Targeted screening of high-risk cattle populations for BSE to augment mandatory reporting of clinical suspects

The European Union summary report on surveillance for the presence of transmissible spongiform encephalopathies (TSE) in 2022

This report presents the results of surveillance on transmissible spongiform encephalopathies (TSE) in cattle, sheep, goats, cervids and other species, and genotyping in sheep and goats, carried out in 2022 by 27 Member States (MS, EU27), the United Kingdom (in respect of Northern Ireland [XI]) and other eight non-EU reporting countries: Bosnia and Herzegovina, Iceland, Montenegro, North Macedonia, Norway, Serbia, Switzerland and Türkiye. In total, 977,008 cattle were tested by EU27 and XI (-4.3%, compared with 2021), and 52,395 cattle by eight non-EU reporting countries, with one case of H-BSE in France. In total, 295,145 sheep and 109,074 goats were tested in the EU27 and XI (-5.2% and -7.9%, respectively, compared to 2021). In the other non-EU reporting countries, 25,535 sheep and 633 goats were tested. In sheep, 557 cases of scrapie were reported by 17 MS and XI: 480 classical scrapie (CS) by five MS (93 index cases [IC] with genotypes of susceptible groups in 97.6% of the cases), 77 atypical scrapie (AS) (76 IC) by 14 MS and XI. In the other non-EU reporting countries, Norway reported 16 cases of ovine AS. Ovine random genotyping was reported by eight MS and genotypes of susceptible groups accounted for 7.3%. In goats, 224 cases of scrapie were reported, all from EU MS: 216 CS (42 IC) by six MS, and 8 AS (8 IC) by four MS. In Cyprus, two cases of CS were reported in goats carrying the heterozygous DN146 allele. In total, 3202 cervids were tested for chronic wasting disease by 10 MS. One wild European moose tested positive in Finland. Norway tested 17,583 cervids with two European moose, one reindeer and one red deer positive. In total, 154 animals from four other species tested negative in Finland.

The European Union summary report on surveillance for the presence of transmissible spongiform encephalopathies (TSE) in 2020

This report presents the results of surveillance on transmissible spongiform encephalopathies (TSE) in cattle, sheep, goats, cervids and other species, and genotyping in sheep, carried out in 2020 by 27 Member States (MS, EU27), the United Kingdom (UK) and other seven non-EU countries: Bosnia and Herzegovina, Iceland, Montenegro, North Macedonia, Norway, Serbia and Switzerland. In total, 1,122,671 cattle were tested by EU27 and the UK (-2.4%, compared with 2019), and 51,775 cattle by the other seven non-EU, with three cases of H-BSE in France, Ireland and Spain, and two L-BSE in France and Switzerland. In total, 332,579 sheep and 120,615 goats were tested in the EU27 and the UK (-1.6% and -16%, respectively). In sheep, 688 cases of scrapie were reported by 16 MS and the UK: 589 classical scrapie (CS) by seven MS [81 index cases (IC), one of ARR/ARR genotype and 97% with genotypes of susceptible groups], 98 atypical scrapie (AS) (88 IC) by 14 MS and the UK, and one CH1641-like. In addition, Italy reported 12 inconclusive cases. In total, 26,053 sheep and 712 goats were tested in the other non-EU countries with 53 CS in Iceland and 12 AS in Norway. Random genotyping was reported by nine MS: with Cyprus excluded, 8.8% carried the genotypes of susceptible groups. In goats, 328 cases of scrapie were reported: 319 CS (52 IC) by six MS and the UK, and nine AS (9 IC) by five MS. The last of the 3-year surveillance programme for chronic wasting disease (CWD) in Estonia, Finland, Latvia, Lithuania, Poland and Sweden resulted in 6,974 tested cervids and two CWD cases in wild moose, in Finland and Sweden. Other six MS and the UK tested 2,197 cervids, all negative. Norway tested 22,528 cervids of which one wild moose and one wild reindeer were positive. In total, 101 animals from three other species tested negative in Finland.

The European Union summary report on surveillance for the presence of transmissible spongiform encephalopathies (TSE) in 2019

This report presents the results of surveillance on transmissible spongiform encephalopathies (TSE) in cattle, sheep, goats, cervids and other species, and genotyping in sheep, carried out in 2019 by 28 Member States (MS), and by Iceland, Montenegro, North Macedonia, Norway, Serbia and Switzerland (non-MS). In total, 1,150,388 cattle were tested by MS, a 2.7% decrease from 2018 and 44,557 by the six non-MS. Six cases of H-BSE were reported by France (4) and Spain (2), and 1 L-BSE by Poland. The number of H- BSE cases was the largest reported per year including the youngest ever case (5.5 years of age). In total, 338,098 sheep and 143,529 goats were tested in the EU, an increase of 3.9% in both species compared with 2018. In sheep, 17 inconclusive cases by two MS and 997 cases of scrapie were reported: 911 classical (97 index cases (IC), one of ARR/ARR genotype and 98.7% with genotypes of susceptible groups) by seven MS, 86 atypical (AS) (80 IC) by 11 MS. Thirty-one ovine scrapie cases were reported by Iceland and Norway. Random genotyping was only reported by eight MS: Cyprus excluded, 15.7% of genotyped sheep carried genotypes of susceptible groups. In goats, three inconclusive cases by two MS and 390 cases of scrapie were reported: 379 classical (24 IC) by six MS, 11 atypical (10 IC) by six MS. The heterogeneous enforcement of a 3-year surveillance programme for chronic wasting disease (CWD) in six MS (Estonia, Finland, Latvia, Lithuania, Poland and Sweden) resulted in the testing of 7,980 cervids and confirmation of three CWD cases in wild moose in Sweden. Other seven MS tested 2,732 cervids with no positive results. Norway tested 30,147 cervids in 2019, with two new moose cases. In total, 122 animals from four other species reported by three MS TSE tested negative.

