Going up

We are not referring to nationally acquired toxic debt, although a whole new blog could be devoted to the last few years' obsessional pyramid selling of unsustainable credit to people who hadn't a cat in hell's chance of ever paying it back. With that, like the Emperor's new clothes and our own core subject, the propagators of the resulting chaos, actually believed their own guff.

So as GB's debt spirals, and politicians who last year encouraged its growth now attempt to use our money to control it, so does the incidence of bovine badger tuberculosis. And growth more than fulfills Defra's predictions of 20 per cent year on year increase - should they continue current non-policies - which they seem determined to do.

Published figures for the period January - June 2008, show a rise of 23.8 per cent in herds under TB restriction from the same period last year. Another part of the labyrinthine Defra website shows stats in a slightly different format and quotes the lower figure of 19 per cent as an increase in Confirmed herd incidents. This figure is likely to change as more culture results are collected. But the most expensive part of this carnage is cattle slaughterings, up a massive 44 per cent on last year. (20,191 in six months, compared with 13,978 a year ago)

South and West Wales are recording herds under TB restriction of 13 and 14 per cent respectively, while in the West region, Gloucestershire has 24 per cent of herds affected, Hereford / Worcs almost 23 per cent and Devon & Cornwall 18.8 per cent. each. (This compares with the same period in 2007 of 18.6 per cent for Glos. 16.4 per cent for Devon and just 12.7 per cent for Cornwall. England's West region recorded 12.9 per cent of its herds with movement restrictions Jan - June last year. That figure has risen to 16 per cent in 2008.

This is a spiralling pyramid of growth which those of us with cattle herds, do not wish to be part of. Shooting the messengers does not seem to be assisting Defra's control of the situation one bit. These appalling figures, just like the totally avoidable mountain of toxic debt which all taxpayers will have to fund, are going up.

( Note: Web links will change when later statistics are published)

'Bovine' Tuberculosis - 'Badger' Tuberculosis?

We have been castigated on this site many times for flagging up the many victims of 'bovine' TB. "It's 'bovine' the comments shriek, and "what bit of 'cow' don't you understand?" But this clever little bacterium is able to adapt to many mammals and work published by Brosch et al tells us that from the ancient tuberculosis line, the M.bovis lineage has firmly established itself in:

".... natural host spectra as diverse as humans in Africa, voles on the Orkney Isles(UK), seals in Argentina, goats in Spain, and badgers in the UK."

No mention of cattle there - even with a tag of 'bovine'. Not one. Which brings us full circle to why 'we' - that's 'we' as in cattle farmers - are testing and slaughtering cattle. It does not explain why the other half of that 'we', Defra, presently trawling the country gleaning support for its Cost and Responsibility Sharing Levy collection exercise, are hell bent on piling costs onto farmers while accepting no responsibility whatsoever for its own part in the eradication of this multi-species zoonotic disease - but let that pass.

Molecular geneticists say that analysis of recent work suggests that true cattle TB was eliminated by the 1970s, and what we have now is badger adapted TB spreading back into the environment. So maybe it's time for a name change. 'Bovine' TB becomes 'Badger' Tb. We like mycobacterium meles

The single most important thing - one may say the only thing of merit - that baby-Ben Bradshaw accomplished during his tenure of prevarication astride Defra's fence, was to make this disease, the so called 'bovine' TB, notifiable in all mammals. The result has been a steady increase in cases of companion animals and other grazing species as Defra picked up the tab for post mortems. And of course the inevitable spill over into human beings.

For twenty years since the low point of TB eradication in the mid 1980s, when less than 100 herds were under movement restrictions, and under 700 cattle slaughtered, successive administrations have ducked and dived, sanitised eradication policy - other than that applicable to cattle - and totally ignored the message those tested sentinels were giving. This culminated with a 'moratorium' introduced in 1997, on the control of badgers allowed under Section 10 of the Protection of Badgers Act, in response to confirmed outbreaks of cattle TB. Last year Defra proudly announced they had killed 28,000 cattle - but ignored their message. This year will be another vintage, with numbers up a staggering 42 per cent to May and some say, heading for 40,000 by the end of the year. But while Defra may be able to ignore this farm based carnage (except for moaning about its monetary cost, said to account for 40 per cent of Animal Health's budget) they will find it increasingly difficult to ignore the steadily increasing pile of 'other species' - the result of Bradshaw's notification amendment.

