Letter received June 11th 2010 from Roger Breeze(Click here for letter of June 10th 2010)
June 11, 2010
JAPAN: LOST IN THE CRISIS
Dear Mary:
In my note to you yesterday I remarked upon the April 20, 2010 report of the foot and mouth (FMD) outbreak in Japan that said, " Epidemiology - Source of the outbreak(s) or origin of infection: unknown or inconclusive." As mentioned, there are now microbial forensic tools that allow the contemporary geographical origin of viruses and bacteria to be specifically located, in the case of the 2001 anthrax attack in the USA down to the level of a specific laboratory. We do not have all the information we would like for foot and mouth, perhaps because knowing outbreak sources has not been deemed important, and perhaps even embarrassing for the countries concerned. But we do know enough to answer the question.
Why should we concern ourselves about the source of the FMD virus now devastating Japan when there is an immediate crisis to be solved?
The reason is that the real tragedy of FMD is not displayed in Japan, whose farmers’ suffering will be alleviated by government compensation and support and where no one will go hungry or starve. It is takes place silently every day in those countries that live with FMD as an endemic infection. Peter Roeder, then a Food and Agriculture Organization Field Officer, summed it up well in a June 2001 letter to The Times of London published at the height of the British FMD epidemic, in which he described the effects of FMD in various parts of the world: ‘the Cambodian subsistence farming family loses half its rice crop when the buffaloes are hit during paddy field preparation, and the fattening pigs and calves die or require expensive treatment. The progressive Bangladeshi dairy farmer with ten cows loses overnight most of the milk production and daily income from it. When the disease strikes just after lambing time, the northern Iraqi shepherd loses 400 of his 500 lambs from heart damage, together with much of the milk for consumption and sale. These real examples do not cover the full spectrum of impact, but they do illustrate the immediate, direct effects of FMD. The fight against epidemic diseases of humans and animals is far from over; indeed, for livestock diseases it has barely started in most of the world. A concerted fight against FMD and other epidemic diseases is needed, to start at their source where the reservoirs of infection persist. For the more developed nations to assist the developing nations in this fight must be regarded as enlightened self-interest, not benevolence’.
I believe there are no technological barriers to the elimination of the major transboundary livestock diseases in our lifetimes (1). The diseases I refer to are those transmissible diseases that have the potential for very serious and rapid spread, irrespective of national borders; that are of serious socio-economic or public health consequence; and that are of major importance in the international trade of animals and animal products. FMD is a prime example. These diseases formed the former “List A” of the World Organization for Animal Health (OIE). ‘Elimination’ means a condition where diseases no longer threaten the flocks and herds of the developed world or the livelihoods of hundreds of millions of small farmers elsewhere. For some diseases ‘elimination’ may not be the same as eradication because reservoirs of potential infection may persist, but if we commit to a new vision, eradication of many diseases will occur during the lifetime of our children. This is not incredible even for those that appear the most intransigent: in 1885 Louis Pasteur tested his rabies vaccine in man for the first time; in 1983 trials of a vaccine for foxes and other wild animals began in Germany and now many countries are rabies-free. In 1348 the Black Death began its course to kill 100 million people – half the population of Europe. Today in the US we are vaccinating wild prairie dogs against plague to protect the black-footed ferret, an endangered species. Almost 250 years ago the veterinary profession was itself created in response to a cycle of Rinderpest epidemics that wiped out over 200 million cattle in Europe. Rinderpest has now been globally eradicated, even in countries riven by war and sapped by desperate poverty – and in 20 years at a cost of only $20 million.
The government of Japan could do itself and world a great service by determining the source of the current FMD outbreak and then resolving to help that country eliminate FMD. All the tools to do this are available. Many countries have used them to become FMD free. Japan should seize this opportunity to remove the threat beyond its borders to secure the future of its own farmers and those everywhere else. President Obama recently set out the US National Strategy for Countering Biological Threats (2), including the transboundary livestock diseases, in a document that “articulates our vision for managing these evolving and complex risks. It is a vision of shared commitment wherein the United States Government works with domestic and international partners to advance the health security of all people”. This is the challenge; this is the moment. If Japan seizes both it will be in good company.
