Module: 5 Vesicular Diseases Revision: July 2015 “≛” indicates an animation or hyperlink on the slide

S L I D E 1

Welcome to Module 5: Vesicular Diseases. This module was developed as supplemental training for the USDA-APHIS National Veterinary Accreditation Program (NVAP) by the Center for Food Security and Public Health at the College of Veterinary Medicine, Iowa State University. The content for this module was finalized in May 2014 and revisions were completed in July 2015. Presenters: As designed, slide completion time ranges from 30 to 90 seconds each, such that the entire presentation can be completed in 55 minutes. For this topic, there are two handouts that will be referred to during this presentation. Both can be found available in the corresponding web module and print manual. You may want to print out a hard copies and have them with you for demonstration purposes during the presentation. While going through these PowerPoint slides please note that you may see “Animation” and “Hyperlink” noted. This indicated that a slide has either an animation of a hyperlink in it. In order to see exactly how the animation is set-up please view the PowerPoint in the slide show viewing mode.

S L I D E 2

≛

Hyperlinks Presenters: Please select which method you will be using for further sign in instructions. Example: If you are using a tablet or ipad click “electronic”. If you are using the paper sign-in method please click on the work “paper”

S L I D E 3

We will be using a tablet to sign in today. There will not be a paper sign in page. You must sign in at the beginning of every session. For example if you attend 3 module sessions you must sign in at the start of each session for a total of 3 times.

S L I D E 4

• Tap in the first name field (with finger or stylus) • Keypad appears • Enter information • Go to the next field, tap and fill in. • Continue with this until all fields are completed • Birthdate MM/DD/YYYY format • Example 03/09/1987 not just 3/9/87- be certain to fill in a 4 digit birth

year (1987 not 87)

S L I D E 5

• If data not entered exactly like it is in the NVAP system, “No Match Found” will displace

• Try again but not more than 2 times • If you have exceeded the 2 times and cannot get your information

entered, please pass the iPad and see instructor after session to receive credit.

• Certain reasons their name is not displayed include: Their name is not entered correctly - James vs Jim, MCDonald vs Mcdonald vs Mc Donald etc.

S L I D E 6

This slide will be skipped it using electronic sign-in • Print clearly on the sign-in sheets. • It is critical that we have your current email address for your

accreditation renewal. • If you do not know your 6 digit National Accreditation Number, please

see me at the conclusion of the presentation. • You will receive a Certificate of Completion during the presentation. • Keep your Certificate of Completion forever-do not send it to APHIS.

S L I D E 7

≛

Animation Presenters: Please make sure your audience understands the intent of this information by reading what is written here. This informational presentation is intended to familiarize accredited veterinarians with animal health regulatory concepts and activities. Information presented here does not supersede the regulations. For the most up-to-date regulations and standards, please refer to the Code of Federal Regulations and your local Assistant District Director.

S L I D E 8

This presentation will: • Describe the economic impact of vesicular disease outbreaks, • List the four vesicular diseases of importance in the United States, • Demonstrate the clinical signs associated with each vesicular disease, • Review biosecurity measures specific for vesicular diseases, and • Describe how to report a possible vesicular disease case.

S L I D E 9

Vesicular disease is a general term referring to diseases that cause blisters on various body parts of livestock and, in some cases, humans. Included in this category are foot-and-mouth disease (FMD); vesicular stomatitis (VS) of which serotype New Jersey (NJ) and subtype Indiana 1 (IN-1) is the only vesicular disease currently found in the United States; swine vesicular disease (SVD); and vesicular exanthema of swine (VES). Vesicular stomatitis virus is already present in the U.S. However, introduction of the other vesicular diseases (including the other subtypes of VS) would be disastrous to the U.S. livestock industry and the economy in general.

S L I D E

10

≛

Let’s discuss some of those economic impacts. Directly, vesicular disease impacts the productivity of livestock and leads to extensive economic losses to farmers through decreased weight gains, decreased milk production, abortions, and increased mortality in young calves and pigs. Animation The direct costs incurred during the process of eradicating the disease would cost the producer and the government millions of dollars in the event of a small, controlled outbreak with only regionalized exports banned. In a larger outbreak, this figure could reach into the billions of dollars. The expenses arise from examining and diagnosing cases; depopulating and disposing of animals; paying producers for depopulated animals (indemnity); cleaning and disinfecting affected premises; and continued surveillance.

