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Email received January 7 2010 from Dr Colin Fink, (Dr Colin Fink is Clinical Virologist & Hon. Senior Lecturer in Biological Sciences University of Warwick, and Company Medical Director, Micropathology Ltd Research and Diagnosis)

(See also the exchange of views, in September 2009 on the subject of risk to human beings as well as the toll on cows and other mammals between Dr Fink and the farmer, Pat Bird, author of the Bovine TB Blogspot) With their permission, what follows are some of the current thoughts of Dr Colin Fink (in black) and the farmer, Pat Bird (in blue) on the subject of bovine TB

From emails sent to Sept 21 2009 (On suspected human cases)

Tuesday, September 22, 2009 11:55 PM (From Pat Bird)

Dear Mary,

Agree with much of what Dr Fink says, except this:

"...the skin test is just as useless in us as it is in cattle. It will show that we have mounted a T cell response, so have met the organism ( I am not sure whether the skin test is Mycobacterial species specific: I suspect not) but so what? We have met some of the organisms and raised an immune response. That does not mean we are rampantly infected."

Yes and no. The intradermal skin test is the primary universal test for TB in cattle, and with that + slaughter most countries have cleared the disease altogether. The cattle skin test is 'comparative' in UK, as it compares a bovine TB antigen based on AN5 strain, to an avian TB antigen reaction, and records if the animal has mounted an immune response to either, and if so, the difference between the two. The only loopholes in its use are a latency 30/50 days prior to the skin test, or if the animal cannot mount an 'immune' response as it already has the disease. It is then said to be 'anergic'. I have endured years of consecutive 60 day skin tests - or our cattle have - and it does what it says on the tin.

Dr. Fink is quite correct to say, the test does not show that any candidate testing positve is 'rampantly infected'. In the case of cattle, they get no chance - they are shot. In human beings, the first line after contact with either a human case, or animal (farmed or domestic) should be a Mantoux test to detect if exposure has occurred. Which if it is positive, would certainly not mean invasive biopsies.

Records of recent cases describe bloods and PCR to see if sputum was ++ for bTB, together with Xrays. After which, a long course of appropriate antibiotics, if no evidence of operable lesions is detected . The Spanish couple with the alpacas are on a course of prophylactic antibiotics as the infection in their animals is so widespread.

It came as quite a shock to local AHO staff and vets that one of their colleagues contracted bTB via an alpaca postmortem conducted on farm. She developed bTB in the bone of her thumb, which required deep bone scrapes, reconstructive surgery and the inevitable antibiotics. A Cornish woman and her daughter both had clinical bTB and her dog is dead. The mother had lung lesions, the daughter was sputum positive. The dog extensive lesions in many places after selective euthanasia. All had the same 'spoligotype' of bTB that is circulating in tested slaughtered cattle, and the free ranging badgers 'known to inhabit her garden', one of which she 'rescued. She had not worked as veterinary nurse for three years before she became ill.

The amount of cattle we're killing due to 'exposure' to m.bovis in their environment, should be ringing warning bells that the amount of m.bovis is increasing. And it available to any mammal who cares to trip over it.

Any country which ignores a reservoir of bTB as we are doing (in wildlife) , is storing up problems for its human population in the future, and for just the reason Dr. Fink gave. It can wall-up and lurk deep within the body, until the immune system breaks down, when it will release, often decades after exposure. And that is precisely why it is a listed as grade 3 pathogen.

And HPA are not fulfilling their statutory duty if they fail to 'screen' contacts of anything positively confirmed. Particularly children whose immune systems are not fully developed.. (All in my opinion of course.)

September 23, 2009 10:17 AM - From Dr Fink