Best Regards,
Roger
Reference
(1) R.G. Breeze Technology, public policy and control of transboundary livestock diseases in our lifetimes Rev. sci. tech. Off. int. Epiz., 2006, 25 (1), 271-292, available at
http://www.oie.int/boutique/index.php?page=ficprod&id_prec=96&id_produit=292&lang=en&fichrech=1
(2) National Security Council National Strategy for Countering Biological Threats, Nov 2009, available at
http://www.whitehouse.gov/sites/default/files/National_Strategy_for_Countering_BioThreats.pdf
EXTRACT from the letter from Dr Roger Breeze. Read in full below
I have a few questions:
- Why in 2010 - in Japan of all places - is a government vet turning up to a reported case of suspect FMD without the tools to make a diagnosis? For sure, if positive and missed, this will be the most important decision of that person’s career and a catastrophe for animal agriculture. An on-farm PCR test for FMD on April 9 (using the $50 Tetracore FMD real time PCR test, www.tetracore.com) on a $50,000 IdahoTechnology RAPID PCR machine (www.idahotechnology.com) would have given the answer within an hour. Since this is a preclinical test that detects FMD-infected animals 2 to 3 days before they show clinical signs of disease a pooled sample from several animals could have been used. The best science could have given the answer in one hour: in fact it took 11 days.
And to confirm that infection, why does Japan not have the Tessarae resequencing microarray at the NIAH so that within 5 hours ALL the pathogens in the sample can be identified and 1500 bases of the actual genetic sequences of all those present can be directly defined (www.tessarae.com)? A PCR-positive sample taken on April 9 could have been identified by microarray the same day along with actual sequence information - in fact it was 14 days later before the official confirmation.
How is it that on 19 April the local government veterinary service tests by PCR for all the diseases except the one that matters - FMD? Is it because that regional lab did not possess the FMD PCR test used at NIAH? (Just as regional labs the world over defer to the National Lab as if it were still 1999!) If the lab is equipped and competent to run PCR tests for bluetongue, bovine viral diarrhoea-mucosal disease, infectious bovine rhinotracheitis and Ibaraki disease, why not FMD? For the want of a $50 PCR test kit in the right place Japan is paying dearly.
Why is the source of an FMD outbreak or infection always "unknown or inconclusive"? Why are we not applying modern microbial forensic tools to trace the virus to its source outside Japan by its biological signature (Carrillo, C. and Rock, D. Molecular epidemiology and forensics of RNA viruses, in Microbial Forensics, Editors Breeze, R.G., Budowle, B. and Schutzer, S. E., Elsevier, 2005, 174-185)?
.........
JUNE 9, 2010 FOOT AND MOUTH DISEASE: JAPAN IN CRITICAL SITUATION SAYS MINISTER. HOW COULD JAPAN EXPECT ANYTHING ELSE SAYS YOUR CORRESPONDENT.
Dear Mary:
Before writing to you I looked out of my window in Washington DC, prompted by the metaphor of "Starlight" that inspired the 2000 US National Reconnaissance Office study of the future of surveillance known as "Proteus." For thousands of years humans stared at the night sky without realizing that it had depth as well as breadth. They did not understand that light from the nearest star you will see tomorrow night in France took 4 years to reach Earth and that from the farthest 4000 years. When one set out George Bush was still President and as the other left Abraham was still at home in the Land of the Two Rivers. Starlight is a great metaphor for the current state of disease surveillance because we know that an event we will all see tomorrow night was actually over and done with long ago - just like reports of animal disease outbreaks where today’s surprising news was inevitably determined by things that happened in the past.
Today’s (June 9, 2010) ProMedmail has a report (20100609.1925) from new Agriculture Minister Masahiko Yamada that Japan faces a "high risk" that an outbreak of foot and mouth disease may spread from southwestern Miyazaki prefecture to other livestock regions. "Japan is in a critical situation where the disease may break out anywhere, anytime," as infected animals are still alive, Yamada told reporters in Tokyo today. "We must speed up culling and burying them."
