Electronic responses to:

EDITORIALS
Foot and mouth disease: the human consequences

Henry Prempeh, Robert Smith, and Berit Müller
BMJ 2001; 322: 565-566 [Full text]

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Re: Hoof And Mouth Is Not A Transmissable Disease

Email Daniel H Duffy Sr:
duffy@suite224.net

Certain Veterinary colleges and universities, under the auspices of The US Dept of Agriculture, conducted tests over 70 years ago that ruled out Hoof And Mouth as a transmissabled disease. Healthy, PROPERLY FED cows were allowed to mingle with diseased cows throughout the day where they would trample in the manure and urine of the diseased cows and otherwise comingle as cows do. In the evening the health cows were returned to their stalls, properly fed and watered and let out again the next day and so on until all concerned were convinced that Hoof and Mouth, like all other "epidemic" diseases of stock animals, are caused by improper feeds, not bacteria and viruses.

What prompted this response was the comment of one observer who stated that the "virus" of Hoof and Mouth could attach to a worker's clothing and stay "alive" for several days, being liable to transportation to other areas. Since when has the virus been thought to have "life"? These "clusters" are like all other "cluster". First of all , they are not "epidemics", they are "clusters", secondly, every one of them are the results of bad feed or environmental poisons and thirdly, none of them are "transmissable". Those responsible for this terrible oversight belong in jail, not in public service. These disease are no more transmissable than AIDS, a disease caused largely by 1. chemotherapy 2. recreational drugs 3. definition.

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Re: Paradox

Email Ron Law:
juderon@ihug.co.nz

The Food Standards Agency considers that foot and mouth disease has no implications for the human food chain.

The Food Standards Agency considers that mad cow disease does have implications for the human food chain.

The government mass slaughters all foot and mouth diseased animals and their direct contacts.

The government does NOT mass slaughter all mad cow diseased animals and their contacts.

Something's terribly wrong here. Clearly the disparity between the two is not related to public health so it must be some other factor.

Are commercial interests more important than public health?

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Re: Foot and Mouth Disease

Email Dr JK Anand:
anand@jogk.freeserve.co.uk

There are some unanswered questions. 1. It has been suggested that Man contracts the disease only rarely. It is true of clinical disease. Has anyone carried out a serological screen of exposed staff (veterinary, abbatoir and farm empoyees) to determine whether there is sub-clinical infection? It seems quite possible that sub- clinically infected humans are as capable of spreading the disease to animals as plumes of virus bearing wind wafted from the farms. 2. If scraps of uncooked or partially cooked (infected ) meat can spread the infection to pigs and other farm animals then it follows that gulls (which these days act as scavengers inshore forty miles and more) are a possible vehicle of infection. Unless someone has studied the issue it is impossible to exculpate the gulls. Has the MAFF any plans to deal with the gulls? 3. People obliged to go to infected premises are required to step through "disinfectant" solutions. One must ask the question: Who has established scientifically, the dilutions required to kill the virus? Who is advising on the correct dilutions to use?

Unless these three questions are answered satisfactorily, one must assume that the control measures are based only partly on science. JK Anand Retired public heath physician

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Re: Good information matters

Email Dr. Piet Vanthemsche:
pvanthemsche@glo.be

Thanks for the excellent article on FMD. It was concise, understandable and contained vital information for everyone who has to communicate on this dreadfull animal disease. I read the reactions and, as it is the case in Belgium, it seems very difficult to explain to the public why draconic measures are necessary, while there is minimal or no threat to human health.

I mailed the article to all my correspondents, in order to enable them to give objective and correct information. I have the impression that the emotion often interferes with objective information.

I also want to express my deep sympathy and compassion to all those in the UK who are subject to the consequences of the current epidemia. I hope your efforts will prove succesfull and that you will get rid of the disease as soon as possible.