Figures seen by our editors confirm that while 'passive' surveillance (as Defra quaintly describe 'not actually looking for' a disease) of the past revealed a handful of cases in other animals between 1998 and 2004, from 2005 to 2007, incidence of 'bovine' tuberculosis rose sharply. In just those three years, spillover victims include 42 domestic cats, 24 llama, 19 domestic pigs, and single figures of goats, sheep, alpaca, ferrets and a dog. The areas where these animals were found are consistent with endemic TB in wildlife and sentinel cattle casualties. The largest group of casualties - the 42 cats - had identifiable spoligotypes described as

" various spoligotypes, each one consistent with the predominant strain at the location of the infected cat"

We have touched on this in previous postings, camelids here, and domestic cats here and here But the reason for all the testing and slaughter of cattle is not about the health and welfare of animals at all. The totally mislabelled 'bovine' Tuberculosis affects people. It is a zoonosis. It's what they do.

But the most recent case in humans, that of a Cornish lady, her dog and her child has finally alerted the main-stream media to the bigger picture of the total failure of the one sided, cattle based tuberculosis eradication programme operating in this country.

Describing the re-emergence of an old zoonotic threat, an unpublished paper submitted to the BMJ journal 'Thorax', warns that the high level of bovine TB infection circulating in cattle and wildlife across parts of the country is posing an ongoing health risk to humans.

Farmers Guardian has the story;

The paper discusses the case of a former veterinary nurse and her dog, from Cornwall, who contracted the same of the strain of the disease last year. It identifies badgers known to inhabit the woman’s garden as a possible source of infection.

The woman was diagnosed with bTB in late 2007, having felt unwell and suffered from a persistent cough for some time. Her daughter was also confirmed with latent bTB infection. Both were treated with a course of drugs.

The family’s pet dog began showing symptoms two months later. It was put down and subsequently confirmed with the same strain of M Bovis, the bacteria that causes bTB, as the woman.

The strain in question is a rare one found locally in cattle and badgers in the South West, prompting five scientists examining the case to suggest the infection therefore probably originated from either badgers or cattle. .

The point here we think, is that the spoligotype of the most misleadingly labelled mycobacterium bovis - 'bovine' TB, which has killed the dog, and infected its owner(s) is a strain known to circulate within tested (and slaughtered if they react to the test) cattle and untested but highly infective badgers in the SW of Cornwall. There is also doubt as to the assertion that the lady's previous employment as a 'veterinary nurse' and thus assumed intimate contact with cattle, was relevant.

"... they question whether the nurse could have been infected through contact with infected cattle while working as a veterinary nurse. However, this is considered unlikely as she had left the job three years prior to becoming infected and there was no sign of latent infection."

But the most telling phrase of FG's report we think is 'badgers known to inhabit her garden'. Inhabit, as in live. Not passing through then? And having examined the usual suspects, including the lady's past employment, this exposure would seem to be 'possible' (most likely) source of the outbreak.

Badgers were known to inhabit her garden and the scientists conclude that this was a more likely source of infection, according to veterinary sources who have seen the paper.

The Health Protection Agency said human cases of bTB did occur ‘occasionally’ in the UK but the current risk was considered ‘negligible’. But they also confirm that not all tuberculosis cases are strain typed. They were unable to provide the editors of this site with figures for the umbrella term 'tuberculosis complex' used to describe such 'untyped' cases. Farmers Guardian quote eight cases of m. bovis type tuberculosis in humans in the South West of England in 2006 and 2007 and 20 nationally in 2005. Only five cases in dogs have been identified in the past 20 years (to 2006).

In people under the age of 40 - 50, born outside the window of transmission opportunity presented by unpasteurised milk, prior to the TB eradication programme which finished in the mid 1960s, even a single victim is one too many. But as figures in our posting above show, and the horrendous, months long drug regime and other cases of onward transmission within human beings tell us, the spillover from environmental contamination with the misleadingly labelled ' bovine' tuberculosis is rising. And inevitably it will claim more victims than 40,000 cattle.

bTB and camelids

The popularity of camelids in GB can be seen from the estimated numbers of llamas and alpacas which are now conservatively put at 20,000 and 5,000 respectively. But recent spillover cases of "bovine" TB into this population has raised several problems. Correspondence in the Veterinary Record details a case of bTB in a commercial llama herd in Devon which resulted in the death of over half the animals.

