disease, Sheep Pox, Sheep Scab, Swine Fever or in an Order made under the Animal Health Act.
Orders can be related to:
A single disease (Foot and Mouth Disease Order)
A species (The Infectious Diseases of Horses Order 1987)
A specific list (The Specified Diseases (Notification and Slaughter) Order 1992)
Enacting European Union Legislation (The Specified Diseases (Notification) Order 1996)
Why are some diseases notifiable?
Having due regard for:
International Trade
Public Health
Animal welfare
Wider society
Economic impact on the agricultural industry
Cost to the community
Availability of appropriate solutions.
UK Notifiable Animal Diseases
A comprehensive list of notifiable diseases in the UK has been provided (see transcript).
Notifiable Fish and Shellfish Diseases
A list of notifiable fish has been provided (see transcript).
Includes crustaceans and molluscs.
If you suspect a notifiable disease, you must tell FHI immediately if your fish or shellfish:
Could be infected with a notifiable disease (you must report it even if you only suspect an infection)
Are dying in larger numbers than normal
Are affected by unusual deaths
If you know about or suspect a notifiable disease but don't report it you could be fined up to £5,000
Controlling Bee Pests and Diseases
Report suspect bee diseases or pests.
If you are a beekeeper in England and Wales, and you find signs of a notifiable bee disease or pest in your colony, you must contact your regional bee inspector or the NBU and request an inspection of your bees.
Failure to do this is an offence under the Bee Diseases and Pest Control Order 2006 with fines set on a case-by-case basis.
Elsewhere in the UK, you must contact the local office of the relevant government department.
The two notifiable bee pests are:
Small hive beetle
Tropilaelaps mite
The two notifiable bee diseases are:
American foulbrood
European foulbrood
If one of these pests or diseases is found in your colony, the apiary will be put under a Standstill Notice until it is cleared of the pest or disease. The Inspector will provide you with more information about what you need to do.
OIE-WAHIS
OIE World Animal Health Information System is a comprehensive database for reporting and disseminating animal health information worldwide.
Data reflects information gathered by Veterinary Services from OIE Members and non-Members on OIE-listed diseases in domestic animals and wildlife, as well as on emerging diseases and zoonoses.
Publicly accessible with data extraction tools, interactive mapping tools, and dashboards.
Replaces the former WAHIS web interface.
OIE Animal Health Codes
The OIE has developed this Standard Operating Procedure (SOP) for the decision to add (or remove) pathogenic agents of terrestrial animals to (or from) the OIE List and to define the roles and responsibilities of Specialist Commissions, subject-matter experts, OIE Headquarters, and Members Countries in this process.
Scope:
This procedure describes the process to be followed for assessing a pathogenic agent of terrestrial animals against the criteria in Chapter 1.2. of the Terrestrial Code for decisions regarding inclusion in the OIE List in Chapter 1.3.
The procedure has three steps:
1: Request for a listing decision;
2: Decision to initiate the process of assessment of a pathogenic agent;
3: Assessment of a pathogenic agent against the criteria for inclusion in the OIE List by:
SCAD or
subject matter experts via an electronic consultation or
an ad hoc Group (physical meeting)
UK Notifiable Human Diseases
A comprehensive list of notifiable diseases in the UK has been provided (see transcript).
WHO Decision Instrument for Assessment and Notification of Public Health Emergencies
Events detected by the national surveillance system that might constitute a Public Health Emergency of International Concern must be assessed.
Specific diseases (Smallpox, Poliomyelitis, Human influenza caused by a new subtype, SARS) always require notification.
An algorithm is provided to determine whether the event is serious, unusual/unexpected, poses a significant risk of international spread, or could lead to international travel/trade restrictions.
Animal Diseases Matter
Lead to major government response.
Disrupt agriculture, international trade, and the food supply.
Impact beyond agriculture.
Impact credibility of Government / Country.
Comparable with deliberate CBRN incidents.
Failure to control is a risk.
