A Field Manual for

Animal Disease Outbreak Investigation

and Management
A Field Manual for Animal Disease
Outbreak Investigation
and Management
 ©OIE South-East Asia and China Foot-and-Mouth Disease (SEACFMD) Campaign, 2018

OIE Sub-Regional Representation for South-East Asia

Department of Livestock Development
69/1 Phaya Thai Road, Ratchathewi
Bangkok 10400, Thailand

Publications of the OIE Sub-Regional Representation for South-East Asia are protected by international copyright law. Extracts may be
copied, reproduced, translated, adapted or published in journals, documents, books, electronic media or any other medium destined
for the public, information, educational or commercial purposes, provided prior written permission has been granted by the OIE Sub-
Regional Representation for South-East Asia.

© Copyright OIE 2018

World Organisation for Animal Health
12, rue de Prony
75017 Paris, France
Tel.: 33-(0)1 44 15 18 88
Fax: 33-(0)1 42 67 09 87
www.oie.int
DOI : 10.20506/standz.2800
Cover & design: OIE/Paloma Blandín
 iii

Contributors

Ronello C Abila OIE Sub-Regional Representation for South-East Asia,

Bangkok, Thailand
Polly Catherine Cocks AusAID/SPS Capacity Building Project for the MTM
(2007 – 2009)
Mark Stevenson EpiCentre, IVABS, Massey University, Palmerston North,
New Zealand
Mutsuyo Kadohira EpiCentre, IVABS, Massey University, Palmerston North,
New Zealand
Barbara Tornimbene OIE SRR South-East Asia, Bangkok, Thailand
Corissa Miller OIE SRR South-East Asia, Bangkok, Thailand

Acknowledgements

Subhash Morzaria Regional Manager, ADB SPS Project, FAO RAP (2008-2010)
Stephane Forma SEACFMD Technical Adviser (2005 – 2007)
Kachen Wongsathapornchai Veterinary Officer, Department of Livestock Development, Bangkok,
Thailand (2008-2010)
Joy Gordoncillo Science & One Health Coordinator, OIE SRR South-East Asia (2012‑2016)
Karanvir Kukreja STANDZ Project Officer, OIE SRR South-East Asia (2012-2015)
Australian Government Department of Foreign Affairs and Trade (DFAT) and the Asian Development Bank
(ADB) for funding.
Murdoch University for assistance through the ‘Implementing the Capacity Building Project for the MTM’.

A Field Manual for Animal Disease Outbreak Investigation and Management

 iv

Contents
1. Introduction to outbreak investigation and management . . . . . . . . . . . 1
1.1 The importance of outbreak investigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 How long should the investigation take? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.3 Who should investigate an outbreak? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.4 The role of a disease investigator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2. Why do outbreaks occur?

2.1 Host, agent and environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Host . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Agent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2.2 Transmission pathways . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2.3 When does an outbreak occur? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.4 The host population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.5 Epidemic curves and the reproductive ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Epidemic curves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
The basic reproductive number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
The estimated dissemination ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.6 Principles of outbreak control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

3. A step-by-step guide to outbreak management . . . . . . . . . . . . . . . . . . . . . . . 10

4. Gathering information and preparing for the investigation . . . . . . . . . 11

4.1 Receiving a report and collecting initial information . . . . . . . . . . . . . . . . . . . . 11
4.2 Preparing for a field outbreak investigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Preparation of equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Preparation of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Information you should have before investigating an outbreak . . . . . . . . . . . . . . . . . 12

5. Verifying that you actually have a problem

5.1 Gathering information from stakeholders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Animal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Place . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
5.2 Putting it all together . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

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6. Implementing emergency control measures . . . . . . . . . . . . . . . . . . . . . . . . . . 19

6.1 Principles of control measures and biosecurity . . . . . . . . . . . . . . . . . . . . . . . . . 19
6.2 Implementation of control measures and biosecurity . . . . . . . . . . . . . . . . . . . 19
Communication and control measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Practical implementation of control measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
6.3 Treatment of affected livestock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Foot-and-mouth disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

7. Tracing cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
7.1 Defining an outbreak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
7.2 Tracing windows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Constructing the tracing window for the infection source . . . . . . . . . . . . . . . . . . . . . 24
Using the tracing window for the infection source: trace-back . . . . . . . . . . . . . . . . . 25
Constructing the tracing window for spread . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Using the tracing window for spread: trace-forward . . . . . . . . . . . . . . . . . . . . . . . . . 27

8. Collecting samples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

9. Participatory epidemiology
9.1 Participatory methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
9.2 Attitudes and behaviours in PE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
9.3 Team work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
9.4 Examples of useful PE methods for outbreak investigation . . . . . . . . . . . . . 31
Semi-structured interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Focus groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Participatory mapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Proportional piling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Matrix scoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Seasonal calendars and timelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
9.5 Data analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  35

10. Communicating your findings to stakeholders . . . . . . . . . . . . . . . . . . . . . . . 37

10.1 Preparation of an outbreak investigation report . . . . . . . . . . . . . . . . . . . . . . . 37
10.2 Communication in an outbreak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Setting up village meetings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Participatory approaches to information gathering . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Disseminating information during an outbreak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

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11. Case examples: Outbreak investigation

11.1 Outbreak investigation of reported FMD in Maoming,
Guangdong province, P.R. China . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
11.2 Outbreak investigation of FMDV serotype O Ind2001d in Dak Lak
and Dak Nong provinces, Vietnam in 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-43

A. Example outbreak investigation reporting form . . . . . . . . . . . . . . . . . . . A-44

B. Foot-and-mouth disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-48

B.1 Aetiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-48
B.2 Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-48
Worldwide distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-48
Virus survival . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-49
Disease transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-49
Incubation period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-50
Morbidity and mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-50
Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-51
B.3 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-51
Antigen detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-51
Antibody detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-51
B.4 Control and eradication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-52
B.5 Clinical signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-52
Cattle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-52
Pigs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-53
Small ruminants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-53
B.6 Ageing lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-54

C. Classical swine fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-56

C.1 Aetiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-56
C.2 Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-56
Worldwide distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-56
Virus survival . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-56
Disease transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-56
Incubation period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-57
Morbidity and mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-57
C.3 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-58

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C.4 Control and eradication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-58

C.5 Clinical signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-58
Acute CSF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-59
Chronic CSF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-59
Mild or sub-clinical CSF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-59
Congenital CSF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-60

D. Equipment checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-61

D.1 Personal protective equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-61
D.2 Restraint equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-61
D.3 Disinfectant and cleaning material . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-61
D.4 Medical supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-61
D.5 Sample collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-62
D.6 Data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-62
D.7 Communication, transportation, navigation . . . . . . . . . . . . . . . . . . . . . . . .  A-62

E. Cleaning and disinfection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-64

E.1 Types of disinfectants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-64
Soaps and detergents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-64
Oxidising agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-64
Alkalis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-64
Acids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-65
Aldehydes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-65
E.2 Disinfectants for specific diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-65
African swine fever and classical swine fever (Category A viruses) . . . . . . . . . . . . . .  A-65
Avian influenza and Newcastle disease (Category A viruses) . . . . . . . . . . . . . . . . . . .  A-66
Foot-and-mouth disease (Category B viruses) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-66
Rabies (Category A viruses) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-67
E.3 Recommended concentrations and contact times . . . . . . . . . . . . . . . . . . .  A-67
E.4 The decontamination and disinfection process . . . . . . . . . . . . . . . . . . . . .  A-68
Decontamination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-68
Disinfection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-68

F. Sample collection and submission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-69

F.1 Sample collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-69
F.2 Transportation and processing of samples . . . . . . . . . . . . . . . . . . . . . . . . . .  A-69
Protocol for sample submission to the OIE RRL, Pak Chong, Thailand . . . . . . . . . . . .  A-70
F.3 Samples for classical swine fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-71

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G. Participatory epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-72

G.1 Key principles of participatory appraisal . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-72
G.2 Summary guidelines for semi-structured interviews . . . . . . . . . . . . . . . .  A-72
G.3 Summary guidelines for focus group discussions (FGD) . . . . . . . . . . . . .  A-73
G.4 Method for drawing an outbreak risk map . . . . . . . . . . . . . . . . . . . . . . . . .  A-74
G.5 Proportional piling method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-74
G.6 Matrix scoring disease definition method . . . . . . . . . . . . . . . . . . . . . . . . . .  A-76

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-43

List of Figures
Figure 1: The disease triad of host, agent and environment . . . . . . . . . . . . . . . 3
Figure 2: Transmission pathway example — foot-and-mouth disease. . . . . . 4
Figure 3: Line plot showing the relative amount of viral excretion
from an infected host, as a function of time since infection . . . . . . . . . . . . . 5
Figure 4: Epidemic curves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Figure 5: Reproductive number according to the stage of an epidemic . . . . . 8
Figure 6: Data from an infectious disease outbreak in poultry . . . . . . . . . . . . . 9
Figure 7: Diagrammatic representation of an approach to outbreak
investigation and management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Figure 8: An example of a log-book entry showing details of a report received
on a suspected outbreak. It includes the farmer’s name and address
and a brief history of the event . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Figure 9: An example of a log-book entry of an initial report of an outbreak
and how a simple record can provide valuable information to assist
in preparations for an outbreak investigation . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Figure 10: A sketch of the outbreak area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Figure 11: Small group discussions or individual discussions can be useful
for gathering information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Figure 12: Small group discussions or individual discussions can be useful
for gathering information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Figure 13: An example of recording cases in time and place . . . . . . . . . . . . . . . 24
Figure 14: Construction of a tracing window for the infection source . . . . . . 25
Figure 15: Diagram to show the construction of a tracing window for spread 26
Figure 16: Diagram showing construction of tracing windows for source and
for spread using the example of an FMD infected village . . . . . . . . . . . . . . . 27

A Field Manual for Animal Disease Outbreak Investigation and Management

Contents ix

Figure 17: Types of veterinary information collected using participatory

epidemiology methods (Catley, 2005) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Figure 18: A Dutaik (traditional Burmese meeting approach) meeting
in a village, Myanmar. (Oo, 2010) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Figure 19: Example of a map of a Northern Laotian village affected by FMD. 33
Figure 20: Map showing HPAI outbreak in an Indonesian village. . . . . . . . . . . 33
Figure 21: Example of proportional piling method to estimate the risk
pathway of FMD entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Figure 22: Matrix scoring of cattle diseases against disease-signs . . . . . . . . 34
Figure 23: Clinical signs of foot-and-mouth disease in cattle . . . . . . . . . . . . . . A-52
Figure 24: Clinical signs of foot-and-mouth disease in pigs . . . . . . . . . . . . . . . . A-53
Figure 25: Clinical signs of foot-and-mouth disease in sheep . . . . . . . . . . . . . . A-54
Figure 26: Diagram showing the pattern of appearance of FMD lesions and their
relationship with viral excretion as a function of time . . . . . . . . . . . . . . . . . . A-55

List of Tables
Table 1: An example of recording animal information during an outbreak using
a simple table, where an outbreak investigation form is not available . . 14
Table 2: Information needed to construct a tracing window . . . . . . . . . . . . . . . 23
Table 3: Types of veterinary information collected using participatory
epidemiology method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Table 4: Worldwide distribution of foot-and-mouth disease serotypes . . . . . A-48
Table 5: Description of the clinical appearance of FMD lesions according
to the number of days post infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-54
Table 6: Recommended disinfectants for African swine fever and classical
swine fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-65
Table 7: Recommended disinfectants for highly pathogenic avian influenza
and Newcastle diseas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-66
Table 8: Recommended disinfectants for foot-and-mouth disease . . . . . . . . . A-66
Table 9: Recommended disinfectants for rabies . . . . . . . . . . . . . . . . . . . . . . . . . . . A-67
Table 10: Recommended disinfectants and concentrations for inactivation
of viruses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-67

A Field Manual for Animal Disease Outbreak Investigation and Management

 1

1. Introduction to outbreak investigation

and management
This manual on outbreak investigation is intended as a particular situation and environment, thus resulting in
guide to assist field veterinarians and veterinary para- more effective disease control measures.
professionals to investigate and manage infectious disease
outbreaks in livestock. The manual also provides a reference
for those developing contingency plans for infectious Why investigate an outbreak?
disease outbreak management. – To identify the source(s) of infection.
– To prevent further exposure of animals to the infection source(s).
The manual presents a step-by-step guide to investigating a – To determine where the disease has spread.
disease outbreak. While the methods can be applied to any – To guide control measures during and after the outbreak.
outbreak situation, this manual focuses on transboundary – To improve knowledge on the behaviour and pattern of disease.
diseases, particularly foot-and-mouth disease (FMD) and
– To improve knowledge of the risks and routes of introduction.
classical swine fever (CSF), given the importance of these
diseases in South-East Asia. – To provide information that will allow stakeholders to better
understand why outbreaks occur in their area, and factors that
influence the severity of outbreaks if and when they occur.
The step-by-step guide is supported by background
information on why outbreaks occur, the epidemiology
and clinical signs of FMD and CSF, reporting procedures,
sample collection and submission, and control measures.
Generic checklists and forms are provided in the appendices 1.2 How long should
of the manual, which can be copied and adapted for use in
animal disease preparedness, outbreak investigation and the investigation take?
management scenarios.
When a suspected outbreak is reported, the investigation
should commence immediately and continue until there

1.1 The importance of outbreak is sufficient evidence to demonstrate that the infection
has been completely cleared. An outbreak of infectious

investigation disease will continue as long as there is an opportunity for

transmission between susceptible and infected animals. It is
the responsibility of the investigation team or investigating
The primary reason for conducting an outbreak investigation officer to identify and control all possible routes of
is to identify the source of a disease, in order to guide control transmission between infected and susceptible animals in
measures and limit disease spread. Information gathered order to control the outbreak.
may also be used to evaluate existing prevention strategies
and identify ways to prevent future outbreaks. Outbreak
You will sometimes receive reports of an outbreak after signs
investigations provide an opportunity to document three
of disease appear to have resolved. For example, you may
key pieces of information:
receive a report from a remote village stating that one month
– How quickly the disease is spreading within a population ago, 20 cattle and 5 buffalo were sick for about 10 days but
of interest; because they all recovered quickly the farmers did not think
it was important to report the disease. In this situation, it is
– The spatial distribution of disease-positive and disease-
important that the outbreak is still investigated and, while
negative enterprises; and
it may be more difficult to retrieve specific details about the
– Characteristics or behaviours that are more common outbreak after the event, the results of such an investigation
among the disease-positive enterprises, compared with can still provide useful information on possible sources of
those that are disease-negative. the outbreak and may help to guide preventative measures
to reduce the chance of future outbreaks in the area. You
These three key pieces of information allow adaptation may also find during your investigation that the outbreak
of standard disease control procedures to best suit the is, in fact, still ongoing and has spread to other areas. Your

A Field Manual for Animal Disease Outbreak Investigation and Management

1. Introduction to outbreak investigation
and management 2

investigation will allow you to implement appropriate

control measures and reduce further spread of the disease. 1.4 The role of a disease
investigator
1.3 Who should investigate an A disease investigator is like an investigative journalist or a
detective. The role of the disease investigator is to unfold the
outbreak? factors and circumstances leading to an outbreak. You must
not only determine the animals involved in an outbreak,
As a field veterinarian or veterinary para-professional you but also the people involved, for example visitors, animal
will often be the person who first receives a report of a health workers and veterinary practitioners. Investigating an
suspected outbreak of disease. Although you will need to outbreak of disease primarily involves gathering, recording,
inform other levels of the Veterinary Services, it is likely that analysing and reporting information. You will ask many
questions of different people during your investigation. The
you will be largely responsible for performing the outbreak
minimum questions you should ask are referred to as the 4
investigation at the field level.
Ws and 1 H (see below). By asking more detailed questions,
you can expect to receive more detailed answers. This is
This manual outlines the approach that should be taken to critical for getting the full picture of an outbreak.
investigate an outbreak. It should be stressed that it may not
always be possible to follow the exact recommended steps
and processes described here, due to a number of limitations, The 4 Ws and 1 H
such as cost of materials and transportation, availability of What? What species are affected? What age groups are affected?
personnel, and security issues preventing entry into some When? When did the outbreak start? When did the outbreak spread
areas. Because of this, the material presented here should be to other farms?
treated as a guide. However, it should be remembered that Where? Where did the outbreak start? Where are the other farms or
many of the concepts and practices described in this manual villages that are affected? Why? Why did the outbreak occur in this
can be implemented even with very limited resources. particular area?
Strict biosecurity practices should always be followed by How? How did the disease agent come onto this farm? How did the
the investigating officer (see Chapter 6). You should also outbreak behave?
consider simple, often inexpensive methods of preventing
transmission of disease between infected and susceptible
animals. Even very simple measures can be highly effective,
such as advising farmers in villages surrounding an outbreak
area to avoid shared grazing and to keep cattle tethered
within the household, preventing contact between infected
and susceptible animals. See Chapter 2 for a description of
transmission pathways (Section 2.2) and the principles of
outbreak control (Section 2.6), and Appendices B.2 and C.2
for details on transmission of FMD and CSF, respectively.