The herd was established in Devon eight years ago with animals reared outside the county. At the time of disclosure of infection, it comprised 84 adult llamas and their crias. They graze outdoors all year round with occasional supplementary hay fed on the ground, and are only handled for routine vaccinations and worming. Water is provided in troughs, but the llamas also drink from a stream.

The authors point out "the only contiguous cattle herd has had repeated TB breakdowns since 2000 but that direct nose-to-nose contact is not possible between the llama and cattle herds along the common boundary." There have been 19 confirmed cases within a 5 km radius since 2001. Three active badger setts are located on the farm and one in immediately adjacent woodland, but no deer have been seen.

In February 2006, an adult female on the holding was euthanased on welfare grounds following chronic weight loss. Postmortem examination revealed widespread lesions in the lungs, pericardium, and bronchial and mediastinal lymph nodes and M. bovis spoligotype SB0274 (VLA type 11) was recovered. This is the spoligotype most commonly isolated from tuberculous cattle and road traffic accident survey badgers in the same part of Devon.

In May 2006, herd restrictions were applied and the outbreak reported to local consultants in communicable disease control in light of the zoonotic risk. There are no statutory requirements to register and identify South American camelids, or powers to test them for TB, but the owner agreed to have the remainder of the herd tested. But despite two clear herd skin test results, similar clinical signs to the initial case were seen in another adult female in August, which eventually required euthanasia. Lesions were found at postmortem examination and M bovis was subsequently isolated.

In light of this second clinical case and the previous negative herd test result in June, it was decided to blood sample other llamas in the herd to screen for antibodies to M bovis using a novel, non-validated in vitro lateral-flow assay, the VetTB STAT-PAK or `Rapid' test (Waters and others 2006). On the basis of either a positive sero logy result or being considered as dangerous contacts to the previous confirmed cases, 19 more adult llamas and two crias were culled and examined postmortem between August and November. TB associated with M bovis infection was confirmed in four of the adults. Two other adults and a cria also died over this period and on gross postmortem examination showed lesions typical of TB. Specific mycobacterial cultures are still in progress from these three animals.

Testing with both skin tests and bloods were continued for this herd and reactors to both tests were found.

Three tuberculin reactors and at least four seropositive llamas, one of which was a tuberculin reactor, have been identified. The results of postmortem and bacteriological examinations on all these llamas were not available at the time of writing, although one of the seropositive llamas, which had to be euthanased in extremis shortly after testing, presented with gross lesions of advanced TB.

The paper points out both the " susceptibility of llamas to M bovis infection and highlights the difficulty of making an accurate antemortem diagnosis using the tests currently available for this species." They repeat previous advice;

TB should be considered in the differential diagnosis of illthrift in llamas, with or without obvious respiratory involvement, particularly where the animals have been raised in areas of endemic TB in cattle and indigenous wildlife.

In a follow up letter to this report, the authors re-iterate the insensitivety of the intradermal skin test when used on camelids and point out other anomalies ;

Many of us working with camelids believe the test to be so poor as to be fairly meaningless. Nevertheless, this test remains the statutory DEFRA-approved method of checking for TB in camelids, both for importation, exportation, and here in the UK. Moreover, if an `infected' herd achieves two successive clear herd tests 90 days apart there is no requirement to test the herd ever again. Neither is there any requirement to keep movement records or carry out any further postmortem examinations. The `Rapid' blood test shows promise but it is not allowed to be used without the express permission of the State Veterinary Service. That permission is not always forthcoming even when clients have offered to pay privately for the test. Surely DEFRA should be furthering research by promoting blood testing, not hindering it.

They conclude that better methods of identification, surveillance and control of TB in camelids is needed, given the population of these animals within GB, and point out;

They should not be ignored in the overall campaign to eradicate bovine TB. The Devon incident may be only the tip of the iceberg.