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Re: Greek outbreak in 2000

Email Victor Briones:
vbriones@eucmax.sim.ucm.es

Dear friends:

If I am not wrong, the last outbreak of FMD in Greece took place in the summer of 2000, but it was succesfully controlled.

Best regards, excellent article.

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Re: Sub-clinical infection

Email Dr. Christopher Rollinson:
Chrisr@phase1ctu.com

Following on from Dr. Anand's response of the 10th March, have public health officials screened any of the general population during this current outbreak to check if any of the population are carrying the foot and mouth sub-clinically? From personal observations here in the South West there seems to have been an increase in incidence of people reporting ill with high fevers this is normally assumed to be Flu, could this in fact be be a manifestation of foot and mouth in humans? I also note that the type O strain of the virus is the most likely source of infection in man.

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Re: Foot and mouth disease - human consequences

Email Hugh G. Morton:
hugh.morton@virgin.net

EDITOR - Your editorial 'Foot and mouth disease: the human consequences'1 deals with the crisis in agriculture as it affects animals and animal husbandry; reference is made to the rare transmission of the disease to humans. It would have been at least compassionate for the authors to have mentioned the grave consequences to the people of the farming and rural communities - at best, major stress and anxiety states; at worst, suicide and its consequences for families. Are these not 'human consequences', and indeed public health matters?

Hugh G. Morton, retired psychiatrist
Gauldry, Newport-on-Tay, Fife
hugh.morton@virgin.net

1 Prempeh H, Smith R, Muller B. Foot and mouth disease: the human consequences (Ed.) BMJ 2001; 322: 565-6 (10 March)

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Re: Re: Hoof And Mouth Is Not A Transmissable Disease

Email John P. Heptonstall:
john@mac-tcm.demon.co.uk

Editor

Dr. Duffy states that Foot & Mouth (Hoof and Mouth) Disease (FMD)is not a transmissible disease; he mentions research in the USA said to have proved this, his statement appears to have been ignored by respondents sufficiently aroused about the issue to comment, yet apparently not enough to question the validity of Dr Duffy's information, why? He says that FMD is caused by improper feeds, not bacteria and viruses, which reminds one of the BSE scandal. Surely respondents must question this heresy?

If government is right, Dr. Duffy is wrong.

If government is wrong it condones, through ill-conceived and unscientific evidence, the mass slaughter of hundreds of thousands of healthy, and recovering, animals; they are destroying countless businesses, lives, aspirations, dedication and hard work with their current policies.

If Dr Duffy is right, his words amplify those of Abigail Wood, vet and researcher from the University of Macnchester, of whom I read today. According to the author, Abigail believes (rather like another eminent observer, Jonathan Miller) that FMD is little more than an animal 'cold'. Animals recover in a week or two, death occurs in about 5% of cases, the meat is fit to eat. For much of the 19th Century FMD was common across the UK, endemic, it did not destroy farming. Wood says "The instant destruction policy was implemented in the 1950s by the UK governing bodies as a result of growing pressure over the years from pedigree herd owners who wished to see FMD eradicated". Eventually the rest of Europe followed this practice. We live with the results. "In today's intensive farming climate, production and global reputation is everything; along with a desire for the perfect pedigree, a disease-free herd. The UK continues to insist on an 'unfounded' belief that FMD is highly infectious and is to be eradicated at all costs". This rings of animal eugenics, and as one broadsheet journalist wrote yesterday, an animal 'holocaust'.

Why does the government not leave the animals alone to withstand their 'cold', and recover with full immunity?

Why do farmers accept government policy without question, allowing so many of their colleagues to go to the wall along with myriad healthy animals?

Are there no farmers who would contest, as Dr. Duffy and Abigail Wood, that mass slaughter is unnecessary and unscientific - perhaps even a bankrupt response to the situation initiated by corrupted MAFF policies? Do no farmers contest the MAFF stance on transmissibility of FMD?

