1. RETROSPECTIVE STUDY OF RECENT FOOT AND MOUTH DISEASE OUTBREAK INDIAN VETERINARY ASSOCIATION KERALA

2. AN ANALYSIS OF RECENT FMD OUTBREAK OF KERALA WITH ATTRIBUTED CAUSES AND RECOMMENDATIONS

3.  Foot & Mouth Disease – HIGHLY contagious viral disease  Cloven footed animals –mainly affected  Great potential of causing severe economic loss

4.  Animal population-protected against the highly contagious Foot and Mouth Disease  Massive Vaccination campaign conducted by the AHD-under ADCP & FMDCP- from 2004 at six months interval.  Unexpectedly a massive outbreak of FMD occurred in Kerala in 2013 leading to huge economic loss.

5.  Started from August 2013  The Disease equally affected- both Vaccinated & Unvaccinated animals  Wide range of species involved in outbreak  Cattle, Buffalo, Goats & Pigs, Wild animals- forests & captivity  Spotted deer, Sambar deer, hog deer, Gaur & Elephants

6.  Disease observed –even in organized farms taking regular vaccination  Occurred in all 14 districts and almost all panchayaths  Serotype ‘o’ was identified as cause  High mortality and morbidity rate  Mortality-adult cattle & calves Haemorrhagic septicaemia (HS) –identified as reason for mortality- in adult cattle

7.  Status of affected animal- worsened due to existing diseases like Anaplasmosis & Theileriosis  Both Milk and Meat production –declined drastically

8. Under these circumstances Indian Veterinary Association (IVA) the professional body of Veterinarians, Kerala has constituted an expert committee 1. Dr. Nandakumar. S, Veterinary Surgeon, Chief Disease Investigation Office, Palode 2. Dr. Sunitha Karunakaran, District Epidemiologist, ADCP, Thrissur 3. Dr. Bineesh.P. P, Veterinary Surgeon, Veterinary Dispensary, Unnikulam, Calicut

9. The expert committee members conducted  A detailed enquiry regarding the causes -which lead to the current FMD outbreak in the state  Offered valuable suggestions for the prevention and control of such outbreaks in future.

10. Recommendations to control future outbreaks of FMD in the state

11.  Unrestricted introduction of new animals from neighbouring states (Karnataka and Tamil Nadu) having FMD outbreak.  Influx of FMD affected animals for slaughter to Kerala.  FMD Vaccination which was due in July 2013 -delayed by two months -current vaccination phase.

12.  Existing infections like Anaplasmosis, Theileriosis and parasitic load- affected the herd immunity.  Secondary infections –Haemorrhagic septicaemia raised the mortality rate in recovered animals.  Denial by the owners to vaccinate their animals - the misconception of reduction in milk production and fear of vaccination reactions.  Use of balance vaccines from previous vaccination campaign.

13.  Possibility of breach of cold chain during the storage, handling and transportation of vaccine to the field  Frequent withdrawals from multi dose vials (100 ml) and use of balance vaccine after a day’s vaccination might have caused deterioration in the quality of vaccine.

14.  Immunogenicity & duration of immunity offered by the present vaccine especially for serotype O, is doubtful.

15.  ANIMAL RELATED FACTORS  VACCINE RELATED FACTORS  VACCINE HANDLING  MISCELLANEOUS FACTORS

16. Vaccination strategy  Three times a year vaccination of FMD in January, May and September covering 100% population of cattle and Buffalo and yearly HS vaccination in June-July.  Calves – after initial vaccination at 4 months, booster vaccination after a month can be thought

17. Proper deworming & deinfestation of ectoparasites  Dewormers and ectoparasiticides should be distributed 2 weeks prior to vaccination campaign along with health cards. Haemorrhagic septicaemia  Increased death rates are reported in FMD recovered animals due to HS.  A region wise study of Antibiotic Sensitivity Pattern of Pasteurella multocida in the state is highly recommended

18.  Animals brought from other states -allowed to enter the state only after FMD vaccination and a quarantine period of three weeks.  Quarantine facility should be made at the 14 check posts of the state.  Animals should be under strict clinical inspection of Veterinarians in these checkposts.

19.  Slaughter houses-near checkposts of the state.  Animals brought from outside state-slaughtered with ante mortem and post mortem inspection by Veterinarian.  Only dressed meat or meat products -allowed to enter the state.  Live animals should not be allowed to enter the state for slaughter.

20. Study to be conducted-National agency 1) Antigenic difference/relation of vaccine strain and field isolated strain of FMD Virus from Kerala. 2) Immunogenicity, duration of immunity and suitability of strains of the present vaccine, especially of serotype O.

21. 3) Increasing the antigenic mass in the current vaccines to prolong the immunity. 4) The nature of the virus, the severity of lesions, the extent of spread and the host range in the current outbreak.

22. A pre vaccination trial  Conducted in field conditions – to ensure required post vaccination antibody titre in serum.  Compare the results with controlled conditions

23.  Thermal data loggers- or continuous monitoring facility -installed in all walk-in coolers-14 districts  Refrigerator-exclusively for storage of vaccine- should be provided –to all field level institutions  An inverter or automatic generator – for refrigerator backup -2 KVA-8 to 9 hrs backup-Rs 40,000/-

24.  Non reversible temperature labels on Vaccine vials –for monitoring cold chain maintenance  A carrier or cool pail-with a special lid -which can be closed frequently between vaccinations-adequate numbers to all field level institutions  30 ml vials replaces- 100 ml multi dose vials  Left over vaccine discarded-at end user site

25. Vaccination programme 1) Publicity- materials reach institutions -2 weeks prior to vaccination campaign 2) Vaccination time-Team starts from early hours of day –finish off by 12 Noon 3) Tagging-should not be the duty of vaccinator at the time of vaccination-time consuming- delay in completion of vaccination target

26. Wild life reservoir  A barrier of vaccinated animals must be created in forest boundaries  Compulsory vaccination in the forest fringes inhabited by tribal population possessing domestic livestock should be carried out with the help of Eco Development Committee and forest department.

27. Man Power  Central RRT & vaccination squad- for doing only vaccinations-created for each district  Central Rapid Response Team-under direct control of ADCP  LI-of subcentres-included in RRT  Each vaccination squad-one LI & one attendant

28.  Each squad- complete vaccination of 30 animals per day  Vaccination in a panchayath completed within 4-5 days.  Sufficient number of squads is to be allotted - based on cattle population.  Vehicle facility should be provided to the squads. .

29.  Ward wise allotment of vaccination duty to the squads  Rotation of vaccination squads at Taluk/Block levels to cover all the panchayaths during the vaccination period

30.  Invigilators - LI of VD/VH/VPC as invigilators of vaccination.  Invigilators must verify 20% vaccinations done by each squad the very next day and report it to VS/SVS

31.  Supervising Officers - 10% of invigilated vaccinations should be supervised by VS/SVS  Healthy staff – Healthy staff/volunteers should accompany to assist vaccination and restrain animals.

32.  Training - Adequate training to the Veterinary Officers and LI prior to vaccination campaign  Veterinary Professionals -Adequate number should be posted at the 14 check posts, slaughter houses and district ADCP urgently

33.  Cost of vaccination- Vaccination free of cost considering the present outbreak as a serious disaster to farmers.  At the same time vaccinating own animals should be the duty of farmers.  Refusal/reluctance of vaccination should be penalised.

34.  Health Card- One health card per animal  A “Health Card” for identifying the animal, entering the details of vaccination, treatments and deworming.  Health Card supplied to farmers 2 weeks prior to vaccination along with dewormers and ectoparasiticides

35.  Incentives to farmers- Feed supplements  Gosureksha Insurance –Free for all vaccinated animals

36.  Hundred percentage vaccination coverage of susceptible population need to be achieved to create herd immunity and make the state FMD free.  Heterogeneity within various serotypes of FMD virus and thermo stability of the current vaccine

37.  A detailed study of subtypes/topotypes within serotype ‘O’ of the FMD virus prevalent in the state and its relationship to the vaccine strain  A suitable vaccination strategy for major diseases  Region wise study of ABS pattern of prevalent bacterial pathogens

38.  Strict border control measures  Proper vaccine handling and storage facility  Systematic, well supervised and practical vaccination programme creating herd immunity

39. ACKNOWLEDGEMENTS Indian Veterinary Association, Kerala is thankful to Dr. Nandakumar.S, Dr. Sunitha Karunakaran, Dr. Bineesh.P.P. and Dr.Asha.T.T. for their dedicated efforts in preparing this report