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2. Why do outbreaks occur? 3

2. Why do outbreaks occur?

This chapter will describe how and why an outbreak of – Nutritional status
disease occurs and the factors that contribute to the size of an
– Health status
outbreak. We will also consider how to use our knowledge
of these factors to prevent or control an outbreak of disease. – Immunity

Agent
2.1 Host, agent and environment An agent is the biological pathogen, such as a virus, parasite,
fungus or bacterium, that causes disease in the susceptible
Disease is not a random event, and whether disease occurs host. An agent is primarily interested in where it can live,
depends upon interactions between the host, the agent and grow and reproduce. Some agents can survive and even
the environment in which they exist. Disease occurs when multiply away from the host population (in other animals,
an agent capable of causing disease (for example, a virus or in their products, or in the physical environment), while
bacteria) meets a host that is vulnerable (susceptible) to the others must remain within the host to survive. For example,
agent and in an environment that allows the agent and host FMD virus only affects cloven-footed animals such as cattle,
to interact. For an outbreak to occur there must also be a buffalo, sheep, goats and pigs. CSF, on the other hand, only
chain of transmission for the agent to pass from one host to affects pigs. The following factors determine whether an
another. Whether a disease outbreak occurs will depend on agent causes disease in a particular host:
factors relating to the host, the agent and the environment.
– Infectivity
The interaction between these three components is known
as the disease triad, as shown in Figure 1. – Pathogenicity
– Immunogenicity
HOST – Antigen stability
– Survival

Environment
The environment describes the conditions or influences that
are not part of either the host or the agent, but influence
AGENT ENVIRONMENT their interaction. The following environmental factors can
influence the occurrence of disease, provided that both the
Figure 1: The disease triad of host, agent and environment susceptible host and agent are present:
– Weather
Host – Housing
A host is a living organism in which agents of disease can – Geography
survive. Examples of hosts are domestic livestock such as
cattle, buffalo, pigs, sheep, goats and poultry. The agent – Air quality
(see below) may or may not develop and reproduce in a
particular host and may or may not cause disease in that
host. The following host factors can determine whether
disease will occur:
2.2 Transmission pathways
– Age The chain of transmission is the process by which an agent
can be transmitted from a source to a susceptible host,
– Sex and subsequently from one host to another. For successful
transmission to occur the following factors must exist:
– Genotype
1. A source of the agent: This is often the place where the
– Behaviour agent originates, lives, grows and multiplies. The source

A Field Manual for Animal Disease Outbreak Investigation and Management

2. Why do outbreaks occur? 4

(sometimes called the reservoir) of an agent can be any 2. A portal of exit: The pathway by which the agent leaves
of the following: the source.

– a symptomatic animal 3. A mode of transmission: The method by which the

– an asymptomatic infected animal agent passes to a susceptible host. This transmission can
be either direct or indirect and, for some agents, both
– an animal incubating disease pathways can be used.
– a convalescent animal
4. A portal of entry: The pathway into the host, which
– another animal species gives the agent access to tissues where it can multiply
– the environment and cause disease.

Cloven-hoofed animals:
– Infected and incubating disease
– Infected symptomatic animal
– Subclinically infected animal
SOURCE – Infected convalescent animal
– Contaminated vehicle, clothing, etc.

FMD virus is shed in:

– Fluid from ruptured vesicles
– Expired air
PORTAL OF – Faeces and urine
EXIT – Milk
– Semen

Indirect spread:
Direct spread: – Vehicles
Direct contact between infected and Direct Indirect – Clothing, people, vets
susceptible animals – Other animals
MODE OF
– Feed, manure, equipment
TRANSMISSION

Portals of entry include:

PORTAL OF – Inspiration
ENTRY – Ingestion
– Skin or mucous membrane abrasions

Figure 2: Transmission pathway example — foot-and-mouth disease.

A Field Manual for Animal Disease Outbreak Investigation and Management

2. Why do outbreaks occur? 5

2.3 When does an outbreak well as an agent, a suitable environment and means by
which the host and the agent can come together. Here, we

occur? will consider in more detail the role of the host population.
The proportion of susceptible animals in a population is a
major determinant for whether an outbreak will occur and
As described above, for a disease outbreak to occur there the evolution of that outbreak. In an outbreak of infectious
must be an agent, a susceptible host and a means by which disease, individuals in the population can be classified into
the agent can be transmitted from an infected host to one of the following groups:
subsequent susceptible hosts. When an outbreak occurs at
a particular time, it is because of a change in the natural – Susceptible
‘balance’ between host, agent and environment. Any one of – Incubating
the following changes could result in an outbreak:
– Incubating and infective
– An increase in exposure to the agent. For example,
the amount of agent can be increased to a level capable – Diseased and infective
of causing infection if environmental conditions favour – Sub-clinical and infective
survival of the agent.
– Convalescent and infective
– An increase in the infectivity/virulence of the agent.
For example, changes to the agent’s genotype can occur – Convalescent
in which the virulence of the agent can be increased, – Dead
overcoming resistance of the host and resulting in
disease. – Immune

– xposing the agent to naïve hosts. For example, a cow is

brought from an infected area into a village where there
has been no disease. When she arrives at the village, she
might not be showing any signs of illness, but could be
Viral Excretion

incubating disease (infected but not yet showing clinical

signs). This cow would then introduce infection into the
village and could infect other animals.
– An enhancement of transmission. For example, if
there is greater opportunity for the agent to be moved
between infected and susceptible animals. Time
Incubating Incubating Diseased/ Convalescent Convalescent
– Increased host exposure. For example, the host and & Infectious Sub-clinical & & Infectious
Infection Infectious
agent may have both been present, but an outbreak
occurs when the host has greater exposure to the agent.
Figure 3: Line plot showing the relative amount of viral excretion
– Change in susceptibility of host to the agent. An
from an infected host, as a function of time since infection.
outbreak can occur when the susceptibility of the host
to an agent changes. For example, animals previously
vaccinated or exposed to FMD virus will develop An individual’s vulnerability to infection, ability to infect
immunity; however, in time, this immunity will wane others, and risk of being infected will depend on which of
and the host will again become susceptible. Young or the following categories it belongs to:
naïve animals may also be introduced into a population.
1. Susceptible animals. Susceptible animals are those
An outbreak will occur when there are sufficient
individuals in the host population that are vulnerable
numbers of susceptible animals.
to infection by an agent. The proportion of susceptible
– Introduction through new portals of entry. animals in a host population will influence whether
an outbreak of disease will occur and the extent of the
outbreak.
2.4 The host population 2. Incubating animals. The incubation period of a
particular disease is the period of time between infection
We have already established that for an outbreak to occur of an animal and development of clinical signs. An
there must be adequate numbers of susceptible hosts as incubating animal is infected with the agent but is not

A Field Manual for Animal Disease Outbreak Investigation and Management

2. Why do outbreaks occur? 6

showing any signs of infection. With some infectious

diseases (such as FMD) an infected animal starts to shed 2.5 Epidemic curves and the
the agent before it starts to show clinical signs.
3. Diseased animals. Diseased animals are those that are
reproductive ratio
showing clinical signs. With most infectious conditions Epidemic curves
(not all) those that are showing clinical signs are also
shedding the infectious agent and therefore pose an An epidemic curve is a frequency histogram showing the
infectious risk to other susceptible animals. count of new cases of disease (on the vertical axis of the
plot) as a function of time (on the horizontal axis). Epidemic
4. Sub-clinical animals. Sub-clinically infected animals
curves are useful because they show the progression of an
are those that are infected with an agent, are capable of
epidemic (or outbreak) over time. The shape of the curve
transmitting the agent to susceptible hosts, but do not
can provide useful indications about the nature of disease
show clinical signs of disease themselves. These animals
transmission and the likely stage of an outbreak. The
can be highly infectious. In a similar way to incubating
following factors will influence the shape of an epidemic
animals, sub-clinical animals represent an important
curve:
risk, because they are a source of infectious agent but are
not easily detectable. Sub-clinical infections are known – The incubation period of the disease
to occur with FMD, and there have been instances in – The infectivity of the agent
which outbreaks have resulted from the introduction
of a sub-clinically infected animal into a susceptible – The proportion of susceptible animals in the population
population. – Animal density (which influences transmission of
5. Convalescent animals. Convalescent animals are those infective agent from one animal to another).
that have recovered from disease and no longer display
clinical signs. Some convalescent animals will continue For example, a highly infectious agent with a short
to shed infectious agent in the early stages of recovery incubation period infecting a population with a high
and, therefore, represent a risk to susceptible animals. density of susceptible animals produces an epidemic curve
Most will only shed virus for a short time, or not at with a steep initial slope over a relatively short timescale,
all, after clinical signs have resolved. For FMD, some representing a rapid spread of infection among the
animals become carriers, with virus able to be isolated population.
from them for at least 28 days after recovery. Although
this can happen, these animals are not thought to be Common-source epidemics
important sources of transmission of virus to susceptible
hosts. In a common-source epidemic (or outbreak), a group
of animals are exposed to a common source of infective
6. Immune animals. Immunity can occur in a number of
agent. If the group is exposed over a relatively short period,
ways: following infection, following vaccination or, in the
disease cases will emerge over one incubation period. This
very young, due to the presence of circulating maternal
is called a common point source epidemic. With a common
antibodies. The period of immunity varies depending
point source epidemic, the epidemic curve rises rapidly and
on the agent involved and depending on whether it is
contains a definite peak at the top, followed by a gradual
due to natural infection or to vaccination. For FMD,
decline. Figure 4 illustrates an example of a common source
immunity following natural infection is variable and can
epidemic.
last up to two years. Following vaccination, it is generally
understood that protective levels of immunity will be
maintained for anywhere between 6 and 12 months. Delivery of a consignment of feed contaminated with toxin from Clostridium
Therefore, in the case of FMD, the immune period is botulinum to a feedlot would produce an epidemic curve consistent with a
common point source epidemic (assuming the contaminated material was fed
transient and animals (and indeed a population) will
out to stock over a relatively short period of time).
again become susceptible if they are not exposed to
the agent (through either infection or vaccination) on
a regular basis. The introduction of new animals to a Exposure can also occur over a longer period of time, either
population, either through birth or replacements from intermittently or continuously. This creates what is known
unaffected areas, increases the proportion of susceptible as a continuous common-source epidemic. This epidemic
animals in a population. A high proportion of susceptible curve rises rapidly (associated with the introduction of the
animals will increase the likelihood of an outbreak, if an agent). After the initial rise, the number of cases plateaus
infective agent is introduced. rather than tapering off.

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2. Why do outbreaks occur? 7

Propagated epidemics Estimating the time of exposure

A propagated epidemic occurs when a case of disease serves In a common point source epidemic of a known disease
as a source of infection for subsequent cases and those with a known incubation period, you can use the epidemic
subsequent cases, in turn, serve as sources for later cases. An curve to identify the likely period of exposure. To identify
epidemic curve of an uncontrolled outbreak of FMD would the likely period of exposure from an epidemic curve:
produce an epidemic curve typical of a propagated epidemic. – Determine the average, minimum and maximum
In theory, the epidemic curve of a propagated epidemic has incubation period for the disease of interest. For
a successive series of peaks reflecting increasing numbers of FMD these intervals are 4 days, 2 days and 14 days
cases in each generation. The epidemic usually wanes after (respectively). For CSF these intervals are 8 days, 5 days
a few generations, either because the number of susceptible and 10 days (respectively).
animals falls below a critical level, or because intervention
measures become effective. Figure 4 illustrates an example – Identify the peak of the outbreak or the date on which
of a propagated epidemic. the median (i.e. middle) case was observed and count
back on the horizontal axis one incubation period.
Make a note of this date.
Uncontrolled spread of FMD in a population of livestock farms would – Start at the earliest case of the epidemic and count back
produce an epidemic curve consistent with a propagated epidemic. the minimum incubation period. Make a note of this
date.

Ideally, the two dates will be similar, and will identify the
15 time range over which exposure occurred. However, this
technique is not precise, and you usually should widen
12 your period of investigation by
Number of cases

9 10% to 20% on either side of these dates. You should then

investigate possible exposures during this wider time frame
6 in an attempt to identify the possible source.

3 Sometimes, the endpoint of an epidemic is difficult to

pinpoint. A way of getting around this problem is to do
0 a natural log transformation of the horizontal axis (time),
5 10 15 20 which conveniently normalises the (typically) skewed
Day
epidemic curve. With the epidemic curve normalised,
you can now use start time, end time, and the date of the
15 median case to calculate the incubation period. Although
transforming the data to the logarithmic scale gives it
12 convenient mathematical properties, it is important to
transform the values back to their original scale before
Number of cases

9
making interpretations.

6 Interpreting the epidemic curve

The first step in interpreting an epidemic curve is to
3
consider its overall shape. The shape of the epidemic
curve is determined by the epidemic pattern (common
0
source versus propagated), the period of time over which
5 10 15 20 susceptible individuals are exposed, and the minimum,
Day average, and maximum incubation periods for the disease.
An epidemic curve which has a steep upslope and a more
Figure 4: Epidemic curves. The plot on the left is typical of a gradual downslope (a log-normal curve) indicates a common
propagated epidemic. The curve on the right is typical of a point source epidemic in which individuals are exposed to
common-source epidemic. the same source over a relatively brief period. In fact, any

A Field Manual for Animal Disease Outbreak Investigation and Management

2. Why do outbreaks occur? 8

sudden rise in the number of cases suggests sudden exposure introduced into a susceptible population. If, on the other
to a common source. In a common point source epidemic, hand, R0 is greater than one, introduction of the infective
all cases occur within one incubation period. If the duration agent into a susceptible population is likely to produce
of exposure was prolonged (a continuous common-source an epidemic. The larger the R0 value, the more rapid the
epidemic) the epidemic curve will have a plateau instead spread of disease.
of a peak. Intermittent common-source epidemics produce
irregularly jagged epidemic curves which reflect the As an infectious agent invades a population, the number
intermittency and duration of exposure and the number of of susceptible animals progressively declines as a result of
individuals exposed. Propagated epidemics, in theory, show either recovery or death. Eventually, insufficient susceptible
a series of progressively taller peaks one incubation period animals are present to maintain the chain of transmission.
apart, but, in reality, few produce this classic pattern. At this stage, on average, each infectious animal infects less
than 1 susceptible animal and the epidemic dies out. This is
Cases that stand apart may be just as informative as the explained in Figure 5.
overall pattern. An early case may represent a background
or unrelated case, a source of the epidemic, or an individual
who was exposed earlier than most of the cases. Similarly,
late cases may represent unrelated cases, long-incubation- Number of new cases R=1
period cases, secondary cases, or individuals exposed later
than most of the cases. Sometimes, these outliers represent
miscoded or erroneous data. All outliers are worth R>1 R<1
examining carefully, because if they are part of the outbreak,
their unusual exposures may point directly to the source.

