Public health concerns grow over foot and mouth outbreak
BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7291.881 (Published 14 April 2001) Cite this as: BMJ 2001;322:881
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Dr Sumption's letter clarifies a lot of points which the ministers
and Prempeh et al (editorial, 10 March) somehow did not manage to deal
with.
Perhaps the consultants in communicable disease control (who are also
concurrently Medical Officers for Environmental Health) should advise us
the public, about any surveys carried out in to antibody levels against
the FMDVirus, in humans in the affected areas? They should also tell us
how they have managed to exonerate birds, rats etc as vectors. And they
should also advise whether, in the interest of human health, they would
support vaccination of cattle with killed virus preparations, as an
alternative to slaughter.
Dr JK Anand
Competing interests: No competing interests
Dear Sir,
The response by some of the farming bodies and
consumers associations 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 had at the same time (19th April) been no
public 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, with over 400 reported or alleged cases in the literature
and about 40 confirmations. Given that FMD has rarely recently
occurred in countries with excellent diagnostic facilities, and is
endemic in low income countries, the actual figure, particularly in
communities which consume raw milk, may be considerably
higher. The excretion of large concentrations of virus in milk for
several 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 number of
reports of the infection to pigs and calves fed on milk products, and
perhaps for the higher reported incidence of milk related human
FMD infection than other sources of infection, especially for
children. Ingestion is a well recognised route of entry for man. It
can be assumed in the current UK situation that humans will have
consumed infected milk, since milk will be sold into the food chain
until this stopped after clinical infection has been diagnosed.
Pasteurisation should effectively reduce the risk of milk borne
infection, but heat resistant populations of virus are recognised.
Hyslop in 1973 (Bull.Wrld.Hlth Org, 49, 577-585) warned that
"physicians and others who encounter suspicious human lesions
during an outbreak of FMD in a locality should be aware of the
possibility of human infection and consequently take whatever
precautions necessary to isolate the patient pending confirmation
of the condition". He also concluded that "transfer of FMD virus
between animals and man occurs more frequently than was
suspected in the past". Although the pH drop accompanying rigor
mortis inactivates the virus, this does not occur within some
tissues, perhaps most significantly in the vesicles which contain
enormous quantities of virus, and to which animal disposal teams
might be exposed. So when health scares are raised over FMD
vaccination, where there is no history of a threat or basis for risk to
health from the killed vaccine, the medical profession should
compare these to the known risks of human infection from the
virus.
Further, since serum antibodies prevent generalisation of
infection (blocking viraemia, preventing spread from throat to other
parts including body tissues and the mammary gland), vaccination
should reduce the risk of infected milk entering the food chain, and
by reducing the number of cases of infective animals slaughtered
also reduces the risk to slaughtermen and other at-risk groups. In
the current situation, risks need to be minimised, particularly the
entry of virus through minor wounds, which has been a recorded
portal of entry.
Keith Sumption
Centre for Tropical Veterinary Medicine, University of Edinburgh,
Easter Bush, Roslin, Midlothian EH25 9RG, Scotland, UK
Competing interests: No competing interests
Foot and mouth - a different perspective
This is an area in which it is hard to make a living through
agriculture. The hills are farmed by men and women who often have to
supplement their income with other employment. In 1967, the Peak District
escaped foot and mouth disease and so far there have been no confirmed
cases in the National Park ,to my knowldge.
This outbreak has taught me two main lessons. Until now, I had not
realised the deep attachemnt that can form between the farmer and his
animal. One local farmer was telling me that he can trace his present
herd, through there generations, to his grandfather's day. In the last
decade, he has bought in only two cows, and has been present at the birth
of each of his cattle.
Until now, I had not fully realised the importance of the local
countryside, both to me and to many of my non-farming patients. Within a
few days of the start of this epidemic, the countryside rangers had
imprisoned us on tarmac. Their red and white tape across the stiles and
their laminated signs (Access Prohibited. Keep Out. Path closed until
further notice. Contravention may lead to a maximum fine of £5000) have
become as routine as the limestone walls that criss cross the fields. We
can still walk the lanes and sideroads, but they make my feet ache and my
boots complain. Nothing matches the freedom of feeling the moorland under
your feet, whatever the weather. Those are the times when I escape from
the 12 hour days of general practice, when I order ny thoughts and when I
feel close to my maker.
Until now, I had not fully realised that I am not alone in treasuring
the footpaths and the byways. Numerous patients and colleagues have shared
their frustration at not having access to 'their' countryside. I suspect
that none of us had fully understood the important role in our lives that
is played by taking exercise outdoors, until it was denied. Will morbidity
from depression, cardiac disease, or simply metatarsalgia rise strikingly
in the coming weeks as a result? Are there other,as yet unconsidered
longer term implications?
Competing interests: No competing interests