S L I D E

11

≛

The indirect economic effects of FMD come into play when countries around the world close their doors to our exports of beef, pork, mutton, dairy products, and live animals. Based on export data from 2009, the U.S. could lose $3.08 billion in beef exports, $4.3 billion in pork exports, and $27 million in lamb exports (U.S. Meat Export Federation). In a 2002 revenue impact analysis of a potential FMD outbreak in the U.S., it was estimated that $6.8 billion would be lost in farm income and livestock exports would drop $6.6 billion (Paarlberg et al., JAVMA, 2002). Exports and the animal agriculture economy have grown obviously grown since 2002 and the repercussions could be much higher now. Animation Additionally there are indirect social effects. Even though FMD is not a risk to humans, consumption of meat and dairy products could be reduced because of consumer fears. If consumer purchases decrease by 10%, annual farm income would drop $14 billion and with a 20% fall in purchases farm income would decrease $20.8 billion (Paarlberg et al., JAVMA, 2002). Finally, the emotional impact on producers, veterinarians, and the general public could be quite devastating. The destruction of livestock can evoke strong emotions in their owners and the veterinarians charged with disposal. The public in the area may find some of the depopulation and disposal procedures disturbing. The mental health and psychosocial impact needs to be considered and prepared for in the event of a devastating FMD outbreak.

S L I D E

12

≛

Animation Fortunately, there has not been a case of FMD in the United States since 1929. Looking at FMD-caused economic losses from other countries, we can get a feel for how overwhelming and far reaching this disease could be. Animation The 1951 outbreak in Canada cost approximately $710 million plus one year’s loss of livestock and livestock product trade (Sellers RF, Daggupaty SM, Canadian Journal of Veterinary Research, 1990). Animation A 1997 outbreak of FMD in Taiwan cost the country roughly $378.6 million (Yang P.C. et al, Veterinary Record, 1999). Animation Total cost of the 2001 FMD epidemic in Uruguay was approximately $243.6 million (Sutmoller, P. et al., Virus Research 2003; Sutmoller, P. and Casas Olascoaga, R. Presentation at Evidence for the Temporary Committee on Foot-and-Mouth Disease of the European Parliament, 2002). Approximately $6.1 million was paid in compensation to farmers and for cleaning/disinfection and operating expenses. This FMD outbreak resulted in the slaughter of less than 7,000 animals with 28.5 million doses of vaccine used to help control the spread. Photo by T Wilson DVM, 1997 Taiwan FMD Outbreak carcass disposal

S L I D E

13

≛

In contrast, total estimates of economic losses from the 2001 United Kingdom FMD outbreak were approximately $4.7 billion (Thompson, D. et al., Rev Sci Tech OIE 2002). Indemnities paid to farmers for slaughtered livestock were estimated at around $1.7 billion. More than 4 million animals were slaughtered to control this disease and an additional 2.5 million were slaughtered under the Livestock Welfare Disposal Scheme. The true costs may never be known. It is thought that, despite economic estimations, the cost of an FMD outbreak in the U.S. could far exceed preliminary calculations. Animation The agricultural industry is a large sector of the U.S. economy, but there are other industries that will be indirectly affected if an FMD outbreak were to occur. In the U.K., for example, the tourism industry suffered great losses because people were restricted in where they could go and what they could do. Tourism in 2001 there lost between $4.1 and $4.8 billion. Sporting and fund-raising events were canceled, national elections were postponed, and people generally stayed home. It was estimated that sports-related sales and activities alone lost $1.3 billion in the United Kingdom. Photos: by Fred Bourgeios DVM, 2001 UK FMD Outbreak (left), from T. Wilson DVM, 2001 UK FMD Outbreak (Right)

S L I D E

14

≛

Here is a reminder of the vesicular diseases. The next section contains descriptions and pictures of common lesions for these diseases. Importantly, these diseases are CLINICALLY INDISTINGUISHABLE (Animation) from each and can only be differentiated through diagnostic tests. All vesicular diseases produce vesicles that progress to erosions in the mouth, nares, muzzle, teats, and feet. The species each disease affects and the severity of the lesions does differ.