The European Union summary report on surveillance for the presence of transmissible spongiform encephalopathies (TSE) in 2018

This report presents the results of surveillance on transmissible spongiform encephalopathies (TSE) in bovine animals, sheep, goats, cervids and other species, and genotyping in sheep, carried out in 2018 by 28 Member States (MS) according to legislation, and by Iceland, North Macedonia, Norway and Switzerland (non‐MS). In total, 1,181,934 cattle were tested by MS, a 10% decrease from 2017 and 20,402 by the four non‐MS. One case of classical bovine spongiform encephalopathy (BSE) was reported in 2018 by the UK, born after the enforcement of the total feed ban. Three atypical BSE cases (2 L‐type/1 H‐type) were reported by France. Over the year, a total of 325,386 sheep and 138,128 goats were tested in the EU, an increase of 3.4% and 17.8%, respectively, compared to 2017. In sheep, 934 cases of scrapie were reported: 821 classical (99 index cases and 97.8% with genotypes of susceptible groups) by 7 MS and 113 atypical (105 index cases) by 14 MS. Twenty‐nine ovine scrapie cases were reported by Iceland and Norway. Random genotyping was only reported by eight MS and after excluding Cyprus showed that 18.7% of the genotyped sheep carried genotypes of the susceptible groups. In goats, 523 cases of scrapie were reported: 517 classical (38 index cases) by seven MS and six atypical (all index cases) by four MS. The heterogenous enforcement of a 3‐year surveillance programme for chronic wasting disease (CWD) from 1/1/2018 in six MS (Estonia, Finland, Latvia, Lithuania, Poland and Sweden) resulted in the testing of 5,110 cervids and the confirmation of the first case of CWD in the EU: a wild moose in Finland. Other six MS tested 3,075 cervids with no positive results. Norway tested 33,037 cervids in 2018, resulting in seven new cases: six reindeer and one moose. In total, 105 animals from three other species were tested by two MS, with negative results.

The European Union summary report on surveillance for the presence of transmissible spongiform encephalopathies (TSEs) in 2017

This report presents the results of surveillance on transmissible spongiform encephalopathies (TSEs) in bovine animals, sheep, goats, cervids and other animal species, as well as genotyping in sheep, carried out in 2017 in the European Union (EU) according to Regulation (EC) 999/2001, and in Iceland, Norway and Switzerland. In total, 1,312,714 cattle were tested by the 28 EU Member States (MSs) which is a decrease of 3% compared with 2016; 18,526 were tested by the three non‐MSs. For the first time since bovine spongiform encephalopathy (BSE) has been reported, no cases of classical BSE were reported in 2017. Six atypical BSE cases were reported by three different MSs: Spain 1 H‐BSE/2 L‐BSE; France 1 H‐BSE/1 L‐BSE; and Ireland 1 L‐BSE. Over the year, 314,547 sheep and 117,268 goats were tested in the EU. In sheep, 933 cases of scrapie were reported: 839 classical and unknown (145 index cases) by eight MSs and 94 atypical (89 index cases) by 13 MSs. Fourteen ovine scrapie cases were reported by Iceland and Norway. Of all classical scrapie cases, 98.2% occurred in sheep with genotypes of susceptible groups. The genotyping of a random sample in 21 MSs showed that 26.5% of the genotyped sheep carried genotypes of the susceptible groups. In goats 567 cases of scrapie were reported: 558 classical (42 index cases) by seven MSs and nine atypical (seven index cases) by five MSs. In total, 3,585 cervids were tested for TSE by ten MSs, mostly by Romania. All results were negative. Eleven cases of chronic wasting disease (CWD) cases were reported in cervids by Norway: nine wild reindeer, one moose and, for the first time ever, one red deer. In total, 185 animals from five species other than cattle, small ruminants and cervids were tested by three MSs, with negative results.

The European Union summary report on surveillance for the presence of transmissible spongiform encephalopathies (TSE) in 2016

This report presents the results of surveillance activities on transmissible spongiform encephalopathies (TSEs) in bovine animals, sheep, goats, cervids and other species, as well as genotyping data in sheep, carried out in 2016 in the European Union according to Regulation (EC) 999/2001, and in Iceland, Norway and Switzerland. In 2016, 1,352,585 bovine animals were tested in the European Union (5% less than in 2015). For the first time, the United Kingdom did not report any case of bovine spongiform encephalopathy (BSE), whereas France reported one classical and three atypical cases (H), and Spain one atypical case (H). The classical BSE case was born after the enforcement of the total EU-wide feed ban in 2001 (BARB case). In 2016, 286,351 sheep and 110,832 goats were tested (5% and 11% less than in 2015, respectively). Sheep scrapie was reported by 20 Member States (MSs) (685 cases) and goat scrapie by 9 MSs (634 cases). A total of 25 ovine scrapie cases were reported by Iceland and Norway. At the EU level, the occurrence of scrapie in small ruminants remains stable, with classical scrapie (1,175 cases) being reported more frequently than atypical scrapie (135 cases). A total of 97.2% of the classical scrapie cases in sheep occurred in animals with genotypes belonging to the susceptible group, and a random sampling showed that 26.6% of the genotyped sheep held genotypes of the susceptible group (excluding Cyprus). In 2016, five cases of chronic wasting disease were reported in cervids by Norway: three in wild reindeer and two in moose. It was the first time that this disease is reported in Europe. A total of 2,712 cervids were tested for TSEs in seven different member states, 90% of them in Romania, with negative results. A total of 490 animals from other non-ruminant species were tested in four different member states, with negative results.

DISCONTOOLS: Identifying gaps in controlling bovine spongiform encephalopathy

This article summarizes the 2016 update of the DISCONTOOLS project gap analysis on bovine spongiform encephalopathy (BSE), which was based on a combination of literature review and expert knowledge. Uncertainty still exists in relation to the pathogenesis, immunology and epidemiology of BSE, but provided that infected material is prohibited from entering the animal feed chain, cases should continue to decline. BSE does not appear to spread between cattle, but if new strains with this ability appear then control would be considerably more difficult. Atypical types of BSE (L-BSE and H-BSE) have been identified, which have different molecular patterns and pathology, and do not display the same clinical signs as classical BSE. Laboratory transmission experiments indicate that the L-BSE agent has zoonotic potential. There is no satisfactory conclusion regarding the origin of the BSE epidemic. C-BSE case numbers declined rapidly following strict controls banning ruminant protein in animal feed, but occasional cases still occur. It is unclear whether these more recent cases indicate inadequate implementation of the bans, or the possibility that C-BSE might occur spontaneously, as has been postulated for H- and L-BSE. All of this will have implications once existing bans and levels of surveillance are both relaxed. Immunochemical tests can only be applied post-mortem. There is no immunological basis for diagnosis in the live animal. All aspects of disease control are expensive, particularly surveillance, specified risk material removal and feed controls. There is pressure to relax feed controls, and concurrent pressure from other sources to reduce surveillance. While the cost benefit argument can be applied successfully to either of these approaches, it would be necessary to maintain the ban on intraspecies recycling and some baseline surveillance. However, the potential risk is not limited to intraspecies recycling; recycling with cross-species transmission may be an ideal way to select or/and modify properties of transmissible spongiform encephalopathies agents in the future.