Can MAFF professionals identify a FMD virus? According to the author the ELISA test is used, it cannot identify a FMD virus, such a virus has never been identified; if this is so then what exactly does this test identify? It is said by government that a vaccine is available, and that such a vaccine caused the last FMD outbreak in 1981; if no virus has been isolated, how was an 'attenuated virus' vaccine produced? What virus is being pictured in the media in articles on FMD if no such virus has ever been proven to exist?

Farmers are saying that their industry is being devastated by this disease - is it really the disease that is so devastating, or their inability to control political and commercial temptation that is devoid of concern for animals' or farmers' welfare?

Perhaps an excerpt from a 1920 Cheshire newspaper responding to the FMD 1920 outbreak echoes events admirably "Ministry teams were so far behind in their slaughtering that on many farms the cows had recovered before the slaughterers had arrived. Farmers looked at their now-normal cows in belwilderment and asked "Was that it? Was that trivial illness what all the fuss was about?".

Regards

John H.

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Re: Foot and Mouth Editorial

Email Dr JK Anand:
anand@jogk.freeserve.co.uk

The editorial by Prempeh et al prompted me to ask three questions (see Rapid Responses 10 March). With several thousand dead animals lying around, a reservoir of immuno-deficient human population, and disinfectant dabbing of footwear, I would have thought that the experts would have hastened to reply (if the answers are known to them). In the absence of any reply, one might be forgiven for assuming that "evidence-based medicine" has no place in the management of the current outbreak.

Perhaps the CDSC, MAFF and the Medical Officers For Environental Health would consider this point.

JK Anand

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Re: Method of prinary screening

Email DR. KEREN GERSHON & DR. ROMANO AMALIA:
GKEREN@LEUMIT.CO.IL

Dear editor,

We developed recently a simple, effective, non-invasive Lab.procedure, to perform a primary screening of hundreds and thousands of animals within a very short period of time ( hours ) to diagnose an acute viral disease in infected animals even before the appearance of clinical symptoms.By this method we can monitor the epidemiology , early detection and the severity of the disease as well as to evalute the efficacy of post -vaccinations effect if necessary.

This quick method for early identification can assist the decision-makers as whether to isolate part of the non-infected animals, or to immunise them after isolation.
(1) Early identification- before clinical symptoms appear ( results can be read within few hours )
(2) A non-invasive method- sampling saliva and other mucous areas of the animal
(3)The method is done in the field, without the need for expensive laboratory environment
(4) A non-contagious procedure
( The patent is registered in Europe )

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Re: Re: Method of prinary screening

Email John P Heptonstall:
john@mac-tcm.demon.co.uk

Editor

I read recently that a FMD virus has never been isolated. If this is true what is the basis of the FMD test Drs Gershon and Amalia have devised? Can any other diseases confer a positive status on the test, or is it specific to FMD?

Kind regards

John H.

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Re: Foot-and-mouth disease in humans: troubling case report

Email Dr.Thomas Pringle:
tom@cyber-dyne.com

Foot-and-mouth disease in humans: troubling case report
Monday March 26 By Richard Woodman Reuters Health

"Although rare, foot-and-mouth disease can infect humans, according to an old copy of the British Medical Journal that records how a 35-year-old man caught foot-and-mouth disease in 1966. The journal report was dug out of the archives on Monday as the current animal epidemic continued to spread remorselessly across the countryside. [Armstrong R et al. Foot-and-mouth disease in man. BMJ 1967; 4: 529-530]

...No cases of human infection have been reported, but the BMJ case shows the possibility cannot be ruled out. The report says the patient became ill in July 1966--six days after an outbreak of foot-and-mouth developed on the farm where he lived with his brother in Northumberland.

The man--now known to have been Mr. Bobby Brewis--watched but took no part in the slaughter of the farm's animals on 24 July 1966. However one of the affected animals was a cow that supplied milk used in the farmhouse.