As we posted here a similar breakdown affected a herd in Wales. We understand Welsh Assembly are currently 'consulting' on what to do about the situation of spillover bTB into camelids. And as we can find no such documents on the English side of Offa's Dyke, would that be like the 'consultation' on whether to sort out the maintenance reservoir in wildlife - a name they dare not speak - or keeping piling up dead cattle then? We won't be holding our breath.

Under discussion...

The outcome of the European Standing Committee on the Food Chain and Animal Health (SCFCAH) meeting on the export of live animals from GB, which we discussed here is outlined in more detail on the ProMed website. We are grateful for sight of this.

"The Commission gave a brief overview of the Community legislation on
bovine tuberculosis noting that calves under 42 days of age are
exempted for the requirement of the pre-movement testing and that in
this case, current EU provisions rely only on the status of the herd.
In addition, the Commission presented for discussion 4 possible
alternative provisions which could be implemented, either one at a
time or in combination, in order to prevent the spread of TB from
areas with high prevalence of the disease via intra-Community trade
in calves under 42 days of age, and in particular apart from the
mandatory officially tuberculosis-free herd origin:

1. Pre-movement test (intradermal skin test or gamma interferon test)
of individual animals concerned;
2. Low prevalence region origin (below 1 or 0,5 percent or other);
3. Recent herd test (such as, less then 6 months) with strictly
defined frequency of testing the herd (annual, twice a year, etc.);
4. Channelling procedure (post-movement test at destination or
dispatched to a holding at destination from which they can only be
moved directly to a slaughterhouse).

Conclusions-----------

There was general consensus on:
- the need to ensure that the officially bovine tuberculosis-free (TB
OF) status is properly granted to the herds, as this is the basic
requirement in order to ensure safe trade;
- the pre-movement testing is not suitable for animals younger than
42 days of age due to the lack of sensitivity of the test when used
on these animals;
- there is a need to have proportionate and effective measures in
order to address the risk posed by these animals that cannot be
tested before movement.

An acceptable regime for animals below 42 days of age would be as follows:
Bovine animals for breeding and production less than 42 days old
shall only be dispatched to other Member States if they come from an
officially tuberculosis-free bovine herd as defined in Article
2(2)(d) of Directive 64/432/EEC, and:

1. The holding of origin is situated in a Member State or a region of
a Member State as defined in Article 2(2)(p) of Directive 64/432/EEC
in which on average, determined at 31 December of each year, the
annual percentages of bovine herds confirmed as infected with
tuberculosis is not more than 0.5 percent of all herds within the
Member State or region thereof, or
2. All animals in the holding of origin, with the exception of
animals under 6 weeks old, have been subjected with negative results
to the routine intradermal tuberculin test in accordance with Annex B
to Directive 64/432/EEC at an interval of more than 3 months and less
than 6 months during the last 12 months, or
3. All animals in the holding of origin, with the exception of
animals under 6 weeks old, have been subjected with negative results
to the intradermal tuberculin test in accordance with Annex B to
Directive 64/432/EEC, carried out in the 30 days prior to the
movement, or
4. The animals are consigned, through a channelling procedure under
the control of the competent authority of the place of destination,
to a holding from where they can only be removed:
a. to be transported directly to the slaughterhouse for slaughter in
accordance with the first indent of Article 7 of Directive
64/432/EEC, or
b. to be introduced not earlier than at the age of at least 42 days
into another herd in accordance with the procedure provided for in
point 1(c) of Section I of Annex A to Directive 64/432/EEC [see
commentary. - Mod.AS]

On 3 Sep 2008 the conclusions of the meeting were presented to the
Standing Committee for Food Chain and Animal Health under point 4D of
the Committee's agenda."

It is our understanding that this matter will be revisited in October.

"Easily Cured" or an under-appreciated risk?

Recent media coverage of the Cornish lady (and her dog) who contracted bTB, had the glib and airy observation that "TB is easily cured", implying that an aspirin, an organic carrot and a dose of selenium would do the business. So what are the facts on 'treatment' of this ancient disease - assuming diagnosis allows time to treat at all?

Four years ago, a young man died from 'bovine' TB in the Birmingham area. Several more patients presented with symptoms 2004 - 2006 and much detective work was done to try and find a common source. The BBC carried an overview after the case was published in the Lancet last year.