Neuropathological survey reveals underestimation of the prevalence of neuroinfectious diseases in cattle in Switzerland

Neuroinfectious diseases in livestock represent a severe threat to animal health, but their prevalence is not well documented and the etiology of disease often remains unidentified. The aims of this study were to generate baseline data on the prevalence of neuroinfectious diseases in cattle in Switzerland by neuropathological survey, and to identify disease-associated pathogens. The survey was performed over a 1-year period using a representative number of brainstem samples (n=1816) from fallen cattle. In total, 4% (n=73) of the animals had significant lesions, the most frequent types of which were indicative of viral (n=27) and bacterial (n=31) etiologies. Follow-up diagnostics by immunohistochemistry, PCR protocols and next-generation sequencing identified infection with Listeria monocytogenes (n=6), ovine herpesvirus 2 (n=7), bovine astrovirus CH13 (n=2), bovine herpesvirus 6 (n=6), bovine retrovirus CH15 (n=2), posavirus 1 (n=2), and porcine astroviruses (n=2). A retrospective questionnaire-based investigation indicated that animals' owners observed clinical signs of neurological disease in about one-third of cases with lesions, which was estimated to correspond to approximately 85 cases per year in the adult fallen cattle population in Switzerland. This estimate stands in sharp contrast to the number of cases reported to the authorities and reveals a gap in disease surveillance. Systematic neuropathological examination and follow-up molecular testing of neurologically diseased cattle could significantly enhance the efficiency of disease detection for the purposes of estimating the prevalence of endemic diseases, identifying new or re-emerging pathogens, and providing "early warnings" of disease outbreaks.

A comparative study of modified confirmatory techniques and additional immuno-based methods for non-conclusive autolytic bovine spongiform encephalopathy cases

Background

In the framework of the Bovine Spongiform Encephalopathy (BSE) surveillance programme, samples with non-conclusive results using the OIE confirmatory techniques have been repeatedly found. It is therefore necessary to question the adequacy of the previously established consequences of this non-conclusive result: the danger of failing to detect potentially infected cattle or erroneous information that may affect the decision of culling or not of an entire bovine cohort. Moreover, there is a very real risk that the underreporting of cases may possibly lead to distortion of the BSE epidemiological information for a given country.

In this study, samples from bovine nervous tissue presenting non-conclusive results by conventional OIE techniques (Western blot and immunohistochemistry) were analyzed. Their common characteristic was a very advanced degree of autolysis. All techniques recommended by the OIE for BSE diagnosis were applied on all these samples in order to provide a comparative study. Specifically, immunohistochemistry, Western blotting, SAF detection by electron microscopy and mouse bioassay were compared. Besides, other non confirmatory techniques, confocal scanning microscopy and colloidal gold labelling of fibrils, were applied on these samples for confirming and improving the results.

Results

Immunocytochemistry showed immunostaining in agreement with the positive results finally provided by the other confirmatory techniques. These results corroborated the suitability of this technique which was previously developed to examine autolysed (liquified) brain samples. Transmission after inoculation of a transgenic murine model TgbovXV was successful in all inocula but not in all mice, perhaps due to the very scarce PrPsc concentration present in samples.

Electron microscopy, currently fallen into disuse, was demonstrated to be, not only capable to provide a final diagnosis despite the autolytic state of samples, but also to be a sensitive diagnostic alternative for resolving cases with low concentrations of PrPsc.

Conclusions

Demonstration of transmission of the disease even with low concentrations of PrPsc should reinforce that vigilance is required in interpreting results so that subtle changes do not go unnoticed. To maintain a continued supervision of the techniques which are applied in the routine diagnosis would prove essential for the ultimate eradication of the disease.

Structuring targeted surveillance for monitoring disease emergence by mapping observational data onto ecological process

An efficient surveillance system is a crucial factor in identifying, monitoring and tackling outbreaks of infectious diseases. Scarcity of data and limited amounts of economic resources require a targeted effort from public health authorities. In this paper, we propose a mathematical method to identify areas where surveillance is critical and low reporting rates might leave epidemics undetected. Our approach combines the use of reference-based susceptible-exposed-infectious models and observed reporting data; We propose two different specifications, for constant and time-varying surveillance, respectively. Our case study is centred around the spread of the raccoon rabies epidemic in the state of New York, using data collected between 1990 and 2007. Both methods offer a feasible solution to analyse and identify areas of intervention.

Bayesian shared spatial-component models to combine and borrow strength across sparse disease surveillance sources

When analyzing the geographical variations of disease risk, one common problem is data sparseness. In such a setting, we investigate the possibility of using Bayesian shared spatial component models to strengthen inference and correct for any spatially structured sources of bias, when distinct data sources on one or more related diseases are available. Specifically, we apply our models to analyze the spatial variation of risk of two forms of scrapie infection affecting sheep in Wales (UK) using three surveillance sources on each disease. We first model each disease separately from the combined data sources and then extend our approach to jointly analyze diseases and data sources. We assess the predictive performances of several nested joint models through pseudo cross-validatory predictive model checks.

Geographical BSE risk assessment and its impact on disease detection and dissemination

Bovine Spongiform Encephalopathy (BSE) rapidly evolved into an issue of major public concern particularly when, in 1996, evidence was provided that this disease had crossed the species barrier and infected humans in the UK with what has become known as "variant Creutzfeldt Jakob Disease" (vCJD). The aim of this paper is to describe the European Geographical BSE risk assessment (GBR) that was successfully used for assessing the qualitative likelihood that BSE could be present in a country where it was not yet officially recognized. It also discusses how this can lead to risk-based and therefore preventive management of BSE at national and international levels. The basic assumption of the GBR method is that the BSE agent is initially introduced into a country's domestic cattle production system through the importation of contaminated feedstuffs or live cattle. This is referred to as an "external challenge". The ability of the system to cope with such a challenge is, in turn, referred to as its "stability": a stable system will not allow the BSE agent to propagate and amplify following its introduction, while an unstable system will. The BSE-status of a country assessed by this system was used by the European Commission as the basis for trade legislation rules for cattle and their products. The GBR was an invaluable tool in evaluating the potential global spread of BSE as it demonstrated how a disease could be transferred through international trade. This was shown to be a critical factor to address in reducing the spread and amplification of BSE throughout the world. Furthermore, GBR resulted in the implementation of additional measures and management activities both to improve surveillance and to prevent transmission within the cattle population.