S L I D E

15

FMD Etiology—Foot-and-mouth disease virus in the family Picornaviridae and genus Aphthovirus. Distribution—FMD is Endemic in Asia, Africa, the Middle East, and parts of South America. The United States has been free of FMD since 1929. Presenters: For more information about FMD, please review the FMD Factsheet available from the Center for Food Security and Public Health (CFSPH) Foot-and-mouth disease (FMD) species affected include cattle, pigs, sheep, goats, and cloven-hooved wild and domestic animals (horses are NOT affected). Morbidity is 100 percent. Mortality is less than 1 percent, but more severe in young animals. Graphic: Species affected by foot-and-mouth disease. Illustration by: Clint May, Iowa State University

S L I D E

16

Vesicular stomatitis virus is caused by a virus belonging to the family Rhabdoviridae and genus Vesiculovirus. Distribution—VS can be found in North and Central America, and the northern part of South America. US Status - Seasonal epizootics Species Affected - horses, mules, donkeys, cattle, sheep, and goats. Cervidae have only been affected experimentally. This is denoted by the light brown in the graphic to differentiate from those animals in dark brown. Morbidity - varies, but is up to 90% while mortality is low. Graphic: Species affected by vesicular stomatitis. Illustration by: Clint May, Iowa State University Presenters: For more information about Vesicular Stomatitis, please review the VS Factsheet available from the Center for Food Security and Public Health.

S L I D E

17

Another vesicular disease is swine vesicular disease. Etiology—Swine vesicular disease virus is a member of the family Picornaviridae and genus Enterovirus. Distribution—The virus is found throughout many European countries. Swine vesicular disease (SVD) only affects pigs. Clinical signs are severe in animals housed on concrete, including lameness, salivation, and neurological signs. Younger animals more severely affected. Morbidity is low; lesions are less severe than in other vesicular diseases. Mortality is generally not a concern. Graphic: Pigs are the only species affected by swine vesicular disease. Illustration by: Clint May, Iowa State University Presenters: For more information about Swine Vesicular Disease, please review the SVD Factsheet available from the Center for Food Security and Public Health.

S L I D E

18

The last vesicular disease we will review is vesicular exanthema of swine (VES). Etiology—Vesicular exanthema of swine virus is a member of the family Calicivirus and genus Vesivirus. Distribution—The virus has only been found in the United States, but was eradicated in 1956. Pigs are the only species affected by vesicular exanthema. Clinical signs include deep lesions with granulation tissue formation on the feet. Mortality varies and can reach 100 percent. Mortality is generally low. Graphic: Pigs are the only species affected by vesicular exanthema of swine. Illustration by: Clint May, Iowa State University Presenters: For more information about Vesicular Exanthema of Swine, please review the VS Factsheet available from the University of Georgia.

S L I D E

19

S L I D E

20

Here are some pictures of clinical of vesicular disease in cattle: A. Ulceration of dental pad B. Coalescing, ruptured vesicles and erosions on the tongue C. Excessive salivation D. Unruptured vesicles on the tongue (arrows point to two different lesions)

S L I D E

21

Here are some other clinical signs of vesicular disease in cows: E. Ruptured vesicles on the rumen pillars F. Unruptured vesicles on the teat (arrows) G. Hoof lesions in the interdigital space H. Gray streaking in the myocardium due to degeneration and necrosis (also known as "tiger heart" lesions)

S L I D E

22

Here are some vesicular lesions in sheep A. Erosions of dental pad B. Uncomfortable, camped-under stance in this ewe as she tries to reduce

the weight distribution on her limbs which have coronary band lesions (pictured in C)

C. Lesions on the coronary band

S L I D E

23

A. Unruptured vesicles on snout B. Ruptured vesicle on top of snout C. Single vesicle on the tongue D. Erosions of the heel leading to sloughing of the horns of the digits. E. Vesicle lesions on the sole.

S L I D E

24

Clinical signs of vesicular stomatitis in horses include: A. Erosion and ulceration of the tongue B. Ruptured vesicle around the nostrils (arrow points at the medial edge

on the lower nares) C. Extensive erosion of the top lip around nostrils. D. Erosions along the coronary band of the hoof E. Ulcerative lesions of the ear

S L I D E

25

Here is a review table of the species affected by the vesicular diseases. Pigs are the only species to be effected by all 4 vesicular diseases and horses are only affected by Vesicular stomatitis. Remember that based solely on clinical signs, all four of these diseases are indistinguishable.

S L I D E

26

Vesicular diseases are easily spread and people can serve as fomites, improper protocols can disseminate the diseases to other animals and/or properties. You will never know when you may come across a vesicular disease in the field; proper biosecurity, cleaning, and disinfection are of the utmost importance at every farm visit. Remember, the second you suspect a vesicular disease you must contact your Assistant District Director (ADD) and State Animal Health Officer (SAHO) immediately. Since you can severe as a fomite and spread the disease and you may not suspect a vesicular disease initially, biosecurity protocols must be followed at each farm visit. The recommended protocol is outlined on the next slides. Review what to do prior to, during, and at the end of a farm visit.