``On 28th July he complained of a sore throat, which became worse on the 29th. On the 30th he had a temperature of 99 F (37.2 C), an inflamed throat, and a few blisters on the palms and dorsa of both hands.

``On 31st July his temperature was normal but the blisters on his hands had increased in number. There were two further blisters between his toes and five or six wheals on the side and front of his tongue.

``The patient described his lesions as uncomfortable and tingling, while the tongue was hot, tingling and sore.'' The blisters disappeared after several weeks only for a fresh set to develop a week later, and again after five months.

Mr. Brewis's daughter, Amanda, told The Times of London on Monday that her father's illness had mystified the medical profession. ``He always knew he was a quirk of British medical history. In a way he was proud of it. He was a bit of a teaser and a prankster. He used to joke about how he must really be an animal.'' Mr. Brewis, who died six years ago, was living at his farm in the hamlet of Yetlington on the edge of the Cheviot Hills during the 1966 outbreak.The Department of Health made no immediate comment on the rare case."

Then there was this report:

Foot- and-mouth disease as zoonosis.
Arch Virol Suppl 1997;13:95-7 by Bauer K

"Man's susceptibility to the virus of foot- and-mouth disease (FMD) was debated for many years. Today the virus has been isolated and typed (type O, followed by type C and rarely A) in more than 40 human cases. So no doubt remains that FMD is a zoonosis. Considering the high incidence of the disease (in animals) in the past and in some areas up to date, occurrence in man is quite rare.

In the past when FMD was endemic in Central Europe many cases of diseases in man showing vesicles in the mouth or on the hands and feet were called FMD."

Comment: On the one hand, this is a huge improvement over the dozens of press accounts that have stated point-blank that humans cannot get foot-and-mouth disease. And yet the symptoms do not sound all that mild as the current BMJ account would give them. One wonders if there would not be serious problems in a large population that would contain many people with compromised immune systems. As with BSE, is the answer to bury the problem under a stack of misinformation and hollow reassurances?

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Re: Wider health implications

Email Gillian Gibson:
Gillian.gibson@exchange.wirral-ha.nwest.nhs.uk

The article on the implications of foot and mouth on human health has considered only the disease itself.

Whereas some of your respondents have made reference to mental health effects as a result of the outbreak, I see no mention of the wider implications for health resulting from the method of control of the disease. Cumbria appears to be sitting under a pall of smoke; have the local hospitals reported an increased intake of respiratory illnesses which coincide with the appearance of 'animal bonfires'? Will they monitor for this possibility?

It is worth remembering that the burning of straw and stubble has been illegal for some years, yet this is the very fuel being utilised to maintain the burning of the carcases.

There are guidelines for the widespread use of disinfectant to help prevent the spread of the disease; given the quantities involved, what human health implications are there from absorbtion or inhalation of the products in use?

It is likely that there will be an environmental cost to watercourses from the disinfectant as it reaches the waterways from run-off. Will there be extra surveillance of human health for the possibility of ill -health resulting from contaminated water?

Foot and mouth may not have an effect upon human health. The way in which we deal with it certainly will.

Gillian Gibson

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Re: Hazards to human health from carcass disposal

Email Dr Nigel Calvert:
nigel.calvert@nchs.nhs.uk

Dear Sir,

The editorial by Prempeh et al was interesting, and a useful summary of the zoonotic potential of Foot and Mouth Disease. However, I feel that it missed the point that the main hazards to the public health are likely to be from carcass disposal, and the various ways in which this may be done.

Rendering is the preferred option, since the environmental impact - and hence the threat to the public health - is minimal. Unfortunately there is limited rendering capacity in the UK and most carcasses will not be disposed of in this way.

Burial is a safe option, provided that care is taken to avoid water courses and water supplies. As CCDC, my concern is the numerous private water supplies in North Cumbria supplies may become contaminated with the products of decomposition in the coming months and years. However, the Environment Agency reassures us that no burials are putting water supplies at risk. The issue of prions in carcasses has, until now, prevented any cattle being buried, although we understand today, that the government may be allowing younger cattle to be buried and that risk assessments have been favourable. If so, this is welcome since it will reduce the number of carcasses to be burned.