Atypical transmissible spongiform encephalopathies in ruminants: a challenge for disease surveillance and control

Since 1987, when bovine spongiform encephalopathy (BSE) emerged as a novel disease in cattle, enormous efforts were undertaken to monitor and control the disease in ruminants worldwide. The driving force was its high economic impact, which resulted from trade restrictions and the loss of consumer confidence in beef products, the latter because BSE turned out to be a fatal zoonosis, causing variant Creutzfeldt-Jakob disease in human beings. The ban on meat and bone meal in livestock feed and the removal of specified risk materials from the food chain were the main measures to successfully prevent infection in cattle and to protect human beings from BSE exposure. However, although BSE is now under control, previously unknown, so-called atypical transmissible spongiform encephalopathies (TSEs) in cattle and small ruminants have been identified by enhanced disease surveillance. This report briefly reviews and summarizes the current level of knowledge on the spectrum of TSEs in cattle and small ruminants and addresses the question of the extent to which such atypical TSEs have an effect on disease surveillance and control strategies.

The price of the precautionary principle: cost-effectiveness of BSE intervention strategies in The Netherlands

Since 1996, bovine spongiform encephalopathy (BSE) in cattle has been linked to a new variant of Creutzfeldt-Jakob disease (vCJD), a fatal brain disease in man. This paper assessed the cost-effectiveness of BSE control strategies instituted by the European Commission. In a Monte Carlo simulation model, a non-intervention baseline scenario was compared to three intervention strategies: removal of specified risk materials from slaughter animals, post-mortem testing for BSE and the culling of feed and age cohorts of BSE cases. The food risk in the baseline scenario ranged from 16.98 lost life years in 2002 to 2.69 lost life years in 2005. Removing specified risk materials removal practices, post-mortem testing and post-mortem testing plus cohort culling reduced this risk with 93%, 82.7% and 83.1%. The estimated cost-effectiveness of all BSE measures in The Netherlands ranged from 4.3 million euros per life year saved in 2002 to 17.7 million euros in 2005. It was discussed that the cost-effectiveness of BSE control strategies will further deviate from regular health economics thresholds as BSE prevalence and incidence declines.

Evolution of the BSE epidemic in Catalonia (1990-2015) based on a stochastic model

A stochastic model was used to estimate the number of bovine spongiform encephalopathy (BSE) cases that may have occurred in Catalonia (north-east Spain) from January 1990 to December 2015. The model allowed the evolution of the unobserved cases to be estimated differentiating the population into two subgroups: (1) livestock slaughtered for human consumption without clinical signs and (2) cattle at increased risk (including fallen stock, clinical suspects, emergency slaughtered cattle and cattle with clinical signs at ante mortem inspection). If the first bovine affected by BSE had been introduced into the region in 1986, the model predicted that during the period of study the surveillance system would detect a median of 197 outbreaks (2.5-97.5 percentiles: 157-245). The estimated median number of outbreaks that may have appeared before the establishment of the monitoring program was 80 (2.5-97.5 percentiles: 35-152), and the number of cases would have peaked in 2001.

Bovine spongiform encephalopathy

Bovine spongiform encephalopathy is an infectious disease of cattle that is transmitted through the consumption of meat-and-bone meal from infected cattle. The etiologic agent is an aberrant isoform of the native cellular prion protein that is a normal component of neurologic tissue. There currently are no approved tests that can detect BSE in live cattle.

Fundamental issues in mosquito surveillance for arboviral transmission

Marked spatiotemporal variabilities in mosquito infection of arboviruses, exemplified by the transmission of West Nile virus (WNV) in America, require adaptive strategies for mosquito sampling, pool screening and data analyses. Currently there is a lack of reliable and consistent measures of risk exposure, which may compromise comparison of surveillance data. Based on quantitative reasoning, we critically examined fundamental issues regarding mosquito sampling design and estimation of transmission intensity. Two surveillance strategies were proposed, each with a distinct focus, i.e. targeted surveillance for detection of low rates of mosquito infection and extensive surveillance for evaluation of risk exposure with high levels of mosquito infection. We strongly recommend the use of indicators embodying both mosquito abundance and infection rates as measures of risk exposure. Aggregation of surveillance data over long periods of time and across broad areas obscures patterns of focal arboviral transmission. We believe that these quantitative issues, once addressed by mosquito surveillance programs, can improve the epidemiological intelligence of arbovirus transmission.

Neuropathological and molecular comparison between clinical and asymptomatic bovine spongiform encephalopathy cases

Interest in the proper neuropathological and molecular characterization of bovine spongiform encephalopathy (BSE) has increased since asymptomatic and atypical cases were detected in the cattle population by active disease surveillance. In this respect we investigated a total of 95 confirmed BSE cases originating from different active and passive surveillance categories (clinical suspects, emergency-slaughter, fallen stock and routinely slaughter) in Switzerland for their neuropathological and molecular phenotype. We looked for measurable differences between these categories in lesion profile, severity of spongiform change, degree of astrocytosis as well as immunohistochemical and molecular patterns of the disease-associated isoform of the prion protein (PrPd) in the caudal brainstem. Our results indicate significantly higher intensities of spongiform change in clinically affected compared to asymptomatic BSE cases. Similar effects were in trend observed for the intensities of PrPd deposition and astrocytosis, whereas the frequencies of morphological PrPd types and the molecular patterns in Western immunoblot were not different. Importantly, none of the animals included in this study revealed features of atypical BSE. Taken together, this study suggests that both clinically affected as well as asymptomatic Swiss BSE cases in cattle share the neuropathological and molecular phenotype of classical BSE and that asymptomatic classical BSE cases are at a pre-clinical stage of the disease rather than representing a true sub-clinical form of BSE.