You can also use the principle of the epidemic curve to

R=Ro
determine whether emergency control measures have
been successful. If measures such as movement controls Time
(preventing shared grazing, tethering animals within the Figure 5: Reproductive number according to the stage of an
household area) or emergency vaccination have been epidemic.
successful, there should be a decline in the number of new
cases following the date on which the control measure was
established. However, this decline will not be immediate The estimated dissemination ratio
because those animals that were infected before control
measures were implemented will still develop infection A metric called the estimated dissemination ratio (EDR) can
even after the controls have been implemented. Therefore, be used to provide an estimate of R0 during an infectious
you would still expect to see a decline in new clinical cases disease outbreak.
approximately 1 – 4 days (the most common incubation
period for FMD) after implementation of effective control The n-day EDR at day i of an outbreak equals the total
measures. number of incident cases between day i and day [i - (n - 1)]
divided by the total number of incident cases between day
The basic reproductive number (i - n) and day (i - 2n). EDR values are often calculated for
each day of an epidemic and presented as a time series. If
The basic reproductive number (R0, ‘R nought’) is the the EDR is consistently less than one, the epidemic is said
average number of secondary cases an infectious individual to be ‘under control’.
will cause in a completely susceptible population. R0
provides a measure of the intrinsic potential of an infectious Figure 6 is an epidemic curve showing the temporal
agent to spread. R0 depends on a number of factors: evolution of an infectious disease outbreak in poultry.
– The number of contacts made Superimposed on this (as a line) is the 4-day EDR plot. If we
are on day 30 of the epidemic, the 4-day EDR value for day
– The probability of infection given successful contact 30 equals the number of FMD cases identified between day
– The duration of infectiousness 27 and day 30 divided by the number of cases identified
between day 23 and day 26. So, if the number of cases in
– The proportion of contacts that are susceptible
the 27 to 30 day window is greater than the number of cases
If R0 for an infectious disease is less than one, it is unlikely in the 23 to 26 day window, our EDR value (an estimate of
that an epidemic (or outbreak) will occur if the agent is R0) is greater than one.

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2. Why do outbreaks occur? 9

2.6 Principles of outbreak

control
In this chapter we have discussed how and why an outbreak
develops and what factors influence disease incursion and
spread. We will now consider how to use this knowledge
to either prevent or control an infectious disease outbreak.
The principles of disease control involve the following:

Number of cases
1. Reducing contact between infectious and susceptible
animals. Intervention measures to reduce contact
2 200 between infectious and susceptible animals include
separation or quarantine of infected animals, and
1 100 movement controls. It is also important to avoid mixing
of livestock when an outbreak is occurring, for example:
sharing common grazing areas with cattle from a village
0 0 affected by FMD should be avoided.
01-Dec 01-Jan 01-Feb 01-Mar 01-Apr 2. Reducing the number of susceptible animals. As
Date described above, for an outbreak to occur, there must
be sufficient susceptible animals in the population to
Figure 6: Data from an infectious disease outbreak in poultry. allow for continued transmission of the agent from
Histogram of counts of cases as a function of calendar date. infected to susceptible animals. By reducing the number
Line plot showing estimated dissemination ratio (and its 95% of susceptible animals, the extent of the outbreak will
confidence interval) as a function of calendar date. be reduced. If the number of susceptible animals can be
reduced to below the threshold level, an outbreak will
not occur. Vaccination is an effective way to reduce the
EDR plots are particularly useful for infectious disease number of susceptible animals in a population.
outbreak investigations because they provide warning that
3. Decreasing the amount of infectious agent. Decreasing
an outbreak has not yet reached its peak. In Figure 6, the
the amount of infectious agent reduces the level of agent
relatively high EDR values (greater than 1) in early March the host is exposed to or prevents exposure completely.
2001 indicated that the epidemic had not yet reached its This type of measure is usually aimed at a point in the
peak. By the time the epidemic had reached its peak in early transmission pathway when the agent is at its most
April 2001, the EDR plot had started to drop below one, vulnerable. For example, during the time that the agent
indicating that the epidemic had largely been brought under is exposed to the external environment, it is highly
control. From May 2001 the 4-day EDR plot fluctuated vulnerable to human intervention. An example of this
around one, indicative of ongoing disease transmission type of intervention would be application of disinfectants
(evidenced by the long ‘tail’ to the epidemic). to contaminated areas or contaminated equipment.

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3. A step-by-step guide to outbreak management

This section and subsequent sections of this document influencing how disease spreads in animal populations. The
form the basis of the step-by-step approach to outbreak subsequent sections provide specific details about various
investigation and management. Figure 7 provides an aspects of infectious disease outbreak management, based
outline of the steps that comprise the outbreak investigation on the steps shown in Figure 7.
and management process. The previous sections of this
document provided background information about factors

1. Preparation for field investigation

6. Communication of
information back to
stakeholders

2. Verification of the outbreak

3. Implementation of emergency control measures

4. Backward and forward tracing

5. Collection of samples

Data analysis

Figure 7: Diagrammatic representation of an approach to outbreak investigation and management.

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4. Gathering information and preparing
for the investigation 11

4. Gathering information and preparing

for the investigation
This step covers the period from when you first receive a be false positives. If your outbreak detection criteria are too
report of a suspected outbreak to when you begin your field specific (that is, the criteria of what constitutes an outbreak
investigation. It will consider how you are likely to hear of a are too strict) it is likely that all of the outbreaks that you
disease outbreak; how you should record this initial report; investigate will be true positives (that is, you will not waste
and how and what you should prepare before embarking any time investigating false positives), but in doing so it is
on a field outbreak investigation. likely that you will miss a potentially important number of
true positives.

4.1 Receiving a report and As a rule of thumb, the same or similar report of an unusual pattern
of disease events from one or more independent sources provides
collecting initial information strong evidence that the reported pattern of disease events is a true-
positive (as opposed to being a false-positive) disease report.
A report of a suspected outbreak can be made by a number
of different people, for example:
Failure to act on a report may discourage future reporting
– Farmers of disease, resulting in an outbreak going unnoticed and
uncontrolled.
– Village animal health and veterinary workers
– Local authorities At the time that a disease report is first received, some basic
– Members of the public information should be retrieved so that there is a record
of the report for future reference. At this time, you can
– Private veterinarians collect some of the main details of the event to help guide
– Livestock traders your initial response. Such information can be collected in
the office log book, diary or other recording system used
– Medical doctors (in the case of zoonotic diseases)
within the office. The entry in the book might look similar
– Others to Figure 8.

Reporting from any of these groups should be encouraged A small amount of information (such as in the example
and any report received should be taken seriously and above) can provide valuable clues about the nature of the
followed up. Issues of outbreak detection sensitivity and disease, location, and the extent and time frame of the
specificity are important here. If your outbreak detection outbreak. A lot more information will be required later
criteria are too sensitive (that is, the criteria of what in the investigation when you go to the field, but a brief
constitutes an outbreak are too liberal) it is likely that a description such as this is a valuable guide for your initial
considerable number of the outbreaks you investigate will response.

Figure 8: An example of a log-book entry showing details of a report received on a suspected outbreak. It includes the farmer’s name
and address and a brief history of the event.

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4. Gathering information and preparing
for the investigation 12

4.2 Preparing for a field outbreak outbreak. As part of emergency response preparedness, a
checklist is important to ensure that you have everything on

investigation hand at the (often unexpected) time you need it.

Before starting the field component of the outbreak Preparation of information

investigation, you should ensure that you are well prepared Before embarking on a field visit, it is important that you
for field activities. This involves making sure you have all equip yourself with certain information that will help
the equipment and information you require to conduct the you during your investigation. The information provided
initial outbreak investigation. to you at the time the outbreak is reported (for example,
Figure 8), should already provide details about the species
Preparation of equipment of animals involved, the time of the outbreak, the clinical
signs, and the location of the outbreak. Taking the example
It is important that you take with you the essential from Figure 8, we will consider what can be learned from
equipment needed to conduct an outbreak investigation even a small amount of information provided in the initial
in the field. This may vary a great deal in each situation. report. Figure 9 provides annotations to the log-book
However, there are certain items which should always be entries shown in Figure 8 to show how even very basic
included, such as disinfection equipment (to ensure that outbreak information can be used to guide further outbreak
you can at least disinfect your own vehicle and equipment management activities.
after leaving an infected area to avoid transmitting disease
to other areas), recording equipment, e.g. paper and pens
Information you should have before investigating
and/or a specific form for taking down information, and
animal restraint equipment to ensure that you can examine
an outbreak
animals safely and effectively. 1. Location. You should know the location of the outbreak
from the initial report. Before going to investigate the
An equipment checklist is provided in Appendix D as a outbreak you should find out more information about
guide to the equipment needed for a field investigation. that place. Have there been any previous outbreaks in
The checklist can also be used at times when there is no the area? Are any outbreaks ongoing? Which livestock

Figure 9: An example of a log-book entry of an initial report of an outbreak and how a simple record can provide valuable information to
assist in preparations for an outbreak investigation.

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4. Gathering information and preparing
for the investigation 13

species and husbandry methods are used? Which main 2. Disease information. If you have an idea of possible
roads/transport routes are used? Where are animals disease processes or diagnoses based on the information
and animal products obtained from? Where do they go that has been provided, it is important that you have a
once they are sold? Are there any livestock markets and good working knowledge of the aetiology, epidemiology,
slaughterhouses that might be relevant to the outbreak? pathogenesis, clinical signs, diagnosis, treatment
By knowing the location of the outbreak, you can also and control of these diseases. Some of these details
prepare maps of the area, which are often very useful at for FMD and CSF are provided in the appendices.
the time of the investigation. This information will help you to implement suitable
emergency control measures and provide advice to
When you travel to the outbreak area, make sure
farmers and other livestock owners.
that you have with you the facilities to record details
of outbreak locations. Facilities, in this sense, would Once you have prepared the equipment that you require
include a GPS-enabled smartphone and detailed maps and you have all the available information on the location
of the area (which would allow you to record the exact and the suspected diseases, you can then commence the
location of affected villages or households). field component of the outbreak investigation.

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5. Verifying that you actually have a problem

Verifying that you actually have an outbreak is the first 3. Time: details of the time of onset of disease in affected
step that occurs in the field. Once you have verified that an households, farms or villages.
outbreak exists, you should then proceed to:
1. Identify the possible causes of the outbreak. Further details and a more complete description of
important questions to ask are provided below.
2. Make an initial assessment of the extent of the outbreak.
3. Gather information to guide further investigation and Animal
control measures.
Animal factors are consistent with the description of the
‘host’ described in Chapter 2. Animal factors include details
Information gathering once you arrive at the outbreak farm
of the species, age and sex of disease-positive (‘affected’) and
or village will allow you to develop a list of differential
disease-negative (‘non-affected’) animals in the population
diagnoses, to understand the timing and extent of the
at risk. Enumerating the number of affected animals and
outbreak and to identify the index case. Identification of
comparing that number with the size of the population at
the index case and all cases prevalent at the time of initial
risk (that is, calculating an attack rate) and then comparing
investigation is important because it allows you to identify
attack rates for different classes of stock (e.g. different
the likely source of infection and where disease has spread.
species, different ages, different breeds) provides valuable
Often, you will have a suspicion of the disease causing the
information.
outbreak at this stage and it will be necessary to implement
control measures based on your assessment of the situation. There is some basic information that must always be
Rapid implementation of control measures, even before a collected during an outbreak investigation:
definitive diagnosis has been reached, will help to limit the 1. Counts of the animal population at risk of disease.
spread and the size of the outbreak. This section is divided Ideally this will be categorised into counts of individuals
into two parts, based on the information collected during by species and age.
this phase of the investigation.
2. Counts of the number of affected animals by species and
age (morbidity).

5.1 Gathering information 3. Counts of the number of dead animals by species and
age (mortality).
from stakeholders This basic information will often be recorded using an
It is important during this stage of the investigation that you outbreak investigation form. If the form is not available, you
collect core information from individuals closely involved can easily record the information in your notebook in the
with the affected animals, including farmers, livestock format shown in Table 1.
owners and livestock traders. An outbreak investigation
form (Appendix A) can and should be used to guide the Table 1: An example of recording animal information during an
questioning process during this phase of the investigation. outbreak using a simple table, where an outbreak investigation
However, you should understand the key questions and the form is not available.
objectives of this step, so that you can conduct interviews Location Total Sick Dead
and information-gathering exercises even when you are
Farm 1 - cattle 3 3 0
called unexpectedly to an outbreak and do not have the
Farm 1 - buffalo 1 0 0
form with you. The information that needs to be collected
can be divided into three main categories: Farm 1 - pigs 2 0 0
Farm 1 - goats 0 0 0
1. Animal: details of the animals involved in the outbreak
(species, breed, age).
Attack rates
2. Place: details of the geographical location of disease-
positive and disease-negative households, farms or When describing the frequency of disease in animal
villages. populations we use the concept of attack rates. The attack

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5. Verifying that you actually have a problem 15

rate is the number of cases of a given disease event divided

by the number of animals at risk at the beginning of an It is often useful to compare attack rates for different classes of
outbreak (in epidemiology, ‘attack rate’ and incidence risk stock:
[cumulative incidence] are synonymous). The attack rate
Attack rate for buffalo = 3 ÷ 30
provides a quantitative measure of the proportion of the at-
risk population that are disease-positive. Attack rate for buffalo = 0.10
Attack rate for buffalo = 10 FMD cases per 100 animals at risk.

Attack rate = Number of cases of disease Attack rate for cattle = 20 ÷ 100
Number of individuals at risk (1)
Attack rate for cattle = 0.20

In addition to calculating a point estimate of attack rate, we Attack rate for cattle = 20 FMD cases per 100 animals at risk.
also need to be aware of the certainty that we have about The FMD attack rate for buffalo is 10 (95% CI 4 to 26) cases per
that point estimate. A measure of certainty comes from 100 individuals at risk. The FMD attack rate for cattle is 20 (95% CI
calculating a confidence interval around the point estimate. 13 to 29) cases per 100 individuals at risk. This suggests that cattle
are twice as likely to be identified as FMD-positive, compared with
The point estimate of attack rate makes a statement of our buffalo. This example shows how attack rates can be useful for
best estimate of the true population value of the frequency comparing the frequency of disease in different groups of animals.
of disease in a given population at a given point in time. A similar process can be followed for sex, age or other variables.
A confidence interval around that point estimate provides
the likely range of values we expect that population value
to take. For example, a 95% confidence interval for a given
attack rate provides the minimum and maximum bound When using measures of disease frequency, you can see
of the attack rate values that encompass 95% of the true from the example above that we always include details on
population values. the number of animals affected and the total number of
individuals at risk. If we do not account for the size of the
The confidence interval for a proportion (i.e. an attack rate) population of individuals at risk we cannot make a valid
is calculated as follows: comparison across groups. For example, if we go to a village
and find that 30 young cattle (less than 24 months of age)
and 30 older cattle (greater than 24 months of age) have
pˆ ± (z × SEp) where SEp = pˆ(1– pˆ) (2)
FMD, we cannot make a valid comparison of the frequency
n
of disease across the two age groups because we have no
Where pˆ is the observed proportion, n the sample size and idea of the total number of animals present in each age
z the appropriate critical value from the z distribution (use group.
z = 1.96 if you are calculating a 95% confidence interval).
If it is established that there are 30 young cattle and 150
older cattle in the village, attack rates for the two groups
Consider an outbreak of FMD in a village where there are 100 would be calculated as follows:
cattle and 30 buffalo. Of this group, 20 head of cattle and 3 head of
buffalo are identified as FMD-positive. The attack rate would be: Attack rate for young cattle = 30 ÷ 30
Attack rate = 23 ÷ 130 Attack rate for young cattle = 1.00
Attack rate = 0.18
Attack rate for young cattle = 100 (95% CI 89 to 100) FMD
Attack rate = 18 FMD cases per 100 animals at risk. cases per 100 animals at risk.
The 95% confidence interval for the attack rate is:
SEp = [(0.2 × (1 - 0.2)) / 130]0.5 Attack rate for older cattle = 30 ÷ 150

