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Bovine Tuberculosis Eradication Program Historical Perspective Mitchell Palmer, DVM, PhD and W. Ray Waters, DVM, PhD National Animal Disease Center USDA,

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Presentation on theme: "Bovine Tuberculosis Eradication Program Historical Perspective Mitchell Palmer, DVM, PhD and W. Ray Waters, DVM, PhD National Animal Disease Center USDA,"— Presentation transcript:

1 Bovine Tuberculosis Eradication Program Historical Perspective Mitchell Palmer, DVM, PhD and W. Ray Waters, DVM, PhD National Animal Disease Center USDA, ARS Mark S. Camacho, DVM, MPH Regional Epidemiologist USDA, APHIS, Veterinary Services

2 7/3/20152 Tuberculosis- Ancient Origins

3 7/3/20153 Ancient history of tuberculosis  The earliest detection of Mycobacterium tuberculosis is in the remains of bison dated 18,000 years before the present.  Skeletal remains show prehistoric humans (4000 BC) had TB, and tubercular decay has been found in the spines of mummies from 3000–2400 BC. Source: Wikipedia

4 7/3/20154 Ancient History of Tuberculosis  “Phthisis” (wasting away) is a Greek term for tuberculosis; around 460 BC, Hippocrates identified phthisis as the most widespread disease of the times involving coughing up blood and fever, which was almost always fatal.- Hippocrates (460-370 BC)  “Why when one comes near consumptives… does one contract their disease…the reason is that the breath is bad and heavy…one breathes this pernicious air and takes in the disease because there is in the air something disease producing.” Aristotle (384-322 BC)

5 7/3/20155 “Consumption” and “White Plague”  Disease appears to “consume” it’s victims… causing them to waste away.  Tuberculous patients appear pale.

6 7/3/20156 Human Tuberculosis- The Numbers  19 th Century- 20% of all human deaths were caused by tuberculosis.  21 st Century- 2 billion infected worldwide. Annually: 8-9 million new cases, 1.5 million die. 10-15 thousand cases/yr in the US. Most cases are due to “reactivation”.

7 Disease of Poverty 7/3/20157 CountryAll CasesPer 100,000 India2,200,000189 China1,000,000 75 South Africa 500,000993 Cambodia 61,000424 Indonesia 450,000187 Pakistan 410,000231 Bangladesh 340,000225 Ethiopia 220,000258 Europe 380,000 42 United States 9,951 3.2 Global total8,700,000125  Uncommon in wealthy western countries today.  Still rampant in the world’s poorest countries.

8 Bovine Tuberculosis  “There is scarcely a subject related to agriculture or public health that has occasioned as much or as bitter discussion, or has led to the expression of so many divergent views as this one of tuberculosis in cattle.” Leonard Pearson (1905) 7/3/20158

9 9 Mycobacterium tuberculosis complex  M. tuberculosis  M. canetti  M. africanum  M. pinnipedii  M. bovis  Broadest host range  M. bovis and M. tuberculosis shared a common ancestor

10 7/3/201510 Bovine Tuberculosis- The Numbers  Pigs, goats, sheep, camelids, horses, sheep, dogs, cats.  Livestock worldwide (cattle, Asiatic water buffalo). 69% of countries in tropics. 80% of countries in Africa. One of the most important livestock diseases in China.  Estimate 1 billion cattle worldwide with 50 million infected. 1/3 live in regions where bovine TB is controlled. 1/3 live in areas where disease is widespread but prevalence unknown. 1/3 live in areas of high prevalence

11 7/3/201511 Discovery Human vs Bovine Tuberculosis Robert Koch’s Assumptions

12 7/3/201512 Koch’s Mistake- Mycobacterium bovis  1882, Robert Koch mistakenly stated that tubercle bacilli from humans and cattle were the same.  1901, Koch said that there were differences between the bacilli …but there was little danger of transmission from the bovine bacillus to man.  1905- Nobel Prize, “Bovine tuberculosis is not transmissible to man.”  1908, Stated that bovine infection could be transmitted to humans, but it would be “wrong to place the combat of bovine tuberculosis above that of human tuberculosis.”