Bovine TB can spread from human to human, scientists fear after a cluster of six cases, one fatal, in England. All had visited the same Birmingham bar or nightclub, yet only one of the young patients had been in contact with infected unpasteurised milk or cattle. The Health Protection Agency said although rare, the cases emphasised the need for rigorous checks and controls.

Experts told The Lancet that bovine TB was an under-appreciated cause of disease and death in humans.

This 'under-appreciation' may be because an undisclosed proportion of UK tuberculosis cases are not strain typed, but bundled under the all embracing term, 'tuberculosis complex'. And what was also not made plain was that doctor's text books have not kept up with public health measures applied on-farm in that anyone under the age of 50, (the average age of the Birmingham victims was 32)would have been drinking unpasteurised milk, from regularly tested (and slaughtered if they reacted to the test) cattle.

Certainly unpasteurised milk was the driver for transmission of bTB in the 1930s and 1940s, but during the TB eradication programme undertaken in GB, 1952 - 1960, all cattle in the country were tested and slaughtered if they reacted to the test. This brought the instance of TB reactor cattle down from 40 % of the national herd in 1934 to 0.04% in 1965. Thus strains (spoligotypes) of bTB circulating in the environment, are now limited one the one hand to tested sentinel cattle, mainly slaughtered ahead of clinical disease, and an unchallenged, uncontrolled but highly infectious wildlife reservoir of disease in badgers.

The TB infected index case went on to transmit the disease to several other people, in the confines of a Birmingham nightclub. And their treatment? Were they 'easily cured' as the recent press articles have told us? One of the cocktail of several drugs used for months to control or hopefully cure, tuberculosis is Isoniazid. This is the drug information sheet for it:

ISONIAZIDBrand names: , Nydrazid

Isoniazid is an antibiotic. It prevents tuberculous bacteria from multiplying in the body.Isoniazid is used to treat and to prevent tuberculosis (TB).

Avoid alcohol while taking isoniazid. Alcohol may increase the risk of damage to the liver during isoniazid treatment.
Contact your doctor immediately if you experience numbness or tingling in the hands or feet, weakness, fatigue, loss of appetite, nausea and vomiting, yellowing of the skin or eyes, or darkening of the urine. Before taking this medication, tell your doctor if you have ever had an allergic reaction to isoniazid, kidney disease, or liver disease.

It is not known whether isoniazid will be harmful to an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant or could become pregnant during treatment. It is not known whether isoniazid will be harmful to a nursing baby. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.

Your doctor may also want you to take a supplemental vitamin B6 (pyridoxine) tablet daily during treatment to prevent numbness and tingling caused by low levels of this vitamin. Your doctor may want you to have blood tests or other medical evaluations during treatment with isoniazid to monitor progress and side effects.

Seek emergency medical attention if an overdose is suspected.
Symptoms of an isoniazid overdose include nausea, vomiting, dizziness, slurring of speech, blurred vision, visual hallucinations, seizures, coma, and death.

Avoid alcohol while taking isoniazid. Alcohol will increase the risk of damage to the liver during treatment with this medication.
Use caution with the foods listed below. They can interact with isoniazid and cause a reaction that includes a severe headache, large pupils, neck stiffness, nausea, vomiting, diarrhea, flushing, sweating, itching, irregular heartbeats, and chest pain. A reaction will not necessarily occur, but eat these foods with caution until you know if you will react to them. Call your doctor immediately if you experience any of these symptoms.

Eat the following foods with caution:

cheeses, including American, Blue, Boursault, Brick, Brie, Camembert, Cheddar, Emmenthaler, Gruyere, Mozzarella, Parmesan, Romano, Roquefort, Stilton, and Swiss;

sour cream and yogurt;

beef or chicken liver, fish, meats prepared with tenderizer, bologna, pepperoni, salami, summer sausage, game meat, meat extracts, caviar, dried fish, herring, shrimp paste, and tuna;

avocados, bananas, figs, raisins, and sauerkraut;

soy sauce, miso soup, bean curd, and fava beans;

yeast extracts;

ginseng;

chocolate;

caffeine (coffee, tea, cola, etc.); and

beer (alcoholic and nonalcoholic), red wine (especially Chianti), sherry, vermouth, and other distilled spirits.

Not just an aspirin then? The website for trainee doctors run by the BMJ also had some information on m.bovis and m.tuberculosis infections. In particular note the reference to Isonaizid resistant strains.