SEp = 0.035 Attack rate for older cattle = 0.20

Lower bound of 95% CI = 0.2 – (1.96 × 0.035) Attack rate for older cattle = 20 (95% CI 14 to 27) FMD
cases per 100 animals at risk.
Lower bound of 95% CI = 0.13
Upper bound of 95% CI = 0.2 + (1.96 × 0.035)
Our analyses indicate that younger cattle are five times
Upper bound of 95% CI = 0.27 more likely to be affected by FMD than older cattle. This
The FMD attack rate in this village is 18 (95% CI 13 to 27) cases might be due to increased immunity in the older animals
per 100 individuals at risk. due to exposure to virus from a previous outbreak or due
to vaccination. Alternatively, it could be due to other factors

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5. Verifying that you actually have a problem 16

such as management differences or behaviour differences 2. Seasonal trends. A 12-month period used often to
between younger and older cattle. describe the cyclical pattern of disease that varies
according to the time of the year.
Some diseases have very obvious clinical signs and, if they 3. Long-term trends. An indefinitely long period (often
are present, arriving at a presumptive diagnosis is quite years) used to identify patterns of disease over extended
straightforward. For example, if vesicles are observed on periods of time.
the mouth and/or on the feet of cattle, buffalo and/or pigs
then you would have a very strong suspicion of FMD or The following list provides examples of some questions that
other vesicular diseases. might be asked relating to the time factor of an outbreak.
Again, this list is not exhaustive.
If less-specific signs are observed, such as fever, lethargy and – When did the outbreak start?
inappetance, it may not be possible to come to a provisional
– When were clinical signs first seen?
diagnosis based on clinical signs alone. However, if a
number of animals are affected with these signs, this – When was the last outbreak of this disease, or similar
should be enough to prompt implementation of control clinical signs seen in this household, farm or village?
measures in order to prevent further spread of disease.
– How often have you experienced an outbreak like this
Further investigation can continue once control measures
one?
have been put in place. Veterinarians and veterinary para-
professionals should be familiar with the clinical signs of the – On which household, farm or village were clinical signs
major (important) infectious diseases of livestock in their first noticed?
area. Appendices B and C of these notes provide summary – In which animal were clinical signs first noticed?
information on the aetiology, epidemiology, clinical signs,
and diagnosis of FMD and CSF, respectively.
Place
The following are provided as examples of the type of Describing an outbreak in terms of place can yield important
questions you might ask in order to understand better information about the cause of an outbreak. For cattle in
the animal factors in an outbreak situation. This list is not a feedlot situation, we might look at the pattern of the
exhaustive and you are encouraged to add more questions outbreak among different pens or buildings of the feedlot.
depending on the situation and your experience. More often, however, we would be considering patterns on
– What species are affected? a larger scale, such as different households or farms within
a village, or villages within a village tract.
– What are the clinical signs observed?
– How many animals are affected in the farm/village? It is often useful to consider place and time together. A useful
way of documenting place and time is to draw a plan of the
– How many susceptible animals are there in the
layout of the village (or farm, or village tract) and record on
household, farm or village?
that map the dates on which clinical signs were observed.
– What is the age of affected animals? Such a diagram can provide important information on the
pattern of the outbreak. It is often helpful to sketch this
– What is the gender and stock class of affected animals:
type of diagram during your visit to the affected area. Figure
male, female or both?
10 shows a diagram of a village affected by FMD.
– What is the management system in the village: free
grazing, tethered in household, commercial farm, etc? A diagram similar to that shown in Figure 10 can be
– In which animals (species, age, sex) were clinical signs constructed during an outbreak investigation in order to
first observed? guide further questioning about the source and spread of
the outbreak. In order to construct such a diagram, the
following questions could be asked:
Time – What area is affected by the outbreak –– a feedlot, village,
village tract?
There are three basic time spans used to describe the
temporal pattern of disease: – In which farm were clinical signs first observed?
1. Epidemic period. A period of variable length depending – At each farm (or pen, or village) ask what date were
on the duration of a particular outbreak. clinical signs observed in that place.

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5. Verifying that you actually have a problem 17

– Is the affected farm or village near to a livestock market Now that we have established the type of information
or slaughterhouse? to collect, we should consider methods of collecting
– Have outbreaks of disease like this been experienced in information. On arrival at the village, you are likely to meet
this place before? with the local authority, the village head and the farmer
who reported the outbreak, along with other farmers and
stakeholders. How you proceed to collect information will
5.2 Putting it all together depend on the local situation and customs in a given area.
It may not be suitable to use an outbreak investigation
We have now covered the concepts of collecting information form while retrieving information from these people, as
about animal, time and place in order to understand outbreak they might become worried about the information being
patterns. We have outlined some questions that can be asked
reported in an official document. Sometimes, you will
during the investigation, noting that the questions provided
need to collect the information through discussion, make
can be expanded to gather more information. It is important
to use an outbreak investigation form to guide the interview some rough notes and then complete the form later. There
process and information-gathering procedures, but the are different ways of gathering information in the village
investigator must also be equipped with a sound working setting. Further details on how to organise and conduct
knowledge of the important infectious diseases of livestock these meetings is provided in Chapter 10. Here, we look at
in his/her area so that investigations can be implemented just two examples of how information might be collected
quickly if and when they are necessary. from stakeholders in the field.

Figure 10: A sketch of the outbreak area (constructed with the assistance of local livestock owners) is a useful way to describe and
understand the spatial distribution and timing of disease events. In this example, we can see that Farm 1 was the first place where
clinical signs were seen. Therefore, Farm 1 is the index case for the outbreak in this village. By knowing when disease occurred on
each farm, we can understand better how the disease might have been transmitted between farms. A diagram such as the one above
will help to prompt further questioning. For example, does Farm 1 use the common grazing area (indicated by the red-shaded area) and,
if so, which other farms use this grazing area?

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5. Verifying that you actually have a problem 18

A group meeting such as a Dutaik1 meeting (see Figure 11) 4. The total number of susceptible animals.
to discuss the outbreak with a number of farmers and
5. The number of affected animals and number of dead
also other people from the village can often be useful for
animals.
collecting outbreak information. At such a meeting, farmers
might share their experience of past outbreaks similar to the 6. The time when clinical signs were first observed.
current one. A village meeting provides a good opportunity
7. A description of the clinical signs.
for you to discuss with stakeholders how you will proceed
with the investigation and the control measures that will
be implemented. Ensuring that all stakeholders are well Clinical examination of affected animals is an important
informed is one way of ensuring that control measures will part of the outbreak investigation process. The veterinarian
be conscientiously followed. or the veterinary para-professional should wear appropriate
protective clothing and they should be able to safely restrain
affected animals, conduct a thorough clinical examination
and then make an assessment of the similarity of the observed
clinical signs with those of the important infectious diseases
of livestock such, as FMD and CSF (Appendix B and C).

In order to ensure that biosecurity remains paramount, you

should set up two types of outbreak investigation teams:
one team that will investigate known infected areas, and
another team that will go to areas still considered to be free
of disease. The purpose of the second group is to conduct
active outbreak investigation to search for unreported cases
of disease. Use of a ‘clean’ investigation team means that
Figure 11: Small group discussions or individual discussions can there will be no way that veterinary staff can be responsible
be useful for gathering information. for introducing infection into areas that are free of disease.

Sometimes, you may interview a number of farmers At the same time that you examine animals in an affected
individually in order to get detailed information on the area, samples should be taken to aid diagnosis and to provide
outbreak occurring in their animals, or you may organise further epidemiological information on the outbreak. This
small group discussions between a number of farmers, may include blood and/or serum samples but, in the case
perhaps where there are a number of neighbouring farms of CSF suspicion, a post-mortem examination may be
affected. required. If a post-mortem is performed, appropriate tissue
samples should be taken for virus isolation.
While you are gathering information on animal, time and
place during this step, it is important that the information
you collect is accurately and consistently recorded (see
Figure 12). Filling in an outbreak investigation form
for each household, farm or village affected provides a
convenient means for doing this. If you do not have the
outbreak investigation form with you at the time of the
outbreak, some simple and effective methods can be used
for recording key information. This information might be
collected into a note book or into your office log book. The
details recorded for each household, farm or village include:
1. The name of the person responsible for the care of the
affected stock.
2. The location of the household, farm or village.
Figure 12: Small group discussions or individual discussions can
3. The species of animal affected. be useful for gathering information.

1 A Myanmar term for a community gathering where people sit in a circle with
their knees touching each other’s

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 19

6. Implementing emergency control measures

6.1 Principles of control disease agent’s life cycle is often its most vulnerable, and
is therefore easily targeted by intervention measures.

measures and biosecurity For example, FMD virus is sensitive to pH and can be
easily killed using appropriate disinfectants (Appendix
E). Understanding what kills causative agents will help
One of the major objectives of investigating an outbreak you to devise and apply effective control measures.
of disease is to control the spread of disease and then to
eradicate disease as quickly as possible. A rapid outbreak 3. Maintenance. Understanding how a disease agent is
response and the swift implementation of appropriate maintained within a host population is vital for devising
and effective control measures are vital for successfully effective control and eradication measures. For example,
controlling disease. This may involve introducing very FMD virus might be maintained in carrier animals or
simple control measures, such as preventing animals in sub-clinically affected animals. While these may or may
outbreak areas and surrounding areas from using shared not pose a risk to susceptible animals, it is important
grazing areas. It could also involve keeping susceptible, to be aware of the potential for FMD-infected animals
as well as infected, animals confined to their household to be present without showing clinical signs. This can
to minimise the risk of contact between infected and be important when designing a control programme. A
susceptible animals. control programme that targets only animals showing
clinical signs will not control sub-clinically affected
Biosecurity is vital in containing an outbreak. Biosecurity animals or animals incubating disease. Therefore, these
measures are the measures taken to reduce the chance of animals may continue to pose a threat to susceptible
transmitting infection from an infected area (or animal) animals and facilitate continued spread of disease. By
to an unaffected area (or animal). This includes the understanding the risk presented by these animals,
measures applied on the farm itself (both affected farms control measures can be expanded to include all animals
and unaffected but at-risk farms) and the measures applied that may have been in contact with infected animals,
when leaving/entering the farm. Veterinarians, veterinary regardless of whether they are showing clinical signs.
para-professionals and any other personnel involved in the
outbreak investigation will often disinfect their footwear,
change their clothes and bathe before leaving an infected
6.2 Implementation of control
area, and will disinfect their vehicles and equipment both
when leaving an infected area and entering an unaffected
measures and biosecurity
area.
– STOP animal movements –– provide instructions to
The central concept and objective of control measures and the farmer about how to manage stock without moving
them.
biosecurity is to prevent transmission of infection from
an infected animal to a susceptible animal, and therefore – Leave vehicles outside the farm when you make a visit.
break the transmission pathway (see Chapter 2 on why an – Wash and disinfect all equipment and vehicles before
outbreak occurs). There are a number of ways in which leaving farms.
the transmission pathway can be interrupted, but in order – All people leaving a farm must disinfect footwear and
to do this effectively, it is necessary to understand certain change clothes.
characteristics of the disease agent involved in the outbreak. – Nobody should leave an infected farm to visit other
The following information should be known: livestock premises.
1. Transmission dynamics/transmission pathway. – Minimise the number of people and vehicles entering/
It is important to understand how a disease agent is leaving the infected premises.
transmitted from an infected animal to a susceptible
animal. Transmission can be direct, indirect or vertical
Implementation of emergency control measures and
(from parent to offspring).
biosecurity should be rapid and based on concepts of
2. Survival of the infective agent in the environment. It preventing transmission of infection between infected
is important to know how the causative agent survives and susceptible animals. Control measures should be
in the environment. The environmental stage of a maintained until disease has been eradicated and should be

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6. Implementing emergency control measures 20

supported by strong communication and public awareness should only be lifted 30 days after clinical signs in animals
campaigns. If farmers, the public and other stakeholders are in the last infected premises have resolved.
not well informed of the reason for implementing disease
control measures and the importance of maintaining these Where possible, farmers should be provided with suitable
measures, it is likely that there will be poor compliance. It disinfectants and given thorough instructions on how to use
is also important that, as a veterinarian or veterinary para- them (including how often to change disinfectant solutions
professional, you set an example for others to follow by and how to get more disinfectant when existing supplies are
using good biosecurity procedures during your work in an running low).
affected area.
Farmers and other livestock keepers/handlers in an
Communication and control measures affected area should be advised against travelling to other
You should also discuss the control measures to be areas where livestock are present and should minimise
implemented with stakeholder groups. Stakeholders movement of people and vehicles from the infected/
will include anyone affected by the outbreak or by the suspect area to other areas. It is not practical or ethical to
control measures imposed. Stakeholders will include stop movement of people, but they should be requested
local authorities, police, municipal officers, livestock to carry out disinfection procedures before leaving the
traders, livestock-market owners, other farmers and the affected area, and others should be told to avoid visiting
general public. How information is disseminated to these affected areas where possible. Again, communication is vital
stakeholders will depend on the local situation. Group and it is important to inform farmers of how easily, and
meetings in an affected village or area are often useful ways of by what means, infection can spread. If farmers and other
providing information while also providing an opportunity stakeholders have a clear understanding of why the control
for stakeholders to raise questions or concerns about measures are necessary, they will be more likely to comply
how disease is being managed. Similarly, village meetings with your directions.
should be organised in the villages that are neighbouring
those that are affected to provide advice on biosecurity and
preventative measures. For example, if a village (Village 1)
is infected with FMD and the neighbouring village (Village
6.3 Treatment of affected
2) is free of disease and both villages usually share a water
source on the main road, the farmers from Village 1 should
livestock
be told not to take animals to the water source, because they The type of treatment required for affected animals in an
risk spreading infection from that village to other areas. It outbreak will depend on the particular disease involved and
is also important, however, to advise farmers from Village on the treatments available to you. Some specific instructions
2 to avoid taking animals to that water source while the for the treatment of FMD and CSF are provided below. It
outbreak is occurring, as this will prevent their animals is important to note that there is no specific treatment for
becoming infected and taking the disease back to their viral diseases (excluding anti-viral drugs, which are not
village. Common water sources are an area where there readily available or cost-effective for domestic livestock).
is often mixing of animals and therefore increased risk of Supportive treatment should be provided during the acute
disease transmission. stages of disease. Where sound scientific justification exists,
antibiotics may be used in very select cases to treat existing
Practical implementation of control measures secondary bacterial infections. However, use of antibiotics
to prevent secondary infections, or without sound scientific
All movement of susceptible livestock should be stopped in justification, is not recommended.
affected and adjacent areas. This includes any movements
that allow contact between infected and susceptible animals
When attending an infected area to treat animals, you must
and includes movement for trade as well as normal daily
follow strict biosecurity measures. Veterinarians have been
movement for work or grazing. Animals that are not
known to cause the spread of disease from infected areas to
showing clinical signs but have come into contact with
non-infected areas following visits to treat infected animals.
affected animals should be included in movement controls.
Whenever more cases of disease are found, the control
area should be expanded to include the village tract and Foot-and-mouth disease
surrounding areas in which susceptible animals may have
The following measures should be taken for livestock
grazed. Animal movement controls should remain in place
affected with FMD. Some of the treatments described may
until the outbreak has been brought under control. Controls
not be available to you or may not be affordable by the

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6. Implementing emergency control measures 21

farmer, while others require minimal materials and should 4. Affected animals should have easy access to water
be available to all. While every situation is different, the without walking, particularly when lameness is severe.
information provided below should provide guidance when
you are faced with the need to treat animals involved in an
Classical swine fever
outbreak of FMD.
1. Responsible use of broad-spectrum antibiotics. There is no treatment for CSF. Affected animals should
While FMD is a viral disease and will not, therefore, be be slaughtered for welfare and for control purposes. The
responsive to antibiotics, secondary bacterial infections disease should be explained fully to the farmer so that he/
of lesions may occur. Where such secondary infections she understands the seriousness of the disease and the
become debilitating, treatment with appropriately need for such severe control measures. The clinical signs
selected antibiotics may be warranted. However, of CSF vary from sub-clinical (and therefore unapparent
irresponsible use of antibiotics risks development of infection) to severe disease and death. Livestock owners
antibiotic resistance, which is an increasingly serious are likely to reject the request to slaughter animals when
issue globally. Use of antibiotics prophylactically to sub-clinical infection is present and animals appear healthy.
prevent secondary bacterial infections, or without
Good communication is essential to maintain the trust and
sound scientific justification, is irresponsible and not
support of livestock owners in this situation and to help
recommended.
them to understand the seriousness of the disease and the
2. Advise the farmer to provide soft bedding and soft need to cull infected animals.
feed. This will make the animal more comfortable and
encourage eating when lesions in both the feet and
mouth are severe.
3. Extra attention should be given to suckling young
in case they are prevented from suckling due to
maternal teat lesions. Additional milk should be made
available to ensure that the young are adequately fed
during this time. Milk should be taken from the same
species of animal as the young. Young animals should
not be taken to another village or farm to be fed as this
may spread disease.