13 Mycobacterium bovis  1865- Jean-Antoine Villemin- transfer of material from humans or cattle to rabbits. Not a spontaneous disease Tuberculosis infectious, the effect of “some contagious agent.” Moved “consumption” to “tuberculosis”  1885- Auguste Chauveau- cattle-to-cattle transmission through ingestion. In man and cattle transmission through consumption of milk and meat was possible.  1898- Theobald Smith distinguishes M. bovis from M. tuberculosis. Smith Villemin Chauveau Smith

14 Mycobacterium bovis  1901- John McFadyean and Royal Commission on Tuberculosis conducts research.  1911- Royal Commission on tuberculosis  “Man must therefore be added to the list of animals notably susceptible to bovine tubercle bacilli.”  Proposed test and slaughter. McFadyean

15 Robert Koch  British, American, German Commissions formed.  Koch countered by McFadyean, Bang, Ravenel, Salmon, Lister, Virchow, Smith, Nocard.  Koch’s declarations emboldened special interest groups and political opposition to eradication.  Koch’s influence carried the discussion into the 1930s long after science had settled on the issue.  Not officially M. bovis until 1970 7/3/201515

16 Zoonotic Potential  As early as 1885 growing demand by public health officials for safe meat and milk.  M. bovis responsible for up to 25% of human tuberculosis, especially in children.  At the same time, 2/3 of all condemned US beef carcasses were for “tuberculous meat”.  Motivation for:  1) Mandatory pasteurization  2) Bovine TB eradication program

17 Why a bovine tuberculosis program?  Public Health Concerns 25% of human cases Easily transmitted through unpasteurized milk  Carcass condemnation Most common cause for condemnation Rising rates of condemnation  Europe more severely affected showing where uncontrolled disease might lead 7/3/201517

18 7/3/201518 Tuberculin: The Foundation for an Eradication Campaign

19 Tuberculin Testing  1890- Koch develops tuberculin. Fails as treatment but veterinarians recognized the potential as a diagnostic aid.  Veterinarians (Gutmann and Bang) begin using it to diagnose bovine tuberculosis.  1892- Leonard Pearson (age 24) travels to Koch’s lab and brings tuberculin to Pennsylvania for first cattle skin tests.  Preventative  Treatment  Koch’s lymph  Paratoloid  Tuberculin Pearson

20 First tuberculin tests in US Jersey cattle owned by Joseph Gillingham, Clairmont Farms, Villa Nova, PA- Trustee of University  Much attention and criticism  Dr. Samuel Dixon- Academy of Natural Science in Philadelphia- called Gillingham a fool and Pearson a dreamer  Dr. W.L. Zuill- professor of veterinary surgery-headed a commission to discredit tuberculin’s diagnostic properties  SC administration and monitor body temperature  51 of 79 showed positive reactions.  Necropsies began on farm- continued at University  Producers, veterinarians, physicians, reporters  All 51 had gross lesions  Pearson to Gillingham- “..his sacrifice would come to be a blessing to every cattleman in the US.” 7/3/201520

21 Tuberculin Testing  Voluntary, at the farmer’s expense, no indemnity, carcasses buried.  Pearson’s plan- reactors appraised, postmortems under official supervision, meat salvaged.  Public education- on-farm necropsies drew large crowds.

22 Tuberculin Testing- Challenges  1892-1915: Testing methods varied  Subcutaneous  Intrapalpebral  Intradermal  No standard tuberculin  1908- human intradermal test used  1921- intradermal the official method used by the USDA Bureau of Animal Industry (BAI)  Rumors, fears, misconceptions  Inaccurate, harmful, milk shortages

23 Tuberculin Testing- Challenges  1925- Iowa Supreme Court  “Pitchfork Brigade”  Iowa “Cow War”  1931- Tipton IA, (Cedar County)  Hundreds of farmers opposed to testing  State Vets threatened  Governor Daniel Turner imposed martial law and called in the National Guard  Martial law lasted 2 months

24 Iowa “Cow War” Characters  William Butterbrodt- West Branch, IA  “If there is no resistance there will be no trouble”  Arrested for stampeding cattle  Jake Lenker-  Chased off officers and vets  Iowa Farmer’s Protective Association  1000 National Guard Troops and State Veterinarian  Norman Baker  KTNT “The naked truth”  Cancer clinic, hypnotist, mail order artist

25 7/3/201525

26 Tuberculin Testing- Challenges  Interval to retest was unknown-desensitization  BAI recommendations to retest varied from 7 to 60 days  Potential for fraud  “cow massaging” and “plugging the test”  Inducing inflammation