Notifiable Diseases Outbreak: Foot and Mouth Disease (FMD)
The 2001 outbreak was the worst FMD outbreak to affect Western Europe.
Took 220 days to eradicate.
Economic cost of ~$£8bn~.
Slaughter of ~six million animals.
Led to The Animal By-Products (Amendment) (England) Order 2001.
Britain only survived the aforementioned disaster because it has the world’s 5th Highest GDP and doesn’t rely on animal product exports.
Aphthavirus - picornavirus
Survives well in the environment (maybe for ~1 month) and is readily transmitted on equipment, clothes, vehicles, wildlife (as fomites) and wind.
Infects ruminants and pigs (plus some other spp) causing subclinical-to-severe disease.
+/- zoonotic?
What happens if a notifiable disease is suspected?
If you suspect any notifiable disease you MUST notify APHA immediately by telephone.
A Duty VO (Veterinary Officer) will discuss over the phone and if FMD can’t be ruled out will visit the farm.
If FMD still can’t be ruled out then samples are taken and sent to Pirbright and the farm is declared a ‘Suspect Premises’.
Suspect Premises involves:
Warning / Keep Out signs.
Records of animals, bedding etc on site.
Isolation of animals.
Prevention of movement of animals.
Disinfectants at entrances and exits.
Prevention of all movements that might spread the infection.
Rodent control.
What happens if a notifiable disease is confirmed?
Formal confirmation by CVO (Chief Veterinary Officer)
Informs OIE and EC and reports regularly to both on progress of the outbreak.
UK loses FMD-free status, exports of cattle and cattle products pretty much stop, certainly from within the control zone.
Zones
Protection Zone - a minimum of 3km radius from the IP (Infected Premise).
Surveillance Zone - a minimum of 10km in radius from the IP.
Restricted Zone a national movement ban across GB
Infected premises:
Restrictions already imposed on the premises remain in force.
Susceptible animals humanely culled.
Carcasses will be disposed of, and preliminary disinfection carried out on the farm.
The epidemiological investigation continues to establish where the disease came from and where it may have spread.
Disposal of Carcasses
Carcasses will normally be disposed of by commercial incineration, rendering, or licensed commercial landfill.
Every effort will be made to ensure that on-farm pyres or mass burial are not used in the future, but this cannot be completely ruled out if demand exceeds the capacity of the preferred disposal options.
Contact Premises
Other premises are often identified through the epidemiological inquiry where the infection may have come from or spread to; these are regarded as contact premises.
The spread to or from the IP can arise through many different methods including movement of live animals, people, farm equipment, vehicles, slurry/manure etc and geographical location of the farm (e.g., an adjacent farm where stock have nose-to-nose contact or under a virus plume from infected pigs).
When a contact premises is identified though tracings from the IP, an assessment will be made about the level of risk that any susceptible animals may have been exposed to. If susceptible animals may have been exposed, restrictions will be served on the premises:
If the risk of exposure is very high (usually limited to the movement of live animals from an infected premises during the infective period) the premises would be considered a dangerous contact and the animals culled;
However, if the level of exposure is not deemed high enough to warrant culling, the premises and animals will remain under restriction and their health status will be monitored (regularly inspected for signs of disease) for 3 to 4 weeks from the last known contact with the IP and may also be sampled on an epidemiological basis.
Pre-emptive Culling
Powers are provided in the Animal Health Act for the possible application of pre-emptive (or preventive or fire break) culling of animals not exposed to FMD infection.
Such powers cannot be used unless a disease control (slaughter) protocol has been published, and vaccination has first been considered to prevent the spread of disease. The reasons for not using vaccination would be published.
Vaccination is preferred to pre-emptive culling of animals.
FMD Serotypes
Highly diverse with 7 serotypes:
O (pan-Asia UK)
A
C
Asia 1
SAT 1 (south african territories)
SAT 2
SAT 3
Relevance to Veterinary Personnel
Government Veterinarians may be engaged on temporary contracts. This may include retired Government veterinarians and veterinary practitioners.