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7. Tracing cases
Every outbreak of an infectious disease will have a source of the spread of an outbreak from an infected source is known
infection, and in almost all situations, there will be spread as ‘trace-forward’. The information collected during tracing
of disease from this initial source. The source of infection can be used to:
can be anything capable of bringing a disease agent from
– Find affected areas and implement control measures in
an infected animal in one area to a susceptible population
those areas to limit further spread
in another area, or at another time, and establishing an
outbreak. Possible sources of an outbreak might include: – Find the source and implement control measures to
prevent further exposure to the source
– An infected animal showing clinical signs that is
introduced to a new area with susceptible animals – Provide information on possible sources and routes of
spread to help prevent future outbreaks
– A sub-clinically infected animal, or an animal incubating
the disease, that is introduced to an area with susceptible
animals
– A vehicle or person that has visited an infected area 7.1 Defining an outbreak
and carries the disease agent to an area where there are
susceptible animals In order to understand and identify the source and spread
of an outbreak, it is important to determine when one
– Contaminated meat from an infected animal, where this outbreak ends and another begins, as each individual
meat is consumed by susceptible animals outbreak will have a different source and must be traced
separately. To determine what constitutes a single outbreak,
The spread of an outbreak involves the transmission of and what constitutes a separate outbreak, we must define
the disease to other animals and other areas. The spread of exactly what we mean by the term ‘outbreak’. To do this, we
disease from an initial source can be by: use an outbreak definition. The outbreak definition below
is used by the SEACFMD campaign to define what is meant
– Movement of infected animals to areas where there are
by a single outbreak of FMD.
susceptible animals
– Direct contact between infected and susceptible animals An FMD ‘outbreak’ is defined as the occurrence of FMD in one or
that share common areas more animals on a farm, in a village, or in a group of animals sharing
a common area (e.g. pastureland, watering point, slaughterhouse,
– Movement of contaminated people, vehicles or market). All cases occurring within 2 weeks of the previous case are
equipment from an infected area to other areas where regarded as part of the same outbreak.
there are susceptible animals
– Any other means of transmitting the disease agent from You can see that the definition provided above explicitly
an infected animal to a group of susceptible animals takes into account the three elements of animal, time and
place. The space aspect describes how affected animals
In order to find the source of an outbreak and trace its that belong to the same farm, village or common area
spread, it is important to understand what materials (pastureland, watering point, slaughterhouse, market) are
(animal, human, vehicle, and equipment) might be able considered to be part of the same outbreak. This accounts
to transport the disease agent between infected and for local transmission between animals that come into
susceptible animals, and also the types of infected animal regular contact and share common areas. For example, if
that can directly transmit the disease agent to susceptible two villages use a single grazing area where animals mix
animals. All of these potential methods of carrying disease and FMD is found to be present in both villages, this will
from one infected animal (or area) to an animal (or area) constitute a single outbreak and will be assumed to have
free of disease are known as risk materials. A description originated from a single source.
of the transmission dynamics and a list of risk materials for
FMD and CSF are provided in Appendices B and C. The time aspect is also important when defining an outbreak.
According to the definition above, to be considered part of
The method of identifying the source of an outbreak and the same outbreak, additional cases must occur not longer
finding the spread of that outbreak is called tracing. Tracing than two weeks after a previous case. The two-week time
the source of an outbreak is known as ‘trace-back’; tracing period relates to the maximum incubation period of FMD,

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7. Tracing cases 23

so that animals that are affected more than 2 weeks after 2. The identity of the index case farm
previous cases are unlikely to have been directly infected
3. The date clinical signs started on the index case farm
by the previous cases and must have been infected by a
different source. The later cases are then said to belong to a
Incubation period is defined as the period of time between
new outbreak.
the date of infection and the date of onset of clinical signs.
The incubation period for any disease will be given as a
For every separate outbreak, tracing should be carried out
range, e.g. the incubation period of FMD is 2 – 14 days.
to determine the source and spread of disease. This allows
for control measures to be implemented in order to prevent
The index case (animal, household, farm or village) is the first
continued exposure of susceptible animals to the source of
case (animal, household, farm or village) identified as infected
disease, and to prevent further spread of the disease from during an outbreak. If we are investigating an outbreak of
infected to susceptible animals. disease in a village and farms are the epidemiological unit
of interest, the index case can be identified by interviewing
farmers. A group of farmers might be asked which farm in
7.2 Tracing windows the village was first affected by the disease, or which farmer
first noticed disease in his/her animals. Alternatively, you
Before you can begin to trace the source and the spread of an could approach each farmer individually and ask them when
outbreak, you will need to gather information to construct a they first noticed signs of disease in their animals. Identifying
‘tracing window’. A tracing window refers to the most likely the index case is important for tracing, as the index case is
period of time during which the disease could have been assumed to be the case which was exposed to the actual
introduced to an area (tracing window for source), or the source of the outbreak.
most likely period of time during which the disease may
have spread to another area (tracing window for spread). The information collected during the process of outbreak
verification (and described in Chapter 5) should be sufficient
The tracing window for source is used to guide further to construct tracing windows. This information will usually
questioning on the trace-back of an outbreak (to find the be collected using the outbreak investigation form. In this
source), and the tracing window for spread is used to chapter, we will continue with the same example introduced
trace-forward (to find the spread) of an outbreak. We will in Chapter 5, in which it was shown how to make a diagram
consider here the information required for construction of of an FMD-infected village, including details of the time
and place of FMD-affected farms. It will be shown here how
a tracing window and how to construct the tracing window
we can use this information to construct a tracing window.
based on this information. We will then consider how to use
the tracing window to guide questioning to find the actual
We can see from Figure 13 that FMD was first recognised in
source of disease and identify potential areas to which the
Farm 1 on 12 October 2008. Therefore, for this example,
disease could have spread. Table 2 outlines the information we would say that the index case was Farm 1 and we
that will need to be collected to construct a tracing window. assume that the other farms were infected as a result of
spread of disease from Farm 1 through sharing of grazing
The information that is collected from the field and land, visiting common water sources, and other means of
from other information sources is used to determine the transmission between infected and susceptible animals.
main parameters needed to construct a tracing window. Based on the clinical signs observed in affected animals,
These are: you suspect that the disease responsible for this outbreak is
1. The minimum and maximum incubation periods of the FMD. You then look up the incubation period for FMD and
disease find it to range from 2 to 14 days (Appendix B).

Table 2: Information needed to construct a tracing window

Information required Information source
Details of the disease cases (affected animals, farms, villages etc.) in area where Field investigation: outbreak investigation form; village meeting; individual
investigation is being conducted. questioning.
Date when clinical signs first seen for each case (animal, farm, village etc.). Field investigation: outbreak investigation form (Appendix A); village meeting;
individual questioning.
Minimum and maximum incubation periods for the suspected disease. Text books, OIE Terrestrial Animal Health Code, Appendices B and C of this
manual.

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7. Tracing cases 24

Figure 13: An example of recording cases in time and place.

We now have the following information that will allow us to to the source of disease and onset of clinical signs in the
construct a tracing window: index case.
1. The incubation period of FMD is 2 to 14 days
To calculate the earliest time at which the disease could
2. The index case is Farm 1 have been introduced to the index case, the maximum
3. The date of onset of clinical signs on the index case farm incubation period is subtracted from day 0. So, from the
was 12 October 2008 example, we would say that the earliest time that disease
is introduced to Farm 1 is 12 October minus 14 days (the
maximum incubation period for FMD). So, the earliest time
Constructing the tracing window for the infection could have been introduced is the 29 September
infection source 2008. We say, therefore, that on 29 September 2008 the
When constructing the tracing window, we will refer to the tracing window opens.
day when clinical signs are first seen on the index case farm
as day 0. So, for our example, day 0 is 12 October 2008. We then need to know what is the latest possible time that
Once you have identified day 0 you will need to calculate the disease could have been introduced for clinical signs
the time period during which the index case must have to be seen on day 0. To calculate this, we subtract the
become infected such that it would start to show clinical minimum incubation period from day 0. For our example,
signs on day 0. By doing this, you are identifying when the we subtract 2 days (minimum incubation period for FMD)
index case could have been exposed to the source of disease. from 12 October 2008 (day 0). So, the latest time that
This time period is calculated using the incubation period. infection could have been introduced is the 10 October
The incubation period is used because this represents the 2008. We say that on the 10 October 2008 the tracing
time from infection to onset of clinical signs and therefore window closes. The construction of a tracing window for
accounts for the delay between exposure of the index case the infection source is shown in Figure 14.

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7. Tracing cases 25

Maximun incubation period

Minimum
incubation
period

Day of onset Day of

of signs investigation

Tracing window for source

Control
measures
start

Figure 14: Construction of a tracing window for the infection source.

animal (this animal may not have been showing signs of

Using the tracing window for the infection
disease when it arrived on the farm, and may not even have
source: trace-back developed clinical signs of disease), delivery of contaminated
As described earlier, the purpose of tracing is to identify the animal feed, a visit from a person living in an area where
source of an outbreak and target control measures at limiting there is an outbreak of FMD, or a visit by a veterinarian
or village animal health worker that has previously treated
further exposure of susceptible animals to that source. Once
infected animals and not followed correct biosecurity
the tracing window has been calculated, this should guide
procedures. The farmer must be thoroughly questioned
further questioning on risk materials being introduced to
about all possible routes of infection onto the farm. Each
the area during that time, which could represent the source
potential source that is identified should be followed up by
of infection. In this context the term ‘risk materials’ refers to the investigating team to determine whether or not it could
anything on which a disease agent can be transferred from represent the source of disease.
an infected animal to a susceptible animal. Risk materials
for FMD and CSF are listed in Appendices B and C.
In this example, we might establish that, between 29
September and 10 October, Farm 1 had bought draught
Using our example, we have identified the index case as cattle from a livestock market in another township and had
Farm 1 and the tracing window for source as 29 September been visited by someone from a village nearby that keeps
2008 to 10 October 2008. Therefore, we need to question cattle and pigs. We might also find out that the manager of
the farmer from Farm 1, and also other farmers and Farm 1 does not buy feed from other farms but grows his
stakeholders, regarding possible risk materials that were own animal feed. You must follow up both the purchase
brought onto Farm 1, or which may have come into contact of the cattle and the visit from the nearby village. On
with animals from Farm 1, between 29 September and 10 following up, you find that there has been no reported
October 2008. This might include purchase of an infected outbreak of disease at the livestock market where the cattle

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7. Tracing cases 26

were purchased, or at the village of the person who sold the window for spread closes when no further spread from the
cattle. You then follow up the person that visited and found outbreak area is possible. The point at which this situation
that his animals had, indeed, been showing signs of disease is reached varies considerably in different situations. For
before he visited Farm 1, and he described clinical signs example, if no control measures are implemented, there
similar to FMD. This is the most likely source of disease and is potential for the disease to spread until all the affected
control measures should be implemented on that person’s animals have recovered and have stopped shedding virus.
farm to prevent further exposure to the source. For FMD, this is often taken to be at least 30 days after the
affected animals have recovered from the disease. If effective
Constructing the tracing window for spread control measures are implemented, however, the tracing
window may close much earlier, providing the control
To identify where a disease may have spread, another tracing measures prevent further spread of infection.
window must be calculated — the tracing window for spread.
The tracing window for spread covers the period of time Using our example, suppose that the outbreak at the village
during which infection could have been transmitted from the is reported to you on 21 October 2008 and, when you go
outbreak area which you are investigating, to other areas. It there, you discover from your interviews that the earliest case
is important to identify the areas to which disease may have was on Farm 1 on 12 October 2008. During your initial visit
spread so that control measures can be implemented in those on 21 October, you perform a clinical examination of the
places to limit further, ongoing spread of disease. The tracing animals and find that they are displaying symptoms typical
window for spread extends from the earliest time that the of FMD. Based on your suspicion, you decide to implement
disease could have spread from the infected area up until the emergency control measures (see Chapter 6) and you stop
time that no further spread is possible. The earliest time the animal movement into and out of the village and provide
disease could begin to spread is taken to be the same as when instructions to the farmers and traders in the village to use
the infection is introduced to the area. So, the tracing window strict disinfection procedures if they are leaving the affected
for spread opens at the same time as the tracing window for area. These control measures are implemented immediately
the source. To calculate the earliest time when disease could and prevent further spread of the disease from the outbreak
have spread from the outbreak area, subtract the maximum area. So, we assume that no further spread occurs after 21
incubation period from day 0. October. This, therefore, is when the tracing window for
spread closes. Your investigation will then need to continue
From our earlier example, day 0 was 12 October 2008. examining possible routes of spread from the affected area to
Therefore, to calculate when the tracing window for spread other areas between 29 September 2008 (when the tracing
opens, subtract 14 days (the maximum incubation for FMD) window for spread opens) and 21 October 2008 (when
from 12 October 2008. This means that on 29 September the tracing window for spread closes). Figure 15 shows an
2008 the tracing window for spread opens. The tracing example of the tracing window for spread.

Maximun incubation period

Minimum
incubation
period

Day of onset Day of

of signs investigation

Control
measures
start
Tracing window for spread

Figure 15: Diagram to show the construction of a tracing window for spread.

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7. Tracing cases 27

Using the tracing window for spread: trace- area in order to limit the risk of transmitting disease with
forward the investigation team). Where disease is found, control
measures should be implemented immediately and tracing
Once the tracing window for spread has been determined should commence as for the previous affected area. This
it can be used to guide your questioning on possible spread process of tracing, follow up and implementation of control
of disease from the investigation area. This is important as measures should continue until no further cases are found
there will often be some spread of disease from the initial and the outbreak is eradicated. Remember that if a risk
source. The areas to which the disease has spread must be material has been moved to an area recently (within the
identified as soon as possible so that the outbreak can be maximum incubation period of the suspected disease) the
controlled rapidly. To do this, it will be necessary to ask animals in that area may be infected but not yet showing
farmers and other people in the affected area about the clinical signs. Therefore, control measures should be
movement of risk materials from the affected area to other implemented where there is a risk that disease may have
areas during the period of time identified as the tracing spread to an area, and the animals must be kept under
window for spread. observation. Once they have been under observation for at
least the maximum incubation period (14 days for FMD)
Returning to our earlier example, the tracing window and no clinical signs have appeared, control measures can
for spread was taken to be from the 29 September to 21 be lifted. If clinical signs do appear, then control measures
should be maintained. A summary of the tracing window
October. You should therefore ask about any movements of
methodology for source and spread are shown in Figure 16.
animals (even if they did not show clinical signs), people,
vehicles, milk or feed from the affected village to other areas
during this period. For each area identified as a recipient
of potentially infected material, you must follow up to
determine whether disease transmission actually occurred.
Each area identified should be visited (preferably by an
investigation team that has not been involved in the affected

Maximun incubation period

Minimum
incubation
period

29 Sep 10 Oct 12 Oct 21 Oct

Day of onset Day of

of signs investigation

Tracing window for source Control

measures
start
Tracing window for spread

Figure 16: Diagram showing construction of tracing windows for source and for spread using the example of an
FMD infected village.