27 Tuberculin Testing “Tuberculous Cattle Trust”  “Tuberculous Cattle Trust”  James Dorsey of Gilberts, IL  20,000 cows/yr- ~50% tuberculous  “plugging the test”  Over 10-year period 10,000 new foci of infection across US, Canada and Mexico  1914- 12 states ban cattle from IL, unless tested by federal veterinarians  1915- Dorsey indicted, sentenced to 8 yrs  Pardoned by Pres. Woodrow Wilson after 4 yrs.  Estimated responsible for thousands of human cases compared to “Typhoid Mary” responsible for 47 cases

28 Methods of Control- Controversy  Bang’s Method- control without slaughter  Segregation in to 2 herds (reactors/non-reactors)  Herds housed and controlled separately  Calves removed at birth, colostrum/milk pasteurized  Slaughter from infected herd done under inspection  Monitor non-reactor herd  Popular in Europe, not in US  Costly, poor public acceptance  Test and Remove  Indemnity, use of milk/meat, quarantine  Disposition of infected cattle - 1906 law- burning or burying diseased cattle  In reality infected portions trimmed or sent to far away plants for slaughter

29 Methods of Control- Controversy  Robert Von Ostertag- “Father of Veterinary Meat Inspection”  Remove only animals with “open” lesions and track visibly infected animals.  Manchester Plan (English)  Periodic testing of milk for bacilli and trace back to herd of origin.  French- relied on BCG vaccination.

30 Methods of Control- Lack of Uniformity  1904- 24 states with tuberculin test barriers  Variability in timing, stringency, etc.  Different approaches in different jurisdictions without consultation or cooperation  Need for uniformity  “It does not require any extended argument to convince us that the question to be discussed is necessity for some uniformity…let regulations be drawn up by the Bureau of Animal Industry” S.H. Ward (MN State Vet)

31 US Bureau of Animal Industry  1883- Veterinary Division in USDA  1884- BAI created by congressional mandate. “…prevent the exportation of diseased cattle, and to provide means for the suppression and extirpation of bovine pleuropneumonia and other contagious diseases.”  Daniel E. Salmon- 1 st Director  Success with pleuropneumonia and FMD  BAI had power to condemn animals capable of spreading disease across state lines.  1893- First official skin test by Dr. E.C. Shroeder (15/34 reactions, 13/15 lesions)  1900- tuberculin testing required on all imported cattle 7/3/201531 Daniel E. Salmon

32 BAI- Noteworthy Research  Capable forward thinking scientists  Fred Kilborne, Cooper Curtice and Smith discovered (Babesia bigemina) cause of Texas Fever  Salmonella  Tuberculosis  1906 Pathology Division Alonzo D. Melvin- Chief Test and removal method Herds in MD, VA, DC tested annually for 12 years. 17,000 tests, prevalence decreased 19% to 0.17% 7/3/201532 Smith Moore Kilborne Curtice

33 BAI- Noteworthy Research  Differentiation of human and bovine tubercle bacilli.  Differential virulence of the bovine and human bacilli in cattle.  Morphological and biochemical differences in cultures of human and bovine tubercle bacilli.  Transmissibility of bovine tubercle bacilli from cattle to swine.  Immunization of cattle with BCG.  Tuberculin potency testing.  Alternative routes of tuberculin administration.  Use of test and remove method of tuberculosis control. 7/3/201533 Moore

34 7/3/201534 Eradication Program States Led Way  Pennsylvania first state to establish program (voluntary)  2 M cattle, prevalence 2-3%  Some herds with 30% to 100% infected.  1895- PA State Livestock Sanitary Board formed  $40,000/yr- TB, anthrax, glanders, rabies  Option of Test/Remove with Indemnity or Bang’s Method  PA manufactured tuberculin and anthrax vaccine  1898- mandatory testing  1899- 33,000 cattle tested  13.7% positive  $102,909 indemnity payments ($22.56/head)

35 7/3/201535 Eradication Program States Led Way  Massachusetts  Different laws passed in 1892, 1894, 1895, and 1896 led to confusion.  State Legislature passed a law restricting the use of tuberculin to confirmation of a diagnosis made by physical exam.  Prevented widespread and systematic testing.  Neighboring Maine refused cattle deemed TB-free by physical exam only.