Quantitative risk assessment for bovine spongiform encephalopathy in low- or zero-prevalence countries: the example of Norway

A predictive case-cohort model is applied to Norwegian data to analyze the interaction between challenge and stability factors for bovine spongiform encephalopathy (BSE) during the period 1980-2010. For each year, the BSE risk in cattle is estimated as the expected number of cases. The age distribution of expected cases as well as the relative impact of different challenges is estimated. The model consists of a simple, transparent, and practical deterministic spreadsheet calculation model, in which the following country-specific inputs are entered: (i) annual imports of live cattle and meat and bone meal, (ii) age distribution of native cattle, and (iii) estimated annual basic reproduction ratio (R(0)) for BSE. Results for Norway indicate that the highest risk of BSE cases was in 1989, when a total BSE risk of 0.13 cases per year was expected. After that date, the year-to-year decrease in risk ranged between 3% and 47%, except for a secondary peak in 1994 at 0.06 cases per year. The primary peak was almost entirely (99%) attributable to the importation of 11 cattle from the United Kingdom between 1982 and 1986. The secondary peak, in 1994, originated mainly from the recycling of the U.K. imported cattle (92%). In 2006, the remaining risk was 0.0003 cases per year, or 0.001 per million cows per year, with a maximal age-specific incidence of 0.03 cases per million per year in 10-year-old cattle. Only 15% of the cases were expected in imported cattle. The probability of having zero cases in Norway in 2006 was estimated to be 99.97%. The model and results are compared to previous risk assessments of Norway by the EU.

Complementary approach of data analysis and modeling to estimate the pattern of the BSE epidemic: the example of France

Clinical surveillance was the only way to detect bovine spongiform encephalopathy (BSE) until July 2000 in France. From the 103 cases identified as such between 1991 and June 2000, we used a back-calculation method to reconstruct the longitudinal trend of BSE infections. Between July 1987 and June 1997, an estimated 51,300 (CI =[24,300-84,700]) cattle were infected in France. The comprehensive surveillance of BSE with rapid tests, set up in France since 2001 at the abattoir and fallen plant, allowed study of the relative exposure of the successive birth cohorts with nonconditional logistic regression models adjusted for possible confounding variables. The results were in agreement with those of the back-calculation model, estimating a decrease of the BSE exposure from the birth cohort July 1995-June 1996 that matched with the decrease of the infection after June 1996. In view of the long incubation period of BSE, it is not possible to precisely assess the impact of any control measure before several years. Modeling was therefore used to estimate prospectively the efficiency of the ban of meat and bone meal extended to all farm species in November 2000. Using parameters about age at infection and incubation time estimated earlier, we assessed the minimum time to first detection if infections still occurred. We have waited up to June 2007 to know if less than 100 infections occurred among French cattle during the 6 months following January 2001.

Comparison of the historic recycling risk for BSE in three European countries by calculating the basic reproduction ratio R0

A deterministic model of BSE transmission is used to calculate the R(0) values for specific years of the BSE epidemics in the United Kingdom (UK), the Netherlands (NL), and Switzerland (CH). In all three countries, the R(0) values decreased below 1 after the introduction of a ban on feeding meat and bone meal (MBM) to ruminants around the 1990s. A variety of additional measures against BSE led to further decrease of R(0) to about 0.06 in the years around 1998. The calculated R(0) values were consistent with the observations made on the surveillance results for UK, but were partially conflicting with the surveillance results for NL and CH. There was evidence for a dependency of the BSE epidemic in NL and CH from an infection source not considered in the deterministic transmission model. Imports of MBM and feed components can be an explanation for this discrepancy, and the importance of imports for these observations is discussed.

BSE risk assessment as a basis for updating French screening policy

The current French bovine spongiform encephalopathy (BSE) surveillance system, based on rapid testing of all cattle over 24 months of age and on clinical diagnosis, detects all clinical cases and some preclinical cases of BSE. Several indicators point to a marked shrinkage of the French BSE epidemic in recent years, owing to risk reduction measures. Meat and bone meal, the only known vector of the BSE agent, was banned in feed for all farmed species in November 2000. Thus the surveillance system may be relaxed. The objective of this risk assessment study was to provide information for decisionmakers on the minimum age at which healthy and high-risk cattle now need to be screened with rapid tests. For this purpose, we used the back-calculation method to project the course of the BSE epidemic. We examined the predicted patterns of the number and age distribution of cases of BSE that would be detected by the different existing surveillance streams. Various theoretical sensitivities of rapid tests were explored. Assuming that feed-borne sources of infection no longer exist, and that BSE does not occur spontaneously, our models suggest that it would have been possible to raise the minimum age for rapid tests to 66 months in early 2006, whereas theoretical reasoning, based on the assumption that the total meat and bone meal ban was effective in November 2001, suggests that this age cutoff could only be raised to 48 months in early 2006. These results only apply to cattle born and bred in France. If the situation remains unchanged, the age cutoff could be raised incrementally each year.

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.

Adjusted incidence risks of BSE in risk subpopulations of cattle in Japan

Immediately after the detection of the first case of BSE in 2001, the Japanese government introduced active surveillance targeting fallen-stock and all cattle slaughtered for human consumption. By the end of 2004, four million animals were tested with rapid tests under the passive and active surveillance. As a result 13 additional cases were detected. I focused on the 1996 birth cohort, in which nine cases of BSE were detected during 2001-2004, and estimated the prevalence of BSE infection of that birth cohort using maximum-likelihood methods. Using the estimated prevalence of infection as an input variable, I calculated the adjusted incidence risk of BSE by different ages and risk subpopulations (clinical-suspects, fallen-stock, sick-slaughter and healthy-slaughter animals). The adjusted incidence risk of BSE in sick-slaughter animals (animals showing clinical signs not compatible with BSE when slaughtered for human consumption) was 18.7 and 4.5-78.4 times higher than the incidence risk in fallen-stock and healthy-slaughter animals, respectively.

Evaluation of cost-effectiveness of targeted sampling methods for detection ofMycobacterium aviumsubsp paratuberculosisinfection in dairy herds

OBJECTIVE

To investigate the epidemiologic and financial impacts of targeted sampling of subpopulations of cows, compared with random sampling of all cows, for classification of dairy herd infection status for paratuberculosis.

ANIMALS

All cows from 4 infected herds with a low-to-moderate prevalence of paratuberculosis and from 1 noninfected herd in California.

PROCEDURE

The infection status of each cow was classified on the basis of results of an ELISA or combined ELISA and fecal culture results. Thirteen sampling schemes designed to randomly sample cows on the basis of lactation number, stage of lactation, and milk production were evaluated. Sampling without replacement was used to obtain a probability of herd detection of paratuberculosis for each evaluated sampling method and for simulated sample sizes between 30 and 150 cows. Marginal cost-effectiveness analysis was used to determine the cost increase relative to the increase in detection probability.