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 28

8. Collecting samples
Collection of samples for laboratory testing is an important Details of sample collection, transportation and submission
part of the investigation and can be used to confirm a are provided in Appendix F.
diagnosis, determine the strain of the agent involved and,
in some situations, provide additional information on the
epidemiology of the disease. Consideration of the type
of samples to collect and how they should be stored and
transported to the laboratory are important, because these
decisions will influence the diagnostic value obtained
from the samples when they are examined (tested) in the
laboratory.

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 29

9. Participatory epidemiology
Participatory epidemiology (PE) is the systematic use 2007). The key principles of participatory appraisal that
of participatory approaches and methods to improve the investigator needs to keep in mind when collecting
understanding of the patterns of diseases in populations information are listed in Appendix G.
and thereby improve options for animal disease control.
PE developed from participatory rural appraisal (PRA) in Four main participatory methods are used in PE (Table 3)
the 1980s, when veterinarians started using participatory (Jost et al., 2007; Catley et al., 2012):
methods in community-based projects in Africa and Asia. 1. Informal interviews
Both PE and PRA are multidisciplinary approaches to various
2. Focus groups discussion
development problems in rural communities, but PE evolved
with a focus on livestock diseases (Catley et al., 2012). 3. Visualisation methods
4. Ranking and scoring
The term ‘participatory’ is used to refer to the essential
involvement of communities in defining and prioritising A basic assumption is that investigators cannot fully
veterinary-related problems, and in developing solutions to anticipate the priorities and problems of the community
veterinary service delivery, disease control or surveillance. they study. Thus, the participatory process empowers the
PE is based on conventional epidemiological concepts and stakeholders, since they are the ones who identify and
allows for the investigation of interactions between host, describe the problems. This ensures that field approaches
agent, and environment, but in a social context of disease are flexible and allow time for the ‘discovery’ of new
transmission. It is based on what is called ‘existing medical information.
knowledge’ (Ameri et al., 2011).
Information gathered using participatory methods must
In the context of infectious disease outbreak investigation, always to be complemented by information from other
the purpose of PE is to get a whole community to take part sources, such as:
in achieving consensus about what has happened in the
past (e.g. how disease was introduced) and what to do in – Secondary information sources: obtained before going
the future (e.g. how best to manage disease outbreaks). PE to the study area and as the study is conducted
can also help in documenting the principal lessons learned – Direct observation: people, animals, housing,
from recent outbreaks, which can then be used as tools environment, etc. while in the study area
to inform veterinary preparedness and response plans for
future outbreaks. In Section 5.1 we briefly described how – Laboratory diagnostics: field diagnostic tests
to collect useful information from stakeholders, in the next complemented by sample collection and analysis by a
paragraphs we will discuss how PE can further help to refine regional or national laboratory for confirmation
data collection and offer new insights into the investigation.
All information collected is then validated by crosschecking,
using multiple techniques and informants: a process called
9.1 Participatory methods ‘triangulation’ (Fig. 17). In PE, two types of methodological
triangulation have been of particular relevance: ‘within-
The active participation of communities in analysing and method’ and ‘across-method’ triangulation. Within-
prioritizing local disease problems, and their involvement method triangulation can be explained using the example
in the design and implementation of research, surveillance, of an interview during which the researcher crosschecks
or disease control activities, is critical to achieving relevant information provided by an informant during the
and sustained benefits. At the initial stage of a participatory interview itself (also known as ‘probing’). Across-method
process, the relationship between outbreak investigator triangulation uses two or more different methods to study
and community members should be based on a common the same research question. For example, when used for
understanding of the objectives of the process, and the disease investigation or exploratory studies, triangulation
emphasis should be on joint analysis (Catley et al., 2012). can be carried out by crosschecking information within
specific participatory methods, by comparing the findings
Participatory approaches are based on open communication of different participatory methods, and by comparing
and transfer of knowledge, using a toolkit of methods findings of participatory and conventional veterinary
guided by some key concepts and attitudes (Jost et al., diagnostic methods.

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9. Participatory epidemiology 30

Table 3. Types of veterinary information collected using participatory epidemiology methods.

Method Information
1. Informal interviews
Semi-structured Used in most PE studies and in combination with visualisation, and ranking and scoring methods; also used as a stand-alone
interviews (SSI) method
Time-line History and timing of disease events
2. Focus groups
3. Visualisation methods
Participatory mapping Livestock movements with respect to the location of grazing areas and water points and spatial exposure to disease vectors
Seasonal calendars Seasonal variation in disease incidence; seasonal variation in human livelihoods; seasonal variation in the livestock trade and in
the consumption of livestock products; seasonal variation in contact with disease vectors, neighbouring livestock and wildlife;
seasonal variation in vector populations
Proportional piling Age structure of livestock herds; disease incidence and mortality estimates by age group; impact of vaccination on livestock
mortality; case fatality rates
Radar diagrams Analysis of disease control strategies
4. Ranking and scoring
Simple ranking Analysis of disease control strategies

Simple scoring Prioritisation of livestock diseases

Matrix ranking Analysis of disease control options

Matrix scoring Local characterisation of the clinical signs and causes of disease; local characterisation of disease vectors; comparison of clinical
diagnoses of livestock keepers and veterinarians; analysis of veterinary service providers
Before-and-after scoring Impact of veterinary services on livelihoods; impact of diseases

Direct observation
Direct observation Secondary Mapping
data & literature Venn and
Flow
diagrams
Semi-
structured
Visualisation
Transects
Structured
Informal
Triangulate
interviews

Timeslines Secondary
data & literature
Pair-wise
Ranking ranking
Direct observation & Scoring

Secondary Simple
data & literature Proportional ranking
piling Matrix
scoring

Direct observation

Figure 17. Types of veterinary information collected using participatory epidemiology methods (Catley, 2005)

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9. Participatory epidemiology 31

9.2 Attitudes and behaviours to include people who are not contributing to the
discussion.

in PE The team members need to carefully prepare how they are

going to run each session and who is going to say what. It
An important aspect of participatory approaches is the
can be very confusing for informants if, for example, the
way we interact with other people. This interaction
team members interrupt or contradict each other.
determines the relationship and trust that develops
between investigators and local people, and affects the
types of issues and information that people are willing to
discuss in an open manner. If we look at this issue from 9.4 Examples of useful
an epidemiological perspective, the relationship between
investigators and livestock keepers is a key factor affecting PE methods for outbreak
the reliability and validity of data. If informants are
concerned that investigators have a ‘hidden agenda’, will investigation
use the information solely for selfish purposes, or may pass
information to authorities, then their participation will be An important aspect of PE methods is their capacity to
poor. In addition, if informants consider outsiders rude reach illiterate people and involve them in description and
or arrogant, or only interested in their own opinions, the analysis of local problems. With methods requiring people
discussion will not be very constructive. to either write or understand text, illiterate people can
easily become isolated and may not contribute because they
For the interaction to be meaningful, investigators must are embarrassed, or because literate people dominate the
believe that an informant has something useful to say. This discussion. Many PE methods, such as interviews, matrix
means respecting local views and opinions, and being scoring, mapping, seasonal calendars, and proportional
open to ideas that may not necessarily agree with modern piling can be conducted using no written words. With
science. This does not mean that, as veterinarians, we must these methods, disease signs (such as mouth ulcers and
automatically accept all indigenous knowledge as valid and feet lesions for FMD, and skin lesions for CSF), disease
useful. The idea is to identify local knowledge and skills causes, parasites, livestock types and other items can be
that seem to agree with our professional expertise, and represented by either everyday objects or pictures. Pictures
explore this local knowledge. can be drawn or printed on to pieces of card and these cards
form the ‘labels’ for the method.

Semi-structured interviews
9.3 Team work
An interview is a focused conversation between two or
Many PE methods work best when a team of two or more more people. It is a method of collecting data by talking
investigators work together. Within the team, roles should to people and asking questions. In structured interviews,
be clearly defined. the instrument used to collect data is a questionnaire.
Questionnaires often use closed questions, which can
– One person should be the facilitator. The facilitator
usually be answered with ‘yes’ or ‘no’ or a short response.
introduces the session, asks questions, explains the
Generally, questions are asked in a manner such that the
method, and checks the information as it arises from
answers fall within an expected range of answers. By
the informants. Therefore, the facilitator interacts
restricting an interview in such a way, one risks losing
directly with the informants and does not need to write valuable information, viewpoints, and the context behind
anything down during the session. In other words, the a response. Remember, if it appears that a response is not
communication flow is not interrupted because the rational, then we have failed to understand some key factor
facilitator keeps stopping the discussion in order to in the situation. By avoiding closed-ended questions, we
write down what has been said. provide the respondent with the opportunity to explain to
– Another team member acts as the recorder. This person us the rationality behind a response.
usually sits slightly back from the group and records
the discussion or results of scoring methods as they For this reason, interviews in PE are semi-structured and
arise. The recorder also watches the group dynamics the interviewer uses checklists of topics to be covered rather
and looks to see who talks in the group and who does than a structured questionnaire. The interviewer introduces
not. If necessary, the recorder can remind the facilitator a topic using an open-ended question, i.e. a question

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9. Participatory epidemiology 32

designed to encourage a full, meaningful answer using the groups with particular characteristics, as this will allow
responder’s own knowledge and feelings. Typically, these more detailed information to be collected (e.g. within the
questions begin with why, when, how, what, where, who? group of livestock farmers, the ones that are responsible
After listening to a response, the interviewer can probe for trading). FGD vary in duration, but typically they are
further with clarifying questions. 1 – 1.5 hours long; often, the first discussion of each sub-
group is longer than subsequent discussions. The number
An example of an open-ended question would be: ‘What of FGD required depends on project needs and different
diseases affect your cattle?’ This allows the respondents to types of groups; generally, at least two groups per sub-group
provide direction to the interview and describe problems are interviewed. The methodology for running an FGD is
in their own terms. Once the participants have noted and described in Appendix G.
described problems, the team can then ask probing questions
to fill in any gaps and to check for internal consistency Participatory mapping
within the individual accounts. Summary guidelines for
semi-structured interviews are listed in Appendix G. Mapping is a type of visualisation method, which is a
popular participatory tool among animal health workers.
Mapping is a useful method for the following reasons:
Focus groups
– Both literate and non-literate people can contribute to
Holding a focus group discussion (FGD) is a method of the construction of a map (as it is not necessary to have
collecting qualitative data which is expressed in words, not written text on the map)
numbers, and there is no numerical generalisation. The
purpose of FGD is to obtain in-depth information on the – When large maps are constructed on the ground, many
concepts, perceptions and ideas of a group. This component people can be involved in the process and contribute
involves general discussion using open-ended questions to ideas. People also correct each other, and make sure that
explore farmers’ understanding of animal health services in the map is accurate
their area and their knowledge of public health, diseases – Maps can represent complex information that would be
affecting their livestock, and other diseases, including difficult to describe using text alone
zoonoses (Sihavong, 2009). FGD are often used to focus
research, for example, when broad research ideas need to – Maps can act as a focus for discussion
be refined or if there is the need to formulate appropriate
questions for structured (quantitative) studies. They can Mapping is best used with a group of informants, say
produce a lot of information quickly and they are very useful between 5 and 15 people, such as in a Dutaik meeting
for exploring beliefs, attitudes, behaviour and concepts in a (Figure 18). Find a clean piece of open ground. Explain
population. They can assist in understanding problems and that you would like the group to produce a picture showing
results from interventions and explore controversial topics. features such as:
– Geographical boundaries of the community; these
boundaries should include the furthest places where
people go to graze their animals (Fig. 19)
– Main human settlements
– Roads and main footpaths
– Rivers, wells and other water sources
– Grazing areas (particularly common grazing areas),
farmed areas, forests and other natural resources
– Ethnic groups
– Movements of livestock by livestock type
– Spatial contacts with herds from other communities or
Figure 18. A Dutaik (traditional Burmese meeting approach)
wildlife
meeting in a village, Myanmar. (Oo, 2010)
– Outbreak index cases
Specific groups are targeted based on the type of information
needed (e.g. within the village, a group of farmers in charge – Source of infection
of livestock). This group can then be divided into sub- – Disease spread

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9. Participatory epidemiology 33

Figure 19. Example of a map of a Northern Laotian village Figure 20. A ‘risk map’ showing an HPAI outbreak in an
affected by FMD. The map shows the location of the main Indonesian village.(Hendrickx and Pissang, 2010)
livestock types, areas of cultivation, geographical features and
possible sources of disease. The map was produced by district
veterinarians as part of an FMD outbreak investigation training
group exercise (OIE, unpublished data)

In order to collect valuable information about a disease similar items that are familiar to the community and locally
outbreak that recently occurred in a neighbourhood, or available) into different piles that represent the categories.
in a village, participants should be asked to list all of the For example, the community could give scores to a set of
disease determinants that they think are associated with the disease problems (the categories) according to the impact
outbreak and then draw a map of that outbreak, showing that the diseases have on their livelihood (the parameter).
as many of the disease determinants as they can. This type Alternatively, the community could be asked to score the
of participatory map is called a ‘risk map’ (Fig. 20), because diseases according to how frequently they occur. Semi-
the participants produce an image that shows the spatial quantitative data is collected by recording the number of
distribution of disease risk. When the group is happy that counters in each category.
the map is finished, they will need to explain the key features
of the map. The process of ‘interviewing the map’ enables It is extremely important for outbreak investigation, as
investigators to learn more about the map and pursue it can be used to define which risk factors have majorly
interesting spatial features. The methodology for developing contributed to the outbreak (Fig. 21), the relative incidence
an outbreak risk map is described in Appendix G. of the disease in the village, or the relative impact of the
outbreak on the livelihoods of farmers. An example of how
Proportional piling to use proportional piling is described in Appendix G.

Proportional piling is a tool that allows respondents to give Matrix scoring

relative scores to a number of different items or categories
according to one criterion. The scoring is done by asking In participatory epidemiology, clinical case definitions are
participants to divide 100 counters (beans, stones or important tools for probing local medical or veterinary

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9. Participatory epidemiology 34

100 stones
representing
FMD entry

FMDV is not
introduced

FMDV is
introduced

POSSIBLE ROUTES
Direct Animal
contact livestock to products
livestock
e.g. common grazing
lands Legal animal Ilegal animal Fomites People Vehicles Wildlife
movement movement

Figure 21. Example of the proportional piling method to estimate the risk pathway of FMD entry. Using a pile of 100 stones to depict an age group, the
informant was asked to divide the stones to show the pattern of ‘FMDV being introduced during the last year’ and ‘FMDV not being introduced during
the last year’. The pile of stones representing FMDV being introduced was then sub-divided by the informant to show the main transmission routes and
the extent to which each of them was responsible for viral introduction.

knowledge, and linking that knowledge to a practitioner’s can be a very useful tool for understanding the symptoms
knowledge about diseases and syndromes. We use signs, and epidemiological characteristics of the different diseases
symptoms, and epidemiological criteria to arrive at a respondents mention, as shown in Figure 22.
diagnosis. Clinical case definition is particularly important
to define the occurrence of an outbreak; it should provide
enough criteria so that the practitioner can arrive at the
expected level of certainty in his or her diagnosis, while
not being too prescriptive so that important cases go
undetected.

Matrix scoring can be very useful during outbreak

investigations, as it helps to build a clinical case definition
and verify if the outbreak has really occurred. The method
is essentially a series of proportional piling exercises in two
dimensions, where a list of items, such as diseases, is scored
against a list of indicators, such as clinical signs.

