1. January 2002 WHO/CSR/APH Efforts and needs for global control of BSE and vCJD Maura N. Ricketts MD MHSc FRCPC WHO/CDS/CSR/EPH

2. January 2002 WHO/CSR/APH  Scrapie - sheep  Transmissible Mink Encephalopathy  Chronic Wasting Disease - mule deer and elk  Bovine Spongiform Encephalopathy (BSE)  Feline Spongiform Encephalopathy (FSE)  Transmissible Encephalopathy of captive bovids and felids Animal TSEs

3. January 2002 WHO/CSR/APH BSE

4. January 2002 WHO/CSR/APH Mad Cow disease (BSE) and vCJD  BSE and vCJD - same agent  BSE epidemic in cattle was caused by BSE- contaminated MBM  Principle source of exposure for humans is food  human to human is a possible secondary route  No test to detect agent in food or living asymptomatic animals

5. January 2002 WHO/CSR/APH EU restricts British cattle exports BSE in the UK n=180,937 OIE, 30 June 2001 feed ban in UK Ban on British beef SBO ban for humans Sale of MBM prohibited

6. January 2002 WHO/CSR/APH Annual Incidence of BSE UK and Ireland (indigenous cases per million bovines over 24 months)

7. January 2002 WHO/CSR/APH Annual Incidence of BSE (indigenous cases per million bovines over 24 months) NB: Guernsey removed

8. January 2002 WHO/CSR/APH BSE Reports in Europe, by Year OIE Data, 21 December 2000 N~182,000 Continental Europe United Kingdom

9. January 2002 WHO/CSR/APH BSE Reports by Year OIE, 3 January 2002

10. January 2002 WHO/CSR/APH BSE Reports Internationally, not UK by Year and Country OIE Data, 30 June 2001 PortugalIrelandFranceSwitzerlandBelgium

11. January 2002 WHO/CSR/APH Annual Incidence of BSE (indigenous cases per million bovines over 24 months)

12. January 2002 WHO/CSR/APH Austria Czech Republic Finland Germany Greece Italy Japan Slovakia Slovenia Spain  1  5  6  125  1  32  1  69 Impact of Active Surveillance: BSE reports in countries previously reporting no cases

13. January 2002 WHO/CSR/APH OIE Data, 30 June 2001 Impact of Active Surveillance: BSE reports in Countries previously reporting no cases Spain Italy Germany

14. January 2002 WHO/CSR/APH BSE Estimates Infections and Cases (n  1,000,000) Cattle infected with BSE (model) Confirmed BSE cases (deaths)

15. January 2002 WHO/CSR/APH Exports from UK 1980 - 1997 UK Customs & Excise Data

16. Total Exports of MBM 1988 - 1993 No data 0 - < 5 5 - < 10 10 - < 20 20 - < 100 100 - < 1.000 1.000 - < 10.000 > 10.000 Legend: (in tonnes)

17. Total Export of Live Bovines 1988 - 1993, Pure Bred AND Non Pure Bred No data 0 - < 5 5 - < 10 10 - < 20 20 - < 100 100 - < 1.000 1.000 - < 10.000 > 10.000 Legend: (number of animals)

18. Total Export of Bovine Offal and Meat preparations 1986 - 1990 No data 0 - < 5 5 - < 10 10 - < 20 20 - < 100 100 - < 1.000 1.000 - < 10.000 > 10.000 Legend: (in tonnes)

19. Total Export of Live Bovines 1980 - 1995, Pure-Bred and Non Pure-Bred No data 0 - < 5 5 - < 10 10 - < 20 20 - < 100 100 - < 1.000 1.000 - < 10.000 > 10.000 Legend: (number of animals)

20. January 2002 WHO/CSR/APH UK Exports of Bovine Offals (tonnes) 1978-1997

21. January 2002 WHO/CSR/APH UK exports of bovine carcass meat (tonnes) 1978-1998

22. Exports of Bovine Offals 1978 - 1997 No data 0 - < 5 5 - < 10 10 - < 20 20 - < 100 100 - < 1.000 1.000 - < 10.000 > 10.000 Legend: (in tonnes)

23. Bovine Offal and Meat Preparations 1980 - 1988 No data 0 - < 5 5 - < 10 10 - < 20 20 - < 100 100 - < 1.000 1.000 - < 10.000 > 10.000 Legend: (in tonnes)

24. Exports of Bovine Carcass Beef 1980 - 1988 No data 0 - < 5 5 - < 10 10 - < 20 20 - < 100 100 - < 1.000 1.000 - < 10.000 > 10.000 Legend: (in tonnes)

25. Exports of Bovine Carcass Meat 1978 - 1998 No data 0 - < 5 5 - < 10 10 - < 20 20 - < 100 100 - < 1.000 1.000 - < 10.000 > 10.000 Legend: (in tonnes)

26. January 2002 WHO/CSR/APH Limitations of C&E data  Does not include exports from other countries with BSE  Export and Import records may not tally  Re-packaging and onward sales obscure the origin of trade goods  Illegal or uncontrolled movements not reported  Doesn’t describe how the imports were used

27. January 2002 WHO/CSR/APH Geographic BSE Risk Assessment Scientific Steering Committee  EC review of the risk of BSE being present in a country  describes the risks of introduction of BSE and recycling  makes estimates of the risk levels of imported materials  requires information about internal risks

28. GBR Category n=46 Countries Source: EU-SSC Website, May 31 2001 No data Category I Category II Category III Category IV Legend:

29. January 2002 WHO/CSR/APH WHO Consultation on Public Health and Animal TSEs: Epidemiology, Risk and Research Requirements 1-3 December 1999 “Eradication of BSE must remain the principle public health objective of national and international animal health control authorities”