RESULTS

Sampling cows in the third or higher lactation and > or = 200 days into lactation yielded the highest detection probability in most instances, resulting in a detection probability that was 1.4 to 2.5 times that obtained by sampling 30 cows in the second or higher lactation. Costs of testing via the alternative method with a 95% detection probability were approximately dollar 300 lower in a high-prevalence herd (31%) and dollar 800 lower in a low-prevalence herd (9%), compared with use of the reference method.

CONCLUSIONS AND CLINICAL RELEVANCE

Detection of herds with paratuberculosis could be improved, and costs of testing substantially reduced by sampling targeted groups of cows.

Concepts for risk-based surveillance in the field of veterinary medicine and veterinary public health: review of current approaches

BACKGROUND

Emerging animal and zoonotic diseases and increasing international trade have resulted in an increased demand for veterinary surveillance systems. However, human and financial resources available to support government veterinary services are becoming more and more limited in many countries world-wide. Intuitively, issues that present higher risks merit higher priority for surveillance resources as investments will yield higher benefit-cost ratios. The rapid rate of acceptance of this core concept of risk-based surveillance has outpaced the development of its theoretical and practical bases.

DISCUSSION

The principal objectives of risk-based veterinary surveillance are to identify surveillance needs to protect the health of livestock and consumers, to set priorities, and to allocate resources effectively and efficiently. An important goal is to achieve a higher benefit-cost ratio with existing or reduced resources. We propose to define risk-based surveillance systems as those that apply risk assessment methods in different steps of traditional surveillance design for early detection and management of diseases or hazards. In risk-based designs, public health, economic and trade consequences of diseases play an important role in selection of diseases or hazards. Furthermore, certain strata of the population of interest have a higher probability to be sampled for detection of diseases or hazards. Evaluation of risk-based surveillance systems shall prove that the efficacy of risk-based systems is equal or higher than traditional systems; however, the efficiency (benefit-cost ratio) shall be higher in risk-based surveillance systems.

SUMMARY

Risk-based surveillance considerations are useful to support both strategic and operational decision making. This article highlights applications of risk-based surveillance systems in the veterinary field including food safety. Examples are provided for risk-based hazard selection, risk-based selection of sampling strata as well as sample size calculation based on risk considerations.

Optimal tracking and testing of U.S. and Canadian herds for BSE: a value-of-information (VOI) approach

The U.S. Department of Agriculture (USDA) tests a subset of cattle slaughtered in the United States for bovine spongiform encephalitis (BSE). Knowing the origin of cattle (U.S. vs. Canadian) at testing could enable new testing or surveillance policies based on the origin of cattle testing positive. For example, if a Canadian cow tests positive for BSE, while no U.S. origin cattle do, the United States could subject Canadian cattle to more stringent testing. This article illustrates the application of a value-of-information (VOI) framework to quantify and compare potential economic costs to the United States of implementing tracking cattle origins to the costs of not doing so. The potential economic value of information from a tracking program is estimated to exceed its costs by more than five-fold if such information can reduce future losses in export and domestic markets and reduce future testing costs required to reassure or win back customers. Sensitivity analyses indicate that this conclusion is somewhat robust to many technical, scientific, and market uncertainties, including the current prevalence of BSE in the United States and/or Canada and the likely reactions of consumers to possible future discoveries of BSE in the United States and/or Canada. Indeed, the potential value of tracking information is great enough to justify locating and tracking Canadian cattle already in the United States when this can be done for a reasonable cost. If aggressive tracking and testing can win back lost exports, then the VOI of a tracking program may increase to over half a billion dollars per year.

The future of BSE from the global perspective

Although, the bovine spongiform encephalopathy (BSE) risk of most countries in Europe has been assessed and they have implemented both measures to control BSE and extensive surveillance systems, complete and valid data is still not consistently available. Globally, data is largely unavailable. Assessments based on incomplete or invalid information could lead to false conclusions. The BSE risk of countries throughout the world must continue to be assessed, and improvements in collection of surveillance data must be made, both in countries already reporting BSE cases and worldwide, in order to evaluate the global BSE picture and assure that cattle and products can be safely traded.

Population-level retrospective study of neurologically expressed disorders in ruminants before the onset of bovine spongiform encephalopathy (BSE) in Belgium, a BSE risk III country

A retrospective epidemiological study (n = 7,875) of neurologically expressed disorders (NED) in ruminants before the onset of the bovine spongiform encephalopathy epidemic (years studied, 1980 to 1997) was carried out in Belgium. The archives of all veterinary laboratories and rabies and transmissible spongiform encephalopathy (TSE) epidemiosurveillance networks were consulted. For all species, a significantly higher number of NED with virological causes (rabies) was reported south of the Sambre-Meuse Valley. During the period 1992 to 1997, for which the data were complete, (i) the predicted annual incidence of NED varied significantly as a function of species and area (higher numbers in areas where rabies was present) but was always above 100 cases per million, and (ii) the mean incidence of suspected TSE cases and, among them, those investigated by histopathological examination varied significantly as a function of species and area. The positive predictive value of a presumptive clinical diagnosis of NED ranged from 0.13 (game) to 0.63 (sheep). Knowledge of the positive predictive value permits the definition of a reference point before certain actions (e.g., awareness and training campaigns) are undertaken. It also shows the usefulness of a systematic necropsy or complementary laboratory tests to establish an etiological diagnosis. TSE analysis of a small, targeted historical sampling (n = 48) permitted the confirmation of one case and uncovered another case of scrapie. The results of the present study help to develop and maintain the quality of the worldwide clinical epidemiological networks for TSE, especially in countries that in the past imported live animals, animal products, and feedstuffs from countries with TSE cases.

Age–period–cohort analysis of the Bovine Spongiform Encephalopathy (BSE) epidemic in Switzerland

Cattle born after animal-feed control measures were implemented in 1990 have become BSE cases in Switzerland, indicating sub-optimal effectiveness of these measures. To evaluate these measures, the incidence of BSE cases in Switzerland recorded through clinical case reporting from January 1991 to June 2000 (categorized into age groups and birth cohorts of 6-month duration) was analyzed by Poisson log-linear regression using an age-period-cohort model. The incidence was maximum in the cattle cohort born from October 1989 to March 1990, and dropped to zero in the cohort born from April to September 1991. A second peak was observed in a cohort born from April to September 1994. The first drop of incidence is interpreted as a result of initial implementation of the feed ban in 1990. The second peak might be related to exposure of cattle to feed intended for pigs and poultry.