An important first step in any study is to understand how

community members think about and characterise diseases.
You may find, for example, that your respondents mention Figure 22. Matrix scoring of cattle diseases against disease
several diseases, each with their own name in the local signs by villagers in Svay Rieng province, Cambodia.
language, but to you they seem very similar. Matrix scoring (Bellet et al., 2012)

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9. Participatory epidemiology 35

It is important to note that when a clinical case definition is During an outbreak investigation, participants can be
being used for early detection of outbreaks, it may be quite asked to construct an outbreak timeline. The investigator
broad, as this will ensure that it picks up all potential cases. can decide on a timescale that will capture all of the events
A laboratory test is then required to confirm the diagnosis. during the outbreak, as well as events before and after that
The methodology for developing a matrix score for disease had a bearing on the outbreak. Key events that both the
identification is described in Appendix G. investigator and the participants can identify are included
(e.g. early warning released). All of the outbreak events are
listed and when all the indicators are ready, a timeline can
Seasonal calendars and timelin es
be prepared.
Many human and animal health problems show seasonal
variation. A seasonal calendar can be used to visualise
and analyse local perceptions about the seasonality of
disease incidence, vector populations, risk factors, farming 9.5 Data analysis
practices, etc. The seasonal occurrence of diseases is
interesting to understand in relation to the seasonality The flexibility of participatory appraisal allows practitioners
of factors that affect their occurrence, such as climate, to review and analyse data on the spot and make changes
management practices, vectors, etc. New or unusual factors to the appraisal checklist. The appraisal team is encouraged
may emerge that are important in a particular area. Factors to discuss observations as the need or interest arises.
linked to the occurrence of the outbreak can be related to Every few days, the team should review the progress of
particular seasonal events. In addition, timelines are useful the appraisal in a systematic manner and assess if the right
tools for exploring the frequency of key disease events and types of questions and exercises are being carried out.
patterns over time and estimating the duration of outbreaks Perhaps new elements of the community or a new class of
and other disease events. key informants have become known and need to be worked
into the interview schedule. Alternatively, a new item for
Seasons are defined by different characteristics in different probing or ranking exercises has become a burning issue
regions. Understanding the characteristics that are used to (Mariner and Paskin, 2000).
define the seasons in the area under investigation is the first
step in creating a seasonal calendar. Other seasonal events
It is the spirit of participatory appraisal that analysis is
(indicators) can then be investigated. Human activities,
continuous. Hypotheses are continuously refined and
namely political, religious, and cultural events such as focused. The process might be compared to a continuous
festivals and holidays, can affect movements and disease cycle of the weighing and comparison of factors. Some
spread. Other seasonal factors, such as availability of water factors or disease determinants are gradually pushed to the
or presence of vectors, may be of interest, depending on the periphery while others are brought into sharper focus at the
disease under investigation. Management and marketing centre of the enquiry.
practices for livestock may be seasonal due to movements,
calving, housing, and buying stock or off-take, and may be
significant in terms of zoonoses risk. The appraisal team can discuss preliminary findings and
hypotheses with community members and key informants.
Many diseases of interest occur as epidemics at finite time These should be advanced as neutral observations, with
points, or as flare-ups of endemic disease. The interviewer requests for the respondent’s views. Care must be taken
may note the years of major epidemics for various diseases not to lead respondents towards endorsement of ‘preferred’
on a timeline. Information on major events, such as views. If the team is concerned regarding ‘politeness’ bias,
droughts and famines or political events may also be try presenting the hypothesis in a negative sense. As an
included to assist informants in remembering the timing of example, ‘Somebody told us ..., but how can that be true?’ If
key disease events. These events may also have an impact the respondent replies that it is, in fact, true, good support
on disease occurrence because of the changing movements for the hypothesis has been indicated. This subject was also
and habits of animals and people. Their inclusion may discussed above in reference to probing. Pay close attention
allow for triangulation of reported risk factors for disease to the factors the respondents introduce in considering the
occurrence. Besides providing information in itself, the findings and hypothesis. This data is more important to the
timeline will provide a useful reference for triangulating the analysis than simple concurrence or disagreement. These
reports made by the community with information in the factors may suggest new avenues for enquiry and offer
official government surveillance system. further means of triangulation.

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9. Participatory epidemiology 36

A good setting for action-oriented analysis of study findings The outcome of the workshop is a set of agreed points for
is a community workshop. These can be formally scheduled action, which specify the duties and responsibilities of all
with invitations, etc. or more ad hoc. At these workshops, parties involved.
study findings are usually presented in a participatory
manner so that the participants debate the findings and,
hopefully, reach agreement on their final interpretation.

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 37

10. Communicating your findings to stakeholders

10.1 Preparation of an outbreak 10.2 Communication
investigation report in an outbreak
An important component of an outbreak investigation Communication and public awareness is crucial to the
is the write-up of the investigation report. It is important success of outbreak investigation and management. The
to document details of the outbreak and the subsequent process of communication includes gathering information
investigation and response. The outbreak investigation during an outbreak (organising group meetings, conducting
report is a way of communicating information about the interviews, etc.) and disseminating information and key
outbreak and the effectiveness of your response to your messages to farmers, the public and other stakeholders.
colleagues and superiors within the Veterinary Services. The Although communications is placed as the final step in the
report will be based mainly on the information gathered outbreak investigation process, it should be carried out at
during the outbreak investigation, using the standard each and every step of the outbreak investigation. Notes
about communication have been integrated into each of the
outbreak investigation form. The following is a description
investigatory steps described in this manual to help guide
of the general outline of an outbreak investigation report.
you during an outbreak.
1. Title.
2. Basic summary information about the outbreak, Setting up village meetings
including details of location (state-division, district,
Village meetings can be very useful for gathering information
township, village tract, or village affected), date of
from and disseminating information to stakeholders.
onset, date of first visit, species affected (using a table
to indicate the total number of animals on the farm, the
Organising a group meeting as opposed to conducting
number affected, and the number dead), and the results
individual interviews is often a faster and more efficient way
of any laboratory tests.
of gathering or disseminating information. The information
3. A description of the outbreak and how it spread through gathered and shared is often greater in a group meeting, as
the village, including details about the animals affected information can be discussed and cross-referenced amongst
(‘animal’), the time of onset (‘time’) and the location the participants. Information on past events is often more
of positive and negative cases (‘place’) (as described in reliable, as the participants can help each other remember
Chapter 5). things. This is referred to as ‘group memory’ and is often
more accurate than individual memory. Group meetings
4. A description of your hypotheses about how the outbreak also provide an opportunity to collect and disseminate
might have started and what were the most likely risk different sorts of information at the same time.
factors/risk materials involved in the introduction of the
disease. When holding a group meeting in a village, it is ideal to have
5. A description of the emergency control measures and all owners of the relevant livestock species present. This is
biosecurity measures implemented. not always possible, but you should aim to include as many
of them as possible. The people who attend the meeting
6. A description of future actions that should be taken to should include those who know the animals best - that is,
fully control the outbreak and also to prevent future individuals responsible for their daily care. The number of
recurrence. participants at each meeting should be considered carefully:
smaller groups are easier to manage, but the ‘group memory’
Ideally, the outbreak investigation report should be tends to be better among larger groups. However, larger
completed as soon as possible after the initial investigation groups can be harder to manage and a lot of information can
in order to keep all levels of the Veterinary Services well be lost during private conversations between individuals.
informed. Follow-up reports can be made when new
information becomes available (e.g. laboratory results, In an outbreak, you will generally be organising a meeting
alteration of control measures, further spread of the initial without a great deal of prior notice. In this situation, it
outbreak). is important that you arrive as early as possible for the

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10. Communicating your findings to stakeholders 38

meeting and are prepared to wait until most people can be It is not always possible to have all of these skills,
there. If possible, you should send a message to the head of particularly if you have recently moved to a new area and
the village or local authority as soon as you make a plan to you are not familiar with the local area where the outbreak
visit the village so that they can organise for the farmers to occurs. In some situations, you may be able to use a local
be gathered at the time of your visit. contact person to assist you in conducting the meetings.
This local contact may have qualities that will assist you
Meetings can be held in a range of places, including to communicate with the participants, such as a detailed
community halls, schools and temples. They can also be knowledge of the local dialect. Note that, if most of the
held in the home of a livestock owner, in an open space or participants are women, it is best to have a woman as the
under a shady tree. presenter.

All participants should have an opportunity to express their

Participatory approaches to information
views. There are many reasons why people are reluctant
gathering to participate during a meeting. The main one is social
Once you have organised the village meeting and the status and local tradition and customs. The village head’s
participants are gathered, you can begin to conduct the opinion, for example, may not be challenged by others, or
meeting. This section provides a guide on how to conduct decision-making may be reserved for community elders.
a village meeting using participatory approaches to gather In some communities, women or young people may be
information. Participatory approaches aim to facilitate reluctant to express themselves. You should be aware of all
exchange of information between the disease investigator these factors when conducting a meeting, and you should
understand social and cultural constraints to participation.
and livestock owners. An example of participatory methods
A good understanding of the local culture, the village
used in this context in Myanmar is the Dutaik Meeting.
area and the sensitivities of the community will be a great
Because the Dutaik Meeting is a traditional meeting used for
advantage. It is also important to remember that as a
discussion in villages, participants tend to be familiar with
veterinarian or veterinary para-professional visiting an area
the routine and structure of the meeting. As a result, they
you may intimidate some village members, who may avoid
will usually share information more readily in the Dutaik
discussing veterinary matters for fear of sounding ignorant.
setting than in other, unfamiliar meeting arrangements.
Be aware of this and make them feel comfortable.

This section will describe some of the skills and qualities

At the meeting, be aware of the range of people with different
that are needed by a disease investigator in order to conduct
social levels, e.g. the head of the village, government officials,
village meetings using participatory approaches. It also
and wealthier livestock owners, etc. Also, remember that
describes some important methods used in conducting
livestock owners have their own ranking as well, which
village meetings, such as encouraging participation, depends on their age, their social ranking in the village, the
listening, building trust, and using particular language. number of livestock they own, etc. To help reduce the social
constraints, everyone should sit at the same level (on the
In order to effectively communicate in an outbreak situation, ground or on chairs). Sitting in a circle is better than the
and when holding a village meeting, the disease investigator disease investigator sitting in front of the audience.
should have:
– A good technical knowledge of the disease under Directing specific questions to specific members in a group
investigation will encourage participation. If there are some people
within the group who do most of the talking, make an effort
– Fluency in the language used by the participants, if to repeat questions and aim them at other members of the
possible (e.g. minority languages or common languages group.
used)
– An ability to speak clearly and an understanding of the At the beginning of the meeting you should conduct an
culture and social customs within the village ‘ice breaking’ exercise, particularly if the group members
are unfamiliar with you and/or with other members of the
– Knowledge of, and respect for, the skills of the participant
group. An ‘ice-breaker’ aims to get all participants to speak
livestock owners and a willingness to let them express
and can be done formally, by asking people to state their
their opinions
names, the number of livestock they have, etc., or informally,
– An ability to encourage participation, particularly of the by using a game or activity to relax the participants. This
quiet and shy members of the group will also get them speaking and thinking about livestock.

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10. Communicating your findings to stakeholders 39

Effective communication is a two-way process and should describe, or ask about, clinical signs, that the participants
not just be a one-way dissemination of information. One know what you are referring to. Again, some clinical signs
of the major roles of veterinarians and veterinary para- may be described using different terminology in different
professionals is providing advice and information on animal areas. Try to use this terminology when speaking to villagers.
health issues to livestock owners, but it is also important When describing the signs of the disease, use pictures and
that the veterinary workers listen and take seriously the photographs and ask owners to tell you what words they
opinions or observations of livestock owners. use to describe the signs in the pictures.

Listening skills are fundamental to rich and meaningful By knowing the local setting, the culture, social status,
communications. You can listen without actually hearing traditions, language spoken, religion, economics,
what is being said because you are too busy interpreting, livelihoods, forms of communication and aspirations of
assuming or preparing a response. Being a good listener participants you will have a much better understanding of
means that people who are engaged in conversation with the group and be able to relate with them more easily. If you
you feel valued, and this gives you a good basis for building are new in an area and are unfamiliar with the local setting,
a productive relationship. It is easy to have a tendency to it is often helpful to have a local contact that can help you
interrupt livestock owners to correct misconceptions and and advise you in communicating with the participants.
provide advice, but you first need to listen and hear what
is being said. To be effective in conducting communications during an
outbreak, it is important that you build a trusting and
understanding relationship with community members.
Active listening encourages the open communication of ideas and When communicating you need to build, maintain and,
feelings by making the participant feel both heard and understood.
if necessary, restore trust. A loss of trust can have severe
Some tips include:
impacts and can severely limit the effectiveness of your
– Look at the person who is speaking —- show that you are both investigation and management of an outbreak. Maintaining
interested in what they are saying and that you understand. If you trust throughout an outbreak requires transparency (i.e.
do not understand, ask questions to clarify. communication should be honest, easily understood,
– Listen to both what is said and how it is said —- pick up on the complete and factually correct).
emotion as well as the words.
– Summarise what you have heard —- show that you have caught Confidentiality must be preserved so that people feel
the main points. comfortable about providing information. This is also
– Respond politely to all questions, even if they seem naïve. important when people report an outbreak. People fear
– Respect the answers and viewpoints that are different from your that there could be repercussions if they report the disease,
own; do not belittle learners or other trainers. e.g. stamping out without compensation, so they must
Good questioning encourages people to go beyond simply providing feel confident and they must trust that you will keep their
information. It prompts them to share their views. Ask open-ended information confidential.
questions rather than closed ones (‘yes’ or ‘no’ answers). For
example, ask ‘What did you do after you saw your animal was sick’ Disseminating information during an outbreak
rather than ‘Did you keep your animal on your premises only after
you saw it was sick and suspected FMD’? During an outbreak there will be important messages that
you should give to different members of the community,
It is most effective if you speak the same language and depending upon how they are involved with the outbreak.
dialect as the group participants. Using the same language This section considers some of the key messages that
and expressions helps reduce the distance between you and should be provided during an outbreak, with emphasis on
the livestock owners and encourages better participation. the messages to livestock owners and traders, and on the
Your language should be clear and simple and avoid different groups (or audience) that should be targeted.
technical terms (something that a trained veterinarian can
often find difficult). Providing clear messages to specific members of the
community during an outbreak is vital to the success of
You should be aware of local terminology, for example, the managing the outbreak. The key messages that you should
be giving to farmers, members of the public and local
disease which you are investigating might be called by a
authorities include:
different name in a particular area. This name should be
identified at the beginning of the meeting and used when 1. Report. Notify and seek help from a veterinary officer
talking to the participants. Make sure that when you or veterinary para-professional as soon as unusual or

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10. Communicating your findings to stakeholders 40

severe signs of disease are seen in your animals. Early It is not just the livestock owners and traders who are
reporting of a problem enables rapid detection of serious your key audience in an outbreak. You may need to make
diseases, such as FMD, before they cause serious social presentations and organise meetings with the following
and economic consequences. groups to effectively contain an outbreak. These audiences
include:
2. Stop animal movement. If your animal has, or is
suspected of having, disease, it should be isolated – Village animal health workers
immediately from other animals to stop the disease
– Government staff at all levels — commune, district,
from being spread. When you are notified of an animal
province
disease outbreak in your area, keep your animals on the
premises and avoid bringing them to common pasture – Border patrol and/or quarantine officers
land or water sources. Movement of animals is a major
– Animal inspectors
factor in the spread of livestock diseases. Some disease,
such as FMD, can also be spread by animal products, – Slaughterhouse owners
people, vehicles etc., so you should avoid moving
– Livestock-market owners
animals into or out of an outbreak area.
– Livestock organisations
3. Do not buy or sell sick animals, even if the price is very
low. If you do this, FMD will be spread to other areas. – Private veterinarians

Livestock owners are one of the major audiences during an

outbreak, as they are responsible for taking care of livestock
and complying with control measures. Livestock owners are
also often the people who are most affected by outbreaks of
disease in livestock. Livestock traders, dealers and marketers
are another essential target group for disseminating
information during an outbreak. The messages for traders
are the same as those for farmers, but there needs to be an
emphasis on the importance of doing the ‘right thing’ when
it comes to buying animals. Animals must be bought from
disease-free areas where possible. They should not buy sick
animals and should follow regulations for quarantine and
disease prevention, where appropriate.

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11. Case examples: Outbreak investigation 41

11. Case examples: Outbreak investigation

11.1 Outbreak investigation of reported FMD in Maoming,

Guangdong province, P.R. China
On 17 February 2013, a suspected FMD case was reported by Donghui Swine Farm in Maoming, Guangdong
province in China. The outbreak was reported to have begun on 3 February, but production records suggest that the
suspected case may have occurred on 20 January.