The International Animal Health Emergency Reserve (IAHER) agreement was signed in 2004 with Ireland, USA, Canada, Australia, and New Zealand to provide veterinary and technical staff in the event of a disease outbreak. Assistance may also be sought from other EU Member States and is arranged by means of contact between Chief Veterinary Officers (CVOs).
Summary: Notifiable Diseases and the Law
Notifiable diseases are controlled using legal powers.
These powers include:
Compulsory movement restrictions.
Diagnostic testing.
Slaughter.
Other controls deemed necessary.
Compensation is paid in many cases.
Why are lame Dairy cows not notifiable?
It is multifactorial
Prevalent
Not zoonotic
No international agreement
What are Reportable Diseases?
Reportable diseases (in animals) are those where there is a statutory requirement to report laboratory-confirmed isolation of organisms.
In the genera Salmonella and Brucella under the Zoonoses Order 1989. The report is to be made by the laboratory which isolated the organism from an animal-derived sample.
Further diseases are included in the schedule of the Specified Animal Pathogens Order 2008: Trichinella, Mycobacterium bovis
Zoonoses order 1989
Designates Salmonella and Brucella (abortus, melitensis, ovis) as “reportable diseases”.
Applies to any kind of mammal (except man), any four-footed beast, and any kind of bird/
Prevent Entry of Disease
Almost impossible in some countries.
The UK is an island, so control is easier.
Prohibit importation of susceptible animals from countries where the disease exists.
Control contaminated products.
Test animals prior to import.
Quarantine.
Control / Eradicate.
If disease arrives or is already present.
Disease Control
Most countries have taken measures to deal with those animal diseases which present a hazard to their livestock, or to public health or trade.
These measures are implemented by the organizations responsible for state veterinary medicine:
Animal Disease Surveillance
Scanning/Passive
Targeted/Active
Enforcement of Control measures and official controls
Diagnostic Services for livestock diseases and notifiable ones
Research and Science
Strategies for the Control of Notifiable Disease
Include a combination of one or more of:
Prevent contact between infection and the animal:
Movement controls, Farm, protection and surveillance zones.
Slaughter of individual animals (BSE)
Selective slaughter of affected animals or groups (TB)
Whole herd slaughter (FMD, TB)
Vaccination (TB?)
Treatment (Warble Fly)
Critical Success Factors for controlling notifiable diseases
Knowledge of the epidemiology and ecology of the organism
Means of identifying infected animals
Ability to eliminate the pathogen once identified
Ability to stop reintroduction of the pathogen onto premises
Cooperation of all sectors of the industry
Financial Resources
Infrastructure
Trade: A Brexit Perspective
Discussion about the level of qualification needed for individuals issuing export health certificates.
Questioning whether a full veterinary degree is necessary or if someone with lower qualifications could suffice.
Concerns that specialist work in less qualified hands could undermine OV expertise and leave the supply chain at increased risk of food fraud and welfare breaches.
Many countries insist on exports being certified by a veterinary surgeon.
Take Home Messages
Veterinary Public Health and Production animals are the reasons modern veterinary medicine exists.
Disease outbreaks in people and animals shaped the veterinary industry.
Governmental and Non-Governmental Organizations play a pivotal role in Legislating VPH.
Practicing Veterinary Surgeons in the UK who conduct government actions are termed Official Veterinarians (OV).
Who regulates whom, in regards to animals and food production varies across the four countries of the UK.
The United Kingdom regulatory framework regarding VPH can appear very confusing (even to those who work in it).
Notifiable disease MUST be reported; it is a legal obligation.
Notifiable diseases can be exotic, e.g., FMD, or endemic, e.g., bTB.
Not all Notifiable Diseases are Emerging Infectious Diseases, and not all Emerging Infectious Diseases are Notifiable; but there is considerable overlap.
Notifiable diseases and reportable diseases in a UK context have different legal obligations surrounding them.