Incineration is the only option for most older cattle. Pyres dotted across the countryside are a distressing sight for the public, and cause nuisance, smell, hazards to traffic and - potentially - risks to the human health. The main risk is likely to be smoke causing breathing difficulties in people with respiratory disease, and we have issued advice to the public through the local media and to health professionals ny means of bulletins. North Cumbria Communicable Disease Control website ( www.ncbugs.com) has also been used as a way of distributing information.

A number of other potential hazards exist from pyres - dioxins from burning organic material, polyaromatic hydrocarbons from burning creosote -treated wooden sleepers and the potential spread of prions from cattle that may have been incubating BSE. We understand that risk assessments have been done for many of these potential hazards, but the Authority has not seen copies.

MAFF have been coordinating the response to Foot and Mouth here in North Cumbria. The Health Authority has been only peripherally involved, and this is making our task of advising the public about implications for their health difficult. Perhaps one of the lessons to be learnt is that local public health medicine departments should be more closely involved in the decision making about preferred methods of disposal.

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Re: Re: Foot and mouth disease - human consequences

Email Shamsudeen Fagbo:
oloungbo@yahoo.com

I agree with Hugh Morton's comments.It seems the editorial focused on the aspect of physical dis-ease FMD may cause.

What is known is that mental health,which will undoubtedly affect the affected farmers,their communities and those involved in managing the crisis,is a fundamental part of human health.There's always the need to look as public health issues using an integrated,multidisciplinary approach.

Are there studies that have been conducted after earlier outbreaks curbed by massive culling monitoring the mental health of the affected populace and relating it with the outbreak?Are there plans for one during this present one?

Such studies may give a fuller picture of the costs and cost benefits of the slaughter policy currently being pursued.

Shamsudeen Fagbo,veterinarian Jeddah ,Saudi Arabia oloungbo@yahoo.com

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Re: Re: Re: Hoof And Mouth Is Not A Transmissable Disease

Email Dr Keith Sumption:
keiths@vet.ed.ac.uk

Dear Sir, the response by the farming unions in the United Kingdom to the prospect of selective vaccination of cattle against foot-and-mouth has been to raise the issue of consumer confidence in the livestock products from vaccinated animals despite the fact that the vaccine is killed, and at least 22 other vaccines are used in livestock without public anxiety. In contrast there has been no health scare associated with the risk, albeit apparently small, to man. It is recognised that man can be infected transiently or with replication of virus and clinical disease, by exposure to FMD virus. The excretion of large concentrations of virus in milk for up to 4 days prior to development of clinical signs, and the frequent finding that cattle within a herd are are infected almost simultaneously by the airborne route accounts for the frequent transmission (in the past) by infected milk of the infection to pigs fed on milk products. It can be assumed in the current UK and Netherlands situation that humans will have consumed infected milk, since milk will be sold into the food chain until a farm is served with a notice to prevent this when infection is suspected. Pastuerisation will deal with the majority of the infection, but heat resistant populations of virus are recognised. Hyslop in 1976 (Bull.Wrld.Hlth Org, 49, 577-585)warned that "physicians and others who encounter suspicious human lesions during an outbreak of FMD in alocaity should be aware of the possibility fo human infection and consequently take whatever precuations necessary to isolate the patient pending confirmation of the condition". So when health scares are encouraged over FMD vaccination, where there is no history of a threat to health, the medical profession should compare these to the known risks human infection from the virus. Further, since serum antibodies prevent generalisation of infection (blocking viraemia, preventing spread from throat to other parts including the mammary gland), vaccination reduces the risk of infected milk entering the food chain. I would have thought physicians in affected parts of the UK would therefore support vaccination against FMD as a tool in epidemic control.