S L I D E

27

When going to a livestock operation where your client reports drooling or lame animals, complete these general biosecurity preparations upon arrival at the farm: 1. Roll up your vehicle window. 2. Put on clean coveralls and boots. 3. Prepare water and disinfectant. 4. Wash your boots 5. Be certain to wear gloves Graphic: A veterinarian prepared to investigate a suspected vesicular disease. Illustration by: Clint May, Iowa State University

S L I D E

28

When you suspect vesicular disease outbreak on a livestock operation, it is important that you notify the authorities immediately. Do not take samples and do not leave the farm. Contact your local ADD and SAHO. They will provide further instructions. Due to your exposure, remain on the suspect farm until the authorities arrive or advise you otherwise. Notify your own veterinary clinic of the pending situation, even before making a final diagnosis. This is also important because neighboring farms may need to be quarantined, and your colleagues at the clinic may be involved. You may be asked to stay on the farm and help carry out specific disinfection protocols based on recommendations of the Foreign Animal Disease Diagnostician (FADD) and the ADD.

S L I D E

29

≛

Diagnosis of the specific vesicular disease requires laboratory testing at the USDA National Veterinary Services Laboratories (NVSL). NVSL is composed of 4 testing laboratories, three of which are located in Ames, Iowa. The fourth laboratory is the Foreign Animal Disease Diagnostic Laboratory which is located on Plum Island, New York. In general, the ADD authorizes submissions of United States-origin samples to the NVSL. All vesicular disease (except from horses) and all other highly contagious disease samples are sent to Plum Island, NY. The sample submission will be done by an official Foreign Animal Disease Diagnostician (FADD). More than likely this will not be you (Animation).

S L I D E

30

The next few slides will outline a hypothetical scenario to emphasize the important topics of identifying and reporting a suspected vesicular disease case. Remember the second you suspect a vesicular disease your ADD and SAHO must be contacted. Once you suspect a vesicular disease you will not take samples and you will follow all directions put forth by your ADD.

S L I D E

31

In this scenario, you are a veterinarian in a mixed-animal practice. You receive a call from one of your purebred swine clients regarding some lame pigs. The site manager informs you that some of the pigs in the grower barn are lame and off feed. Management has not purchased any animals recently. You were planning on bleeding pigs for swine influenza in a few days, but due to the high volume of animals that the farm ships each week, you decide to do a walk-through today. Graphic: Purebred swine facilities. Illustration by: Travis Engelhaupt, Iowa State University

S L I D E

32

During this initial phone call you collect some additional history from the grower-barn manager. The grower pigs are the most affected no sows or other pigs. The pigs in the grower barn were moved in last week. Between groups, they used the hot water power washer and a bleach solution. The barn dried and sat empty for 2 days before moving these pigs in. No animals in grower group have died. However, they have euthanized some nursery pigs that were not eating.

S L I D E

33

More case history…The grower barn manager also stated that there have not been any management changes lately. They have been using the same feed and vaccinations as always. The only difference is that they were 2 weeks late getting the grower pigs vaccinated because two of their employees were traveling internationally and were delayed getting back after spending a holiday in their home country. There is lameness in the growers. The lame animals also have a fever ranging from 103oF to 106oF. The pigs are fed a medicated feed with 100 g/ton of chlortetracycline in the feed, but no water medications or individual treatments have been given in this group yet.

S L I D E

34

You arrive at the operation and stop by the office to meet with the manager. The manager informs you that they had to put down three more piglets from the nursery since he talked with you this morning. Initially he thought that only the growers were affected, but he is now wondering if the nursery barn might also be affected. Besides the grower and the nursery pigs, all other pigs appear fine. The biosecurity protocols at this farm will not allow you to drive your vehicle from one barn to another, so you collect all the necessary supplies and proceed to the barns. Graphic: A veterinarian's truck with the box open to show supplies. Illustration by: Travis Engelhaupt, Iowa State University

S L I D E

35

≛

Animation Before walking through the barns, it is important to establish a proper sequence when looking at different groups of animals in order to minimize the chances of spreading disease within the farm.