Prevalence of BSE in cattle found dead, euthanased or emergency slaughtered on farms in western France in 2000, 2001 and 2002

The overall trend and the trend within birth cohorts of the prevalence of bovine spongiform encephalopathy (BSE) in cattle found dead, euthanased or emergency slaughtered on farms in the Bretagne, Basse Normandie and Pays de la Loire regions of France, during the periods from August 7 to December 22 in 2000, 2001 and 2002, were analysed by non-conditional logistic regression, adjusted for the region and for the type of animals. The overall prevalence of BSE during these three periods decreased from 2.71 per 1000 in 2000 to 1.41 per 1000 in 2001 and 0.42 per 1000 in 2002. The prevalence within birth cohorts started to decrease for the cohort born between July 1, 1995 and June 30, 1996 (cohort 95/96) and the trend was reinforced for cohort 96/97, suggesting that the exposure of animals to the BSE agent had started to decrease for animals born after July 1995, that is, one year before the ban on specified risk materials in meat and bone meal was implemented in France. However, considering that most of the animals would have been infected at between six and 18 months of age, the decrease may have been due, at least partly, to this control measure.

Conceptual foundations for infectious disease surveillance

The purpose of this report is to offer concepts for consideration in developing infectious disease surveillance systems, defined here as active, formal, and systematic processes intentionally directed to rapidly seek out and identify infectious disease agents or disease. Performance of surveillance systems can be judged by their accuracy (sensitivity and specificity), precision (repeatability), timeliness, multiple utility, and value. Surveillance system operation and function necessary to achieve high performance are defined in part by characteristics of the specific infectious disease, including disease transition state dynamics, that define probabilities of being in the latent, infectious, or clinical phase of disease. Two key components of surveillance are the sampling scheme, which is intended to maximize the probability of capturing an infected animal or specimen as soon as possible after the herd has been exposed, and the diagnostic assays, which should maximize the probability of detecting the agent, or evidence of the agent, if it is present in the specimen, while minimizing the likelihood of a false-positive result. Proportional risk sampling, targeted sampling, and repeated sampling are strategies that can improve overall surveillance system accuracy and particularly the temporal sensitivity related to early detection. Hierarchical sampling schemes and multiplexed assays can maximize efficiency and improve utility by serving multiple surveillance systems and purposes. Development of the surveillance systems needed to address emerging and foreign animal diseases will necessarily require design and architecture that are highly probability-driven to maximize surveillance sensitivity and specificity and to minimize cost.

Monte Carlo simulation of surveillance strategies for scrapie in Norwegian sheep

Our aim was to compare the efficiency of different surveillance strategies for detecting scrapie-infected sheep flocks in the Norwegian population using simulation modelling. The dynamic Monte Carlo simulation model has the flock as the unit. The input parameters include properties of the sheep population (number of flocks, flock size, age distribution, reasons for culling, breeds, prion protein-allele distribution); properties of scrapie (genotype-dependent infection rate and incubation periods, and age- and genotype-dependent prevalence of scrapie); properties of the surveillance strategy (selection of sheep for examination, period in which infected sheep are detectable, and properties of the diagnostic tests). For simplification, the prion protein-alleles were grouped into three allele groups: VRQ, ARR, and ARQ' (ARQ' represents ARQ, ARH and AHQ). Through either abattoir surveillance or surveillance of fallen stock, <or=9% of scrapie flocks were detected. The necessary sample size for detecting any particular number of scrapie flocks was considerably lower using surveillance of fallen stock than abattoir surveillance. After increasing the diagnostic method's sensitivity, only the efficiency of abattoir surveillance increased. The prion protein-genotypes ARQ'/ARQ', VRQ/ARQ' and VRQ/VRQ were overrepresented both in the sampled infected sheep and in the detected sheep. Sheep with ARQ'/ARQ' constituted >70% of the detected sheep (compared to 33% in the underlying population). The model output was sensitive to the susceptibility of infection for the genotype ARQ'/ARQ'. The effect was large for abattoir surveillance (increased susceptibility increased the efficiency of abattoir surveillance).

European Union's rapid TSE testing in adult cattle and sheep: implementation and results in 2001 and 2002

After the discovery of variant Creutzfeldt-Jakob disease (vCJD), scientific advances quickly led to post-mortem tests to identify late-stage bovine spongiform encephalopathy (BSE) disease. These were first used in Switzerland in 1999 for active BSE surveillance of a) fallen and emergency-slaughter bovines (risk stock) and b) 5% sample of routinely slaughtered cattle over 30 months of age. In 1999 and 2000, Switzerland's estimated 103 BSE positives per 1000000 adult cattle put it in the same BSE risk classification as UK and Portugal. In July 2000, the European Union's Scientific Steering Committee published its methodology (and first vetted results) for geographical BSE risk (GBR) assessment in cattle. Member states with no BSE cases found themselves, on rational assessment, classified as GBR III (BSE likely but not confirmed, or confirmed at a lower level). Because of Europe's thus highly assessed BSE risks, active BSE surveillance of adult cattle in all member states began in January 2001 using one of three validated post-mortem tests. Implementation was variable across member states in January to March 2001 but, where operational, active surveillance was typically achieved for around 13300 routinely slaughtered and 1000 risk stock per month per 1000000 adult cattle; BSE positive rates were 60 and 600 per 1000000 routinely slaughtered and risk cattle, respectively. By the second half of 2001, active BSE surveillance was operating reasonably in most member states, although anomalies persisted. Performance and results for July to December 2001 and for January to June 2002 are considered in detail. The BSE positive rate decreased substantially in UK, Portugal and Ireland between semesters, whereas Spain's rates increased for both routinely slaughtered and risk bovines. Based on 1450000 routinely slaughtered and 135000 risk stock as standard, France could have expected 153 BSE positives in July to December 2001 (109 in January to June 2002); Italy 154 (67); and Germany only 39 (48). When sample-based surveillance data were scaled up and combined with clinical BSE cases, Great Britain's BSE positives were estimated at around 400 per 1000000 adult cattle in 2002 compared with over 1000 per 1000000 adult cattle in 2000. Age distributions for cattle subject to active BSE surveillance have been underexploited. The major transmissible spongiform encephalopathy (TSE) which affects sheep and goats is scrapie. Passive surveillance of scrapie is associated with substantial under-reporting. Susceptibility to scrapie depends strongly on sheep genotype; but resistance to scrapie does not necessarily confer resistance of sheep to BSE. Because of uncertainty about the true prevalence of scrapie-infected adult sheep and concern that BSE in sheep may be missed, the European Union pre-empted its planned evaluation of rapid post-mortem TSE tests in sheep by requiring the rapid TSE testing of small ruminants from April 2002 with one of the three cattle-validated tests. Basic requirements for active TSE surveillance in sheep were: random sample of 6000 fallen sheep and of 60000 routinely slaughtered adult native sheep to be tested per member state by end March 2003. Lower surveillance targets were set for countries with under 1000000 adult sheep. Adequately to map scrapie-susceptible genotypes and identify resistant genotypes, a random sample of 500 routinely slaughtered native adult sheep was to be genotyped, together with each TSE rapid test positive adult sheep and two sets of three suitably sampled controls. By the end of August 2002, when 41% of the initial surveillance time had elapsed, only 20% of the European joint target for routinely slaughtered adult sheep had been completed, but that for fallen sheep was exceeded. Except in Ireland, the upper 95% confidence bound on TSE prevalence exceeded 500 per 1000000 routinely slaughtered adult sheep in reporting-compliant countries with more than 1000000 adult sheep. The UK, Greece, Italy and France were likely to approach the goal of 100 TSE rapid test positives on completion of their assigned first-year surveillance target for sheep. Results from the recommended genotyping of TSE positive adult sheep and controls for use in inferring differential TSE-positive susceptibility by genotype are awaited. Only by genotyping 5000-50000 TSE-positive adult sheep, a massive undertaking even on the European scale, will it become clear whether scrapie resistance is relative rather than absolute. This paper details Europe's quantitative evolution in TSE surveillance.