36 7/3/201536 US Livestock Sanitary Association  1894- 8 state officials and the BAI recommended formation of US Livestock Sanitary Association.  1897- 1 st meeting in Ft. Worth, TX.  State and territorial sanitary officials, veterinarians and 5 delegates named by Sec of Ag  1899- TB surpassed Texas Fever  Resolution- TB is contagious and spreading, tuberculin was the best means of diagnosis, states and BAI should authorize methods of control.  1904- Committee on Tuberculosis formed.  Deal vigorously with TB, determine the reliability of tuberculin test, determine methods of carcass disposal, define rules governing interstate movement of cattle.  Dr. Salmon pledged BAI would follow recommendations of Sanitary Association.

37 7/3/201537 Accredited Herds  Committee of 5 state and federal veterinarians and 5 representatives from livestock breeder associations.  1917- Unanimously adopted by Sanitary Association.  Accredited herds- Receive certificate valid for 1 yr  Certificate declared the herd had been TB free for at least 2 yrs  Cattle could be shipped interstate with no further testing.  Producers agreed to regular tuberculin testing and complete/accurate animal identification records.  1927: >96,000 accredited herds, comprising 1.5 M cattle, another 1.3 M having had one TB-free test.

38 7/3/201538 Accredited Herds  BAI- Director Melvin obtained $75,000 ($1.27M) from congress in 1917 to create the Tuberculosis Eradication Division.  Headed by John A. Kiernan (TN State Vet)  1917- 1 st Uniform Methods and Rules approved.  60 days after approval- 1 st herd accredited  US Soldiers Home in Washington, DC.  1918- Accredited Veterinarian Program  By end of 1920: >5500 accredited vets  1921- Eradication offices in 46 states.

39 7/3/201539 Accredited vets get to work  1901- >200,000 cattle tested  prevalence 3.9% to 100% depending on region.  1917 to 1941- 25M cattle tested.  prevalence decreased 4.9% to 0.3%.  1917- Henry A. Wallace  eradication of bovine TB is “an impossible undertaking”  1941- USDA Secretary of Ag- Claude R. Wickard  “the US is now practically free of bovine tuberculosis”  1941- Every county <0.5% prevalence  23-year cost- $200M taxpayer costs plus cost to farmers

40 Eradication Campaign 1917-1940  232 million tuberculin skin tests given.  3.8 million cattle destroyed Cattle population average of 66.4 million  Every county in the US modified accredited (< 0.5% prevalence).  Economic benefits exceeded costs 10:1.  Human M. bovis infection a rarity. 7/3/201540

41  1917-1959 individual animal testing (area testing).  Since 1959 focused on slaughter surveillance. 7/3/201541

42 Economic- Benefits  1917-1962: annual benefits $98.7 million  Net annual benefits $159 million  Decreased cattle lost from 100,000 to <30/yr  Saves $150M in replacement costs. 7/3/201542

43 Benefits- Public Health  Eradication plus pasteurization prevented >25,000 deaths.  Mortality from 150/100,000 in 1918 to <50/100,000 in 1942  <5/100,000 since introduction of streptomycin, isoniazid in the 1940’s and 1950s, <5/10,000 by 1980. 7/3/201543

44 Economic- Costs  1917-1992: actual cost $538M  255M federal, 283M state  Current program costs 3.5-4M/yr 7/3/201544

45 Obstacles to Bovine Tuberculosis Eradication  Importation of infected cattle  Need for rapid, reliable and inexpensive test to be used at border crossings.  Inability to Test and Remove Cattle  Need for reliable, accurate diagnostic tests to remove infected cattle without whole herd depopulation.  Wildlife Reservoirs  Need for vaccines for wildlife.  Safe vaccines  Vaccine delivery systems  Need for vaccines for cattle.  Infected vs Vaccinated 7/3/201545

46 Obstacles to Bovine Tuberculosis Eradication  Importation of infected cattle  Need for rapid, reliable and inexpensive test to be used at border crossings.  Inability to Test and Remove Cattle  Need for reliable, accurate diagnostic tests to remove infected cattle without whole herd depopulation.  Wildlife Reservoirs  Need for vaccines for wildlife.  Safe vaccines  Vaccine delivery systems  Need for vaccines for cattle.  Infected vs Vaccinated 7/3/201546

47 7/3/201547 Questions?

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