...a large proportion of those affected [by tuberculosis] are "young, UK born, white, and reasonably affluent. Almost half of the 7000 cases seen nationwide each year being found in the capital: 7.5% of the TB seen in London is isoniazid resistant.

The bacterium responsible for the outbreak is unusual in that it takes patients longer to recover from the illness. Nine months of antibiotic treatment is required to combat the infection, in contrast to the usual six months. Patients suffering from "normal" TB have a relapse rate of around 2-3%, but the rate is 10% in those with the drug resistant strain. [] Both the incubation period and mortality rates of the strain are similar to "normal" TB.

As a commentator in the Birmingham Post pointed out, "bTB has not gone away".

It has been pointed out that while some UK patients with tuberculosis have to be encouraged with payments to complete their course of treatment (so long and horrible it is) sufferers in the US used to have the big stick treatment. We are not sure whether this is still the case, hence the 'used to', rather than 'have'. But for sure, the seriousness with which the disease was taken was reflected in the compulsory attendance of patients to local police stations to take their medication under supervision. Should they default, then they had committed a criminal act and an arrest warrant was served.
In a part of of own 1936 Public Health Act, it is an offence to travel on public transport while infectious with a notifiable disease. Treatment of a notifiable disease is mandatory. Tuberculosis (of any strain) is a notifiable disease.

We will leave you to decide from those snippets whether bTB should be airbrushed into a politically expedient comfort zone, or treated with the seriousness we think it deserves.

European perspective - SCFCAH

Today the European SCFCAH (Standing Committee on the Food Chain and Animal Health) met to discuss, amongst other things, an ....

"Exchange of views on measures which may be required to prevent the spread of bovine tuberculosis from areas with a high prevalence of the disease via intra-community trade in live cattle: outcome of the working group of 2 September.(MZ)"

They could start by making sure that a maintenance reservoir of disease is not allowed to flourish amongst the tuberculin-tested cattle sentinels in GB. That would be sensible, as they outlined in this document which we posted in July. The responsibilities of EU member state governments with regard to such reservoirs are described quite clearly. One would assume that not even Defra could misunderstand them, but on the experience of the last decade, one would be quite wrong..

... in order to address the role of infected wildlife in the persistence of TB [measures] should be implemented without any delay so as to allow the progress of the eradication programmes. Removal of wildlife, either proactively or reactively following outbreaks, has proven to be an effective ancillary, and in certain situations necessary, measure to control and eradicate TB.

and to reinforce the point:

The elimination or reduction of the risk posed by an infected wildlife reservoir enables the other measures contained in the programme to yield the expected results, whereas the persistence of TB in these wildlife populations impedes the effective elimination of the disease.

Major socio-political resistance (lobbyism) against any measure involving the removal of infected wildlife or interventions affecting the environment are to be expected. The additional costs associated with these actions are not likely to be negligible."

As we pointed out before, the costs of not removing an infected wildlife reservoir are infinitely greater, both in straight monetary terms or the long term transmission opportunities afforded to the many and increasing spillover victims. But Defra's figures for TB incidence in GB in the first five months of the year are appalling. In fact they are a damned disgrace, with cattle slaughterings up a staggering 42 per cent, and confirmed new breakdowns increasing by almost 200 herds. Herds under TB restriction due to a TB breakdown, increased from 4391 in 2007 to 5209 this year.

(Note: The link to Defra website for the May 2008 figures will automatically update when later figures are available. )

Update

Farmers Guardian reports that early indications from the SCFSAH meeting in Brussels suggest that the European Commission has decided against adding further restrictions to UK cattle exports despite European fears that TB could be spread to the continent. But the cattle industry and Defra cannot breath easily yet, as the committee are said to be considering the risk of TB-infected exports at a meeting in October.

So while SCoFCAH monitor the situation without further sanctions at present, official trade restrictions demanded by the Dutch and Belgian veal importers, already imposing their own unofficial boycott, in the short term, have been avoided.

And 'short' is the appropriate word, as cattle slaughterings and herds under TB restriction mount. A week maybe a long time in politics, but a month is very short time span indeed in the life cycle of the bacterium quite misleadingly known as micobacterium bovis. This autumn's casualties are already in the pipeline.