The transmissible spongiform encephalopathies: disease risks for North America

Transmissible spongiform encephalopathies exotic to North America (BSE and associated diseases) are unlikely to be introduced or to persist should they be introduced into the United States [2]. Domestic TSEs (scrapie, CWD, and TME) seem to be relatively restricted in their host range, and none of these diseases is known to naturally cause disease in cattle. It is important that surveillance for TSEs continues, however, particularly in cattle because of the extreme consequences to the livestock industries, and potentially, public health, if BSE becomes established. Because the TSEs have implications beyond effects on their natural host species, adequate surveillance, control, and even eradication of these diseases should be goals for the livestock industries, wildlife managers, and animal health agencies in the United States.

Geographical clustering of cases of bovine spongiform encephalopathy (BSE) born in Switzerland after the feed ban

Over one-third of the cases of BSE in Switzerland have been born after the feed ban of December 1, 1990. Evidence for the geographical clustering of these cases emerged in two distinct regions. All the 354 BSE cases recorded until June 30, 2000 (set A), and the 376 cases recorded up to May 14, 2001 (set B), were georeferenced to the centres of the communities in which the herds of origin were located, and control populations were georeferenced to the centres of the communities in which these herds were located at the time of the census. The latitudes and longitudes of these centres were used in the statistical analysis of the spatial clustering. The Cuzick-Edwards test and the spatial scan statistics were applied to assess the significance of the clusters, while controlling for the spatial distribution of the underlying cattle population. There was global clustering of the cases born after the ban, and distinct and significant (P<0.05) spatial clusters were repeatedly identified in the two case datasets, and in several control populations (all cases born before the feed ban on a random sample of control farms) in terms of cattle density by region or cow density by region. Differential reporting was excluded as the underlying reason for the observed clusters.

Targeted surveillance to assess the prevalence of BSE in high-risk populations in western France and the associated risk factors

A pilot study was set up for the first time in France in August 2000, to obtain more precise estimates on the BSE epidemic in France. Three categories of cattle at risk of BSE (found dead on-farm, euthanased and emergency slaughtered) were sampled exhaustively from August 7 to December 22, 2000, in the three regions assumed to be the most affected with BSE in France (Basse-Normandie, Bretagne and Pays de la Loire). The samples were checked by using Prionics tests, and positive samples were confirmed by Western blot or immunohistochemistry. The overall prevalence of positive cattle was 0.16 per cent. Multifactorial logistic regression showed that there was a significantly higher prevalence among cattle from the birth cohorts July 1993 to June 1994 and July 1994 to June 1995, than among those born before July 1993, and among the categories 'euthanased' and 'emergency slaughtered' than among the category 'dead on-farm, and a higher prevalence in the regions Pays de la Loire and Bretagne than in Basse-Normandie. No significant differences in the prevalence of BSE were observed between dairy, beef suckler and mixed herds.

Monitoring and analysis of bovine spongiform encephalopathy (BSE) testing in Denmark using statistical models

The evolution of monitoring and surveillance for bovine spongiform encephalopathy (BSE) from the phase of passive surveillance that began in the United Kingdom in 1988 until the present is described. Currently, surveillance for BSE in Europe consists of mass testing of cattle slaughtered for human consumption and cattle from certain groups considered to be at higher risk of having clinical or detectable BSE. The results of the ongoing BSE testing in Denmark have been analyzed using two statistical approaches: the "classical" frequentist and the Bayesian that is widely used in quantitative risk analysis. The analyses were intended to provide information for decision-makers, the media and the public as well as to provide inputs for future BSE surveillance models. The results to date suggest that the total number of BSE cases that will be found in Denmark in 2001 will not exceed 16.

Monitoring and surveillance for rare health-related events: a review from the veterinary perspective

Disease monitoring and surveillance systems (MOSSs) have become one of the major components of veterinary activity. Such systems are used to assess the existing levels of prevalence, the effectiveness of control programmes and, after disease eradication, to document the continued absence of disease from a given region or zone. With decreasing disease or infection prevalence, traditional approaches become less reliable and increasingly costly. The objective of this work was to summarize and discuss methodological issues related to veterinary (animal health) MOSSs. There are considerable inconsistencies in the use of the terms 'monitoring' and 'surveillance'. Passive as well as active MOSS have their disadvantages when used for rare health-related events such as emerging and re-emerging diseases. There is a need for evaluation and improvement of these approaches. Integrated systems that call for the use of several parallel surveillance activities seem to be the favoured approach, and analytical methods to combine MOSS data from various sources into a population prevalence, or probability of disease freedom, are under development. The health and safety of the animal and human generations depends on our continuous ability to detect, monitor and control newly emerging or re-emerging livestock diseases and zoonoses rapidly. Uniform surveillance definitions, sound scientifically based approaches that use the resources and data available, and a pool of researchers and veterinary public health officials with sufficient training in epidemiology, are critically important to handle this challenging task.