A Professional Diagnostic Service
I would like to present the concept by illustrating how it might have been had such a diagnostic Service been in operation in February 2001.
A: In preparation for an epidemicDaily diagnostic work will have prepared for emergencies.
- Work will not have been confined to just one or two viruses; a large number of specimens and clinical veterinary problems will have flowed into the lab all the time.
- Equipment will be modern and used every day so that when the emergency arises, excellent equipment is in place.
- The testing of 50-100 farms a day will pose no major problem.
B: Development of up-to-date testing methods
- Liaison with and advice from other important laboratories and from work on other viruses will have provided the Diagnostic Service with the latest advances.
- For example, it will be well known that nucleic acid extraction and real-time PCR offer advances on the older PCR methods in terms of sensitivity and accuracy.
- Commercial companies will do quality control, and scaling-up test numbers can be better done commercially than in-house.
C: The preparation of virology policies and protocols for the management of the outbreak will be under the personal control of the lead virologist on the team
- The important reason to have the veterinary virologist ultimately responsible is that he is obliged to form a view on best practice by consulting widely with research virologists, epidemiologists, and virologists from other countries (e.g. Dr Sutmoller amongst many Europeans)
- A balanced view of best practice - and most importantly on the use of vaccination - will have been formed.
D: Dr Paul Kitching (for example), as virologist responsible for the service, would not agree to anyone other than he or his laboratory staff should interpret the laboratory results.It is poor practice to pass the results of tests to another outside the laboratory for interpretation.
- He would issue printed reports and interpret results on all specimens. (It is good practice to issue printed reports: conversation can be easily misinterpreted and misunderstood.
- FMD is not difficult to diagnose in the laboratory when the appropriate specimens are taken from an animal exhibiting symptoms and signs of illness.
- A negative laboratory result excludes FMD infection.
- There is no rational basis for disregarding the laboratory.
Work once the outbreak has occurredThe veterinary virologist (Paul Kitching, for example) is the hub.
- All relevant persons, especially the field veterinary surgeons, are given the instructions for sampling farms where infection is presumed - and further instructions on sampling with regard to vaccination. There are clear rational explanations.
- Field vets contact Paul Kitching and his staff, not Page Street. The virology can be explained and differential diagnosis discussed, samples to be taken etc.
- Paul Kitching will be responsible for the flying field laboratories doing near-farm testing by PCR and antigen assays, ensuring that confirmatory specimens were also sent to the laboratory.
- Paul Kitching and his staff issue printed reports to every field vet giving the interpreted results. Fax is quick and useful.
- These results are passed to DEFRA so that there is an accurate epidemiological database.
- The laboratory results are used to confine culling to infected farms and trigger local limited vaccination of all susceptible animals with the aim of controlling the spread of infection.
There has been a failure to learn from the 2001 UK epidemic.
- failure to test the culling policy of contiguous premises or over 3km premises against independent data such as laboratory results
- failure to apply vaccination in at least some areas
- failure to assess anti-NSP tests
- failure to learn about the spread of FMD under different circumstances such as extensive grazing on the Brecon Beacons where there is in fact no hard evidence of its spread outside the single infected heft whilst up on the mountain.
There was a failure to apply what was quickly learnt and published by Dr Donaldson; the lack of aerosol spread of the epidemic strain, which rendered the 3km culling policy unnecessary.
A virologist would have planned to learn as much as possible. However, virologists were sidelined during the UK epidemic.
Without authority given to specially trained and dedicated virologists I can see no hope yet that should FMD recur in Britain we are ready to do any better.
Will we continue to make a hash of animal infectious disease?
This has an important implication for human health - just take bovine TB for example, caused by Mycobacterium bovis. This was unjustifiably neglected in the FMD epidemic. There has been a resurgence as untested cattle have been moved all over the country, even from the known residual hotspots, with the spread of TB to previously uninfected herds. What of the dedicated and highly trained veterinary microbiologists?