Remember "Starlight" as we go back to another ProMedmail report (20100420.1284) of April 20, 2010 that told us that foot and mouth (FMD) was suspected in a cow, the first time in Japan since 2000.
" Epidemiology - Source of the outbreak(s) or origin of infection: unknown or inconclusive.
Epidemiological comments: a private veterinarian first found a suspicious case in the affected farm and reported it to the local government's veterinary service on 9 Apr 2010. An official veterinarian observed that a cow had fever, anorexia, salivation, and erosions in the oral cavity on the same day but the others had no clinical signs. Since other 2 suspicious cases were found in the same farm on 16 Apr 2010, the veterinary service examined similar diseases such as bluetongue, bovine viral diarrhoea-mucosal disease (BVD-MD), infectious bovine rhinotracheitis and Ibaraki disease but they showed negative results by PCR tests on 19 Apr 2010. The veterinary service submitted the samples to the National Institute for Animal Health (NIAH) on the same day. The NIAH affirmed the cattle were infected with foot-and-mouth disease virus [FMDV] by PCR test on 20 Apr 2010. The samples are being examined by virus isolation. If it is confirmed, it will be the 1st outbreak of FMD in Japan since 2000."
The NIAH confirmed FMD infection by cell culture on April 23. Today the mass slaughter of cattle and swine has been in full swing for weeks, as Minister Yamada said, and infected swineherds now generate large amounts of virus to threaten even more.
I have a few questions:
Why in 2010 - in Japan of all places - is a government vet turning up to a reported case of suspect FMD without the tools to make a diagnosis? For sure, if positive and missed, this will be the most important decision of that person’s career and a catastrophe for animal agriculture. An on-farm PCR test for FMD on April 9 (using the $50 Tetracore FMD real time PCR test, www.tetracore.com) on a $50,000 IdahoTechnology RAPID PCR machine (www.idahotechnology.com) would have given the answer within an hour. Since this is a preclinical test that detects FMD-infected animals 2 to 3 days before they show clinical signs of disease a pooled sample from several animals could have been used. The best science could have given the answer in one hour: in fact it took 11 days.
And to confirm that infection, why does Japan not have the Tessarae resequencing microarray at the NIAH so that within 5 hours ALL the pathogens in the sample can be identified and 1500 bases of the actual genetic sequences of all those present can be directly defined (www.tessarae.com)? A PCR-positive sample taken on April 9 could have been identified by microarray the same day along with actual sequence information - in fact it was 14 days later before the official confirmation.
How is it that on 19 April the local government veterinary service tests by PCR for all the diseases except the one that matters - FMD? Is it because that regional lab did not possess the FMD PCR test used at NIAH? (Just as regional labs the world over defer to the National Lab as if it were still 1999!) If the lab is equipped and competent to run PCR tests for bluetongue, bovine viral diarrhoea-mucosal disease, infectious bovine rhinotracheitis and Ibaraki disease, why not FMD? For the want of a $50 PCR test kit in the right place Japan is paying dearly.
Why is the source of an FMD outbreak or infection always "unknown or inconclusive"? Why are we not applying modern microbial forensic tools to trace the virus to its source outside Japan by its biological signature (Carrillo, C. and Rock, D. Molecular epidemiology and forensics of RNA viruses, in Microbial Forensics, Editors Breeze, R.G., Budowle, B. and Schutzer, S. E., Elsevier, 2005, 174-185)?
Of course Japan is in a critical situation two months later. You can’t misdiagnose the world’s most infectious virus disease in an intensive animal agricultural region full of cattle and swine for 10 days and not expect catastrophe. Governmental failure to adopt the best science and methodology for FMD surveillance, reporting, investigation and response is like a second marriage - the triumph of hope over experience. Governments keep doing exactly the same things and hoping for a different outcome each time. If it were mandated that all suspected FMD cases were to be tested by PCR on farm Japan would have had a 10 day start on trying to halt the outbreak while it was still small. Sad to say, like we will see the moon and stars again, we know we will be writing much the same sometime soon - just keep this email and change the name of the country when it happens.
Best regards,
Roger