Saturday, September 19, 2009

Constructive Ignorance?

A comment has come into the site which has alarmed us somewhat. Our old friend mycobacterium bovis is, as we have said many times, a very serious zoonosis and as such, anyone who has had contact with either a human or an animal confirmed case should be checked out for the disease by the public health authorities. When bTB is confirmed in cattle, (unless anyone knows differently - see later) the local public health department are alerted by the AHO responsible for the area, and tests offered to anyone who has had contact with the cattle.

But when a pet is confirmed with bTB, the resulting health checks appear to be a tad selective, as this comment shows:
We lost all 4 of our pet cats to bovine TB late last year / early this year. (we had one confirmed case and were instructed by defra to euthanize the other 3 (all the while our vets were telling us not to worry, "this doesn't happen; cats don't get tb"))
Yes they do. We covered some feline victims here and another here. Over forty cats were positively identified with bTB 2005-2007. So what about their owners after sharing armchairs and airspace?

The comment continues that Defra did its job and recommended that the owners of the cats, and their 7yr old son were all be tested for btb. And then a stumbling block. the comment continues:
"Public health in our area of Wales flat out refused us tests. I spent hours every day for weeks on the phone to everyone I could think of (private doctors and hospitals, public health, the county's health board, newspapers, Defra, etc) and had no success."
Ten months on from the death of this cat with confirmed bTB and eight months from the euthanasia of its three companions, the owner is still unaware as to whether or not she or any members of her family were/are infected. She has also heard of another case of bTB in a domestic cat in the same area.

The advice from the numerous bodies dealing with bTB, acting it would seem, in glorious isolation both from each other and reality, was confusing. Defra saying that aerosol transmission was a serious risk, while public health parroting 1950s text books, and quoting "unpasteurized milk or infected udders" as the only source. Catch up, please. That loophole was firmly closed in the 1970s. Where on earth do these people think the exposure of 40,000 sentinel, tested and slaughtered cattle annually is coming from? M. bovis doesn't fly in with the tooth fairy. It is carried by infected mammals. Primarily badgers. And in quantities guaranteed to produce onwards transmission, and subsequent disease in anything which is unlucky enough to fall over the detritus they leave behind. Spill back is now increasingly seen in cats, alpacas, goats, sheep, pigs and other companion mammals.

This lady then asked Defra how her cats could've contracted the disease and Animal Health replied "cows or badgers." The location of these cats is a rural cottage, surrounded by sheep with a few herds of cattle as well. The spoligotype of m.bovis isolated from the first cat is described by local AHO as:
... the strain predominant in our area (the Brecon Beacons in mid Wales).
The comment continues with the worrying observation from local farmers who have had bTB problems in their cattle herds, that despite them having received advice from AHOs to be tested for bTB, they are being turned away by GPs.

This is a case of Wales not joining their respective dots with access to TB testing, Xrays and a merry-go-round between different regional health authorities - for which there is absolutely no excuse. We have touched on problems with human TB in Wales before and in this week's Veterinary press is a timely reminder that all too often, 'tuberculosis' in humans is not strain typed at all, being logged under the all-encompassing title 'tuberculosis complex'. Thus the true level of bTB, which would have involved health agencies joining hands with VLA to strain type, and examining causes and transmission opportunities, is likely to be described by the Public health authorities as 'low'. Of course it's 'low' if it's not looked for, diagnosed or strain typed. Now, our co-editor has a name for this: it could be (he says) different agencies protecting their respective castles, i.e total bloody incompetence, or what we have seen so many times before, when reality becomes uncomfortable - constructive ignorance.

The responsibility for control of this grade 3 pathogen is quite clearly set out in the Health Protection Agency's Zoonosis guidelines which proudly bears the logos of Defra, Animal Health, VLA and the Food Standards Agency. And it is bang up to date, printed in 'April 2009'. So, we suggest (or the boss does) that the first port of call for our Welsh lady, if these agencies fail to hold hands with the powers that be, is the HPU (Health Protection Unit) - with a copy of any correspondence to her local MP.

The booklet is quite proscriptive, describing bTB as a statutory notifiable disease which has 'multi agency discipline'. But that does mean that the numerous agencies can pass this parcel around and no one pick up responsibility for it.

6.1.5 p.16
"Responsibility for investigating transmission from animals to humans in a domestic setting rests with the HPA (Health Protection Agency)"
Meanwhile in her locality our correspondent has discovered a third cat with bTB, whose owners have been refused tests. See the comment section in this posting.

She concludes her story,
It's [ bTB diagnosis] a logistical and bureaucratic nightmare. A GP I saw out of hours (and outside of our own practise) told me that public health are useless. That was reassuring. The bTB situation in the UK is a mess and a nightmare. It is being handled appallingly badly by people who don't seem to care about the health and welfare of animals or humans.
We couldn't possibly comment.

1 comment:

Anonymous said...

I understand that it is possible to fly to Switzerland to get these tests performed properly

It is not (yet) illegal to do this