30. January 2002 WHO/CSR/APH WHO/FAO/OIE BSE: Public Health, Animal Health and Trade  Global Dimension of BSE  Problem areas South-East Asia Central and Eastern European countries (NIS) Mediterranean/North African, IF small ruminants are a problem

31. January 2002 WHO/CSR/APH Risk Assessments for BSE  Any potentially infected material imported?  Consider illegal importation  Consider imports from other EC countries  How was it used?  Did cattle have access to it?  Is there a rendering industry?  Export materials to other countries for rendering? Global Seeding of BSE

32. January 2002 WHO/CSR/APH WHO/FAO/OIE BSE: Public Health, Animal Health and Trade  Public Health - Exposure Assessment  called for pathway analysis  called for standardized international approach to identify whether food is safe to export or not

33. January 2002 WHO/CSR/APH Public Health Assessment  Risk from internal exposures  risk of BSE in cattle (see OIE Code)  risk that high risk materials are consumed by human populations

34. January 2002 WHO/CSR/APH Public Health Assessment  Risk from external exposures i.e. importation of high risk materials  SRMs, MRM  NOT HIGH RISK - milk and milk products, gelatin prepared from hides and skins; WHO - skeletal muscle meat  pharmaceuticals, biologicals, blood not fully evaluated

35. January 2002 WHO/CSR/APH WHO/FAO/OIE BSE: Public Health, Animal Health and Trade  Hazard Identification  brain, eyes (retina), trigeminal ganglia, spinal cord, DRG, distal ileum  removals depend upon risk level  animals subject to measures depend upon risk

36. January 2002 WHO/CSR/APH WHO/FAO/OIE BSE: Public Health, Animal Health and Trade  BSE in Cattle  requested OIE to secure more risk assessments  requested OIE to use methods like GBR to assess risk level i.e. risk based, not rate based

37. January 2002 WHO/CSR/APH Is BSE present in other countries?  We don’t know  The risk exists, is being evaluated  EC is conducting GBR assessments of countries requesting assessments  OIE will review voluntary applications to determine if countries are in compliance with the OIE Code on Animal Health to be considered BSE-free  Risk Assessments requested of all OIE member countries by International Committee of the OIE  Surveillance systems to be established

38. January 2002 WHO/CSR/APH WHO Activities for BSE and vCJD  Standard surveillance methods established  Human - WHO Manual on Surveillance; Euro/Neuro CJD  Animal - OIE and EC  Training in surveillance for human TSEs  Buenos Aires, Bangkok, Beijing, Bratislava, Cairo, Dakar  EC funded surveillance in NIS countries  WHO (human)TSE Collaborating Centres  BSE Risk Assessments  What is appropriate to do?

39. January 2002 WHO/CSR/APH WHO Ave Appia Ch-1211 Geneva 27 Switzerland How to find us….  For WHO Publications on TSEs http://www.who.int/emc/diseases/bse/ /meeting.htm  rickettsm@who.ch  Snail Mail

40. January 2002 WHO/CSR/APH WHO/FAO/OIE BSE: Public Health, Animal Health and Trade  Risk Management Strategies  commensurate with risk  audit compliance

41. January 2002 WHO/CSR/APH WHO/FAO/OIE BSE: Public Health, Animal Health and Trade  Risk Management / MBM  MBM of ruminant origin must not be fed to ruminants  Where MBM is fed to other species ensure no X-contamination if cannot, don’t use any MBM in ruminants and don’t trade

42. January 2002 WHO/CSR/APH WHO/FAO/OIE BSE: Public Health, Animal Health and Trade  Risk Management / MBM  international monitoring of feed bans  better QA of animal feed

43. January 2002 WHO/CSR/APH WHO/FAO/OIE BSE: Public Health, Animal Health and Trade  Risk Management / SRM  list unchanged  consideration of slaughter methods, X-contamination, difficulties in identification of tissues in slaughterhouse  SRM ban extent depends upon risk

44. January 2002 WHO/CSR/APH WHO/FAO/OIE BSE: Public Health, Animal Health and Trade  Animals with Confirmed or Suspected BSE  all suspects destroyed  clinically confirmed plus progeny of female cases destroyed  discussed herd slaughter

45. January 2002 WHO/CSR/APH WHO/FAO/OIE BSE: Public Health, Animal Health and Trade  Surveillance  commensurate with risk  include passive and active  Compliance  …or risk failure

46. January 2002 WHO/CSR/APH WHO/FAO/OIE BSE: Public Health, Animal Health and Trade  BSE in sheep  maybe a problem  improve surveillance of scrapie  OIE to complete draft chapter  where exposure to BSE has occurred, minimize exposure to humans

47. January 2002 WHO/CSR/APH WHO/FAO/OIE BSE: Public Health, Animal Health and Trade  Other Ruminants  Water buffalo, cervids, camelids and other domestic ruminants include in feed bans conduct risk assessment

48. January 2002 WHO/CSR/APH WHO/FAO/OIE BSE: Public Health, Animal Health and Trade  Other farmed animals  pigs and poultry no disease; no evidence for residual infectivity  ostriches disease may not be TSE  horses no neurological disease identified in UK

49. January 2002 WHO/CSR/APH WHO/FAO/OIE BSE: Public Health, Animal Health and Trade  Fur bearing mammals  do not recycle into food animals  Fish  research is ongoing

50. January 2002 WHO/CSR/APH WHO/FAO/OIE BSE: Public Health, Animal Health and Trade  Passage of infectivity  infectivity passes through gut  do not use digestive contents and faecal material from animals fed with MBM as a feed ingredient for animal feed