• Start with the healthiest and/or youngest (most susceptible) animals • Proceed to older, more exposed animals • Examine sick or suspect animals last

Audience Participation with Animations: • Q: In this example which group would you start with? Remember the

youngest, most susceptible animals should be first. A: Farrowing Animation

• Q: Which group would you end with? Remember these should be the sickest. A: Growers Animation

• Q: From here, which other group had evidence of illness? This should be your second to last group. A: Nursery (remember there were euthanasia's in this group) Animation

• The next two groups should be sorted out by exposure risk. The gestating barn would be more susceptible to disease than the Finishing barn. Animation

• In this scenario the proper investigation sequence would be Farrowing Gestating Finishing Nursery Growers Animation

S L I D E

36

• The second you suspect a vesicular disease in the grower pigs, you must contact the ADD and SAHO. If you suspected a vesicular disease before arriving on the farm it is okay to contact your ADD prior to your visit. Remember once you visit the farm you will likely be quarantined on the farm for a period of time and be banned from visiting other farms. Therefore it may be in your best interest to contact your ADD prior to your visit based on your suspicions.

• Once your ADD is contacted, be prepared to explain the history and clinical signs observed and provide directions to the farm for additional investigation. You may be advised to remain on the farm until they arrive or follow strict biosecurity exit steps and go directly home without any animal contact. You should also contact your veterinary clinic as you cannot visit any other farms due to your potential exposure.

S L I D E

37

Final diagnosis of the samples collected at the farm resulted in the first FMD outbreak in the United States since 1929. After additional history collection, it was discovered that one of farm’s international employees had brought some hand-cured meats from home; a country that has endemic FMD in pigs. As he prepared to vaccinate animals after lunch one day, he dropped the last bite of his sandwich in a pen of grower animals. They ate it up faster than he could retrieve it, and he thought nothing of it at the time. The virus was suspected to be in the meat, and pigs can become infected 1 to 3 days after ingestion.

S L I D E

38

Once a diagnosis is confirmed, various follow-up procedures need to occur quite rapidly. Listed below are some things that need to be done regarding the farm’s international production facility and other operations in the area. Producer Education—The farm owners/managers need to understand the implications of an FMD outbreak. You now have the tools to provide them with technical disease information and to explain the economic implications of this disease. Neighboring Properties—Due to the highly contagious nature of FMD, managers at neighboring properties with susceptible animals will need to be notified by the State or Federal animal health authorities. Quarantine—Animals on this premises have been diagnosed with FMD, but the SAHO could have implemented a quarantine before or after a definitive diagnosis. Animals on neighboring farms will also be quarantined. Restricted-Movement Orders—Due to the highly contagious nature of FMD and the high consequences of trade embargoes, State or Federal authorities will implement a restricted-movement order. No animals should be moved off farm, area livestock markets may be shut down, milk shipments may cease, and all but authorized movements into and out of the area around the infected premises may halt temporarily. Graphic: The farm’s property under a quarantine due to the diagnosis of FMD in the UK in 2001. Photo: Drs. T. Wilson and F. Bourgeios

S L I D E

39

≛

In summary, now that we have completed this presentation, you should • Have a better understanding of the economic importance of vesicular

diseases • Be able to recognize clinical signs of the various vesicular diseases

Animation • Realize the importance of biosecurity, cleaning, and disinfection

protocols to prevent disease spread Animation • Know how to report a suspicious vesicular disease Animation

S L I D E

40

Presenters: Make sure your audience members know about obtaining credit for their attendance. This informational presentation has been approved expressly to serve as one unit of supplemental training for participants in USDA's National Veterinary Accreditation Program. Please ensure you complete, sign and retain a certificate stating that you attended this presentation. Contact your ADD for more details on renewing your accreditation.

S L I D E

41

• This presentation is based on content developed by the Center for Food Security and Public Health, which can be found in the web and PDF versions of this module. The illustrations in this presentation were designed by Travis Engelhaupt, Katlyn Harvey, Andrew Kingsbury, and Clint May. The content was reviewed within USDA-APHIS-VS by Kelsie Speiser, MS; David Pyburn, DVM; Larry Miller, DVM; Ming Deng, DVM, MS, PhD; Todd Behre, DVM, PMP; Clement Dussault, VMD; Timothy Cordes, DVM; Jamie Snow, DVM, MPH; and Teresa Drotar, DVM.

• The content was also reviewed by Corrie Brown, DVM, PhD from the College of Veterinary Medicine at the University of Georgia – Athens.

• The content has been reviewed and approved by USDA-APHIS Legislative and Public Affairs.

S L I D E

42

Thank you for your time. I would be glad to answer any questions as time allows. The NVAP website can be found by typing “NVAP” into your search engine.

S L I D E

43

These numbers are available on the NVAP website. We recommend you copy these numbers and put them on your phone for quick reference. Offer to answer any questions while this slide remains visible.