The symptoms included a rise in animal temperature, vesicles and ulcerations on the nose and coronets, sloughy
hooves, and lameness. Swine showing these symptoms are suspected cases. Blood and lymphoid tissues were sampled
from two local slaughterhouses and 97 blood samples were taken from 10 farms within 5 kilometres. All these
samples were analysed by the national reference laboratory.

Vesicle on the nose Sloughy hoof

As of 17 February, the attack rate and case fatality rate of breeding swine were 74.6% (88/118) and 0% (0/88),
respectively. The mortality rate of piglets was 39.3% (110/280), while 550 fattening pigs were still clinically healthy
when culled.

On the affected farm, movement restrictions and disinfection measures were put in place on 17 February. Two days
later, on 19 February, all the pigs were culled and safely disposed of by burying. At the same time, within 3 kilometres,
transportation of swine, cattle and sheep was forbidden and trading markets were closed.

On 27 February, the suspected cases in Donghui Swine Farm were confirmed as FMD type A. Three blood and eight
aetiological samples collected from farms around Donghui Swine Farm were found to be positive. Qualitative analysis
shows that the most probable pathway of introduction was a vehicle. The risk of FMD spreading outside the farm is low.

Disinfection Deep burial

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11. Case examples: Outbreak investigation 42

11.2 Outbreak investigation of FMDV serotype O Ind2001d

in Dak Lak and Dak Nong provinces, Vietnam in 2015
On 10 September 2015, RAHO6 confirmed FMDV serotype O as the virus responsible for an outbreak in pigs in
Village No.4, Thanh Nhat commune, Buon Ma Thuot city, Dak Lak province. The pigs were found to be unvaccinated
and the first clinical signs, includingpyrexia, salivation, lameness, vesicles and erosions in the mouth and feet were
observed on 23 August.

On 30 September 2015, another outbreak occurred in unvaccinated pigs in Village No.9, Tam Thang commune,
Cư Jút district, Dak Nong province. RAHO 6 confirmed that the serotype responsible was FMDV serotype O. Clinical
signs, including pyrexia, salivation, lameness, and vesicles and erosions in the mouth and on the feet, began on
28 September.

Map showing location of Dak Lak and Dak Nong provinces in Vietnam where FMD serotype O Ind2001d occurred

These outbreaks were not the first outbreaks to be caused by FMDV serotype O Ind2001d. The serotype was first
identified in Vietnam on 26 May 2015 following an outbreak in Dak Nong province (> 3 months before these two
investigated outbreaks).

The morbidity rate in infected farms was > 90%, while the mortality rate in infected animals was > 25%. Risk of
disease spreading comes from animal movements (between and within borders).

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Appendices
 A-44

A. Example outbreak investigation reporting form

Epidemiological Investigation Reporting Form

Reporting Form ID: ____________________________________________

Investigating Official: ____________________________________________
Position Held: ____________________________________________
Signature: ____________________________________________
Investigation Date: _________/__________/_________

Section 1: Outbreak reporting

1.1 The officer was informed of this outbreak by:
Owner
Livestock volunteer in village or sub-district
Village or sub-district headman
Other (please specify):_________________________________________

1.2 Reporting Date: _________/__________/_________

Section 2: Index case

2.1 Name and address of owner of the first case:
_____________________________________________________________________________________
i) Village Name:_____________________________________________________________________
ii) Subdistrict/District/Province:__________________________________________________
iii) Coordinates: X ___________________________ Y __________________________

2.2 Date the first signs of disease were noted: _________/__________/_________

2.3 Species of the first case:
Cattle Buffalo Pigs
Sheep Goats Poultry
Other (specify species):____________________________________________________________

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Appendice A A-45

2.4 If the first case was introduced from another area, please provide details:
i) Specify date of introduction: _________/__________/_________
ii) Specify source location: ________________________________________________________________

2.5 Owner managed diseased animals by (answer all applicable options):

Slaughter (specify location)______________________________________________________________
Consumption or distribution (specify location)________________________________________________
Carcass disposal (burial or burning) (specify location)___________________________________________
Treatment (specify treatment)_____________________________________________________________
Other (specify)_________________________________________________________________________

Section 3: List of cases

Owner Name:
Village Name:
Village ID Number (if applicable):
Subdistrict:
District:
Date last Vaccination History
Number Date first Specify
Total number Number Number of animal
Species slaughtered/ animal Vaccinated Vaccinated origin if
susceptible affected deaths affected (if
destroyed affected date times introduced
applicable)

Section 4: Clinical investigation

4.1 Clinical signs

Fever Jaundice
Bleeding/haemorrhage Abortion
Drooling saliva Blisters on mouth/feet/udder

Anorexia Neurological signs
Respiratory signs Diarrhoea
Other (specify) _______________________________________________________________________

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Appendice A A-46

4.2 Autopsy findings – please attach results (if applicable)

4.3 Sample collection (if applicable)

Sample ID: ________________________________________________

Laboratory: ________________________________________________

Sample Type: ________________________________________________

Submission Date: _________/__________/_________

4.4 Laboratory findings – please attach results (if applicable)

Section 5: Environment
5.1 Animal husbandry in outbreak area (choose all applicable answers)

Farm Pen or stable

Grazing in defined area Free-grazing

Other (specify) ______________________________

5.2 Please provide details of any shared water sources within the outbreak area:
____________________________________________________________________

5.3 Name all livestock markets, slaughterhouses and animal collecting centres within a 10 km radius
of the outbreak (if applicable)

Section 6: Risk factors and aetiology

6.1 Have animal herds within the outbreak area received vaccination?
No
Yes
Date of vaccination _________/__________/_________
Lot _________________________________________________

6.2 Have animal herds within a 5km radius of the outbreak area received vaccination?
No
Yes
Date of vaccination _________/__________/_________
Lot _________________________________________________

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6.3 Movement of possible reservoirs

Type of possible reservoir Date of movement Origin Destination
Animals:
Carcass or meat product:
Animal feed:
Farmers, traders or other people:
Vehicles:
Others:

6.4 If an outbreak of this nature has occurred within a 10km radius previously, please provide details:
i) Date of last outbreak _________/__________/_________

ii) Location of last outbreak _______________________________________________________

iii) Disease and serotype confirmed by laboratory (if applicable)_______________

Please attach map(s) of outbreak location, water sources, livestock markets, slaughterhouses and animal collecting
centres within a 10km radius of the outbreak area

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B. Foot-and-mouth disease

B.1 Aetiology
The FMD virus is a member of the Aphthovirus genus of the family Picornaviridae. The virion is non- enveloped, about
25 nm in diameter, and has an icosahedral symmetry. It contains a molecule of single-stranded RNA and 60 copies of each of
the four structural polypeptides (VP1, VP2, VP3 and VP4). Of these, VP1 contains antigenic determinants that are important
in stimulating neutralising antibodies in infected hosts.

There are seven serotypes of FMD virus: A, O, C, SAT 1, SAT 2, SAT 3 and Asia 1. All the serotypes produce a disease that
is clinically indistinguishable but immunologically distinct. There is no cross- immunity among serotypes. Within each
serotype there is a spectrum of antigenic variation, with some strains being closely related to each other and others only
distantly. Antigenic variation tends to be greatest within type A. Analysis of strains of FMD virus by antigenic and genetic
profiles is important in epidemiological studies and for the selection of the most appropriate vaccine strains for a region
where vaccination is practised.

At temperatures below freezing, the virus is stable almost indefinitely. Even at 4 ◦C in simple media the virus retains
infectivity for more than a year. Suspensions of virus will retain infectivity for eight to ten weeks at ambient temperatures of
approximately 22◦C, and for up to ten days at 37 ◦C. Above this temperature, inactivation is more rapid.

Sunlight per se has little effect on the virus. Environmental inactivation is related more to the effects of desiccation (less
than 60 percent relative humidity) and temperature. Acid and alkaline formulations are the most effective methods for
disinfection.

B.2 Epidemiology
Of the domestic livestock species, cattle, water buffaloes, pigs, sheep, goats and deer are susceptible to FMD; the disease
is generally most severe in cattle and pigs. Camelidae (camels, llamas and vicuñas) have a low susceptibility. Wild cloven-
hoofed species are susceptible. Though rare, FMD in elephants, hedgehogs and some rodents has been documented. Some
FMD virus strains have a more pronounced predilection for one livestock species or another (e.g. pigs or cattle).

Worldwide distribution
FMD is endemic and at a high prevalence in many countries in Africa, the Middle East and Asia and is also present in parts
of South America. Europe, North and Central America, the Pacific nations and the Caribbean are free of the disease. Table 4
shows the worldwide distribution of the various serotypes (since the early 1990s).

Table 4: Worldwide distribution of foot-and-mouth disease serotypes.

Serotype Distribution
Type O Asia, parts of Africa and South America, with recent incursions into the United Kingdom and western Europe
Type A Asia, parts of South America and Africa
Type C South Asia and eastern Africa
Type SAT 1 Africa and the Arabian Peninsula
Type SAT 2 Africa and the Arabian Peninsula
Type SAT 3 Southern Africa
Type Asia 1 Asia and south-eastern Europe

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Virus survival

The FMD virus can retain infectivity for considerable periods in the environment, provided it is protected from desiccation,
heat and adverse pH conditions. For example, the virus may survive for 14 days in dry faecal material; six months in slurry
in winter; 39 days in urine; 28 days on the surface of soil in autumn; and three days on the surface of soil in summer. Such
observations have generally been made in countries with a temperate climate, and these times can be expected to be much
shorter in countries with hot climates.

The respiratory system is the major route of infection in ruminant species, and very small doses of virus can initiate infection.
The respiratory route is also the usual portal of entry for pigs, but these animals are much more susceptible to infection by
the oral route than ruminants. The virus can also enter through abrasions in the skin or the mucosae as a result of injury
caused by damage from grass seeds, feeding on rough fodder, foot rot, trauma from milking machines or from fingernails
during nose restraint of cattle.

The virus is excreted in large quantities in expired air, in all secretions and excretions (including milk and semen) and from
ruptured vesicles. Pigs liberate vast quantities of virus in their expired breath - about 3000 times as much as cattle.

Excretion of the FMD virus can begin up to four days before clinical disease becomes apparent, and this is of great
epidemiological significance. Most excretion of the virus ceases four to six days after the appearance of vesicles, when
circulating antibodies develop. The virus tends to persist in foot lesions for a day or two longer than in mouth lesions, so foot
lesions may be a better source of virus for diagnostic purposes in older cases. The FMD virus has been detected in the milk
and semen of experimentally infected cattle for 23 and 56 days, respectively. After recovery, up to 80 percent of ruminant
animals may become persistently infected. This situation is termed the ‘carrier state’ and is defined as carriage of the virus
beyond 28 days after infection.

The maximum reported carrier periods for different species are: three and a half years for cattle; nine months for sheep;
four months for goats; and five years or more for African buffaloes. The virus can be recovered intermittently from such
animals by oesophageal-pharyngeal probang collections. The quantity and frequency of virus that can be collected decline
progressively with time. Pigs do not become long-term carriers and cease excreting the virus within three to four weeks of
becoming infected.

Disease transmission

Pigs are regarded as important amplifying hosts for the disease because of their ability to be infected orally and their capacity
to excrete large quantities of virus in their exhaled breath. Cattle are regarded as good indicator hosts because of their
extreme sensitivity to infection by the respiratory route, and the usual development of severe, classical clinical signs. Sheep
have been thought of as maintenance hosts, because infection with some virus strains can spread through flocks with little
overt sign of disease. It must be stressed that not all FMD viruses will behave in the same way epidemiologically nor will they
all have the same host range. Transmission occurs by: (1) direct contact, (2) indirect transmission, (3) swill feeding of pigs,
(4) windborne spread, and (5) artificial breeding.

The epidemiological pattern of the disease tends to be different in temperate and tropical or semitropical parts of the world.
In the former, the greater survival of the virus in the environment means that indirect transmission through fomites may be
as important as direct contact between infected and susceptible animals. Windborne virus spread is possible under some
environmental circumstances. On the other hand, in hotter climates, indirect means of transmission assume less relative
importance than direct means of transmission. It is often the movement of potentially infected animals and livestock trading
patterns that provide the key to understanding the epidemiology of FMD in such areas.

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Direct transmission of FMD arises from contact with the following material from infected animals:

– Ruptured vesicles
– Faeces
– Urine
– Breath
– Saliva
– Milk
– Windborne spread of virus from infected farms

Indirect transmission of FMD arises from contact with the following material that has been in contact with infected animals:

– Meat, blood, offal, hides

– Vehicles
– Animal bedding
– Clothing, footwear
– People (particularly farmers and veterinarians)
– Animal feed (e.g. hay)

Incubation period
The incubation period in cases of naturally acquired disease is variable and depends mainly on the animal species, strain of
virus, exposure dose and route of entry. It is usually 2 – 8 days but can be longer (up to 11 – 13 days), particularly when the
animal is exposed to lower concentrations of virus. Species-specific incubation periods are as follows:
– Domestic cattle: 1 – 7 days, but usually 3 – 6 days (Sard, 1978; Radostits et al., 2007). Lesions appear at 5 – 8 days after
exposure to infected steers (Burrows, 1968). Incubation periods as long as 13 – 14 days have been reported (Sellers et
al., 1971).
– Domestic sheep: 3 – 8 days, possibly up to 21 days. As short as 18 hours after experimental infection (Geering, 1967).
– Domestic pig: lesions appeared 7 – 13 days after exposure to infected steers (Burrows, 1968).

The incubation period for index cases in an outbreak tends to be longer than for subsequent cases;

it may be as short as 18 – 24 hours when the disease is experimentally produced.

Sub-clinical infectious period is defined as the number of days between the beginning of virus shedding and the onset of
clinical signs. This is estimated to be between 2 and 5 days (Burrows, 1968).

Morbidity and mortality

The percentage of animals that become affected in a population is often high and may approach

100%. Morbidity may be lower under the following conditions:

– Where FMD virus strains are less virulent (e.g. with occult FMD strains, morbidity can be very low in some populations).
– Where species are less susceptible to disease.
– Where there is immunity, either through naturally circulating virus (in endemic regions) or through vaccination.

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In domestic cattle, mortality seldom averages more than 3% and is often less than 1%. Occasionally, mortality rates may be
higher, especially in juveniles. A malignant form of the disease has been reported, resulting in mortality risk approaching
50% in adult cattle (Timoney et al., 1988, Radostits et al., 2007). Complications from secondary bacterial infections may
require euthanasia (Timoney et al., 1988).

In domestic pigs, mortality from FMD is usually less than 5%. It may reach 50% in piglets (Taylor, 1983). Mortality rates are
higher in young pigs than in calves (Timoney et al., 1988). Mortality in unweaned piglets due to myocarditis can be up to
100% and can precede any other signs of the disease (for example, vesicles on the teats of lactating sows).

Usually, the mortality rate in adult sheep (Martin and Aitken, 2000) is zero. Mortality in lambs may be very high (Martin
and Aitken, 2000).

Immunity
Circulating neutralising antibodies develop within four to ten days of infection. Convalescent animals usually have a very
long immunity to reinfection (as long as five years) with closely related virus of the same serotype, but remain fully susceptible
to other serotypes.

The degree of protection after vaccination is greatly influenced by the antigenic relationship between the vaccine strain
and the challenge strain. Vaccines provide only partial immunity against antigenic variants of the same serotype. Potent
vaccines confer immunity as early as four days after injection. However, vaccine immunity is not long lasting and therefore
revaccination at regular intervals (e.g. every 6 – 12 months) is required.

Manufacturers of commercial FMD vaccines normally recommend a primary immunisation regime of an initial dose followed
within three to four weeks by a second dose of vaccine. However, in endemic situations it is more usual to give two doses
at six months apart and to revaccinate thereafter at yearly intervals. A proportion of vaccinated animals, although protected
against the clinical disease, may become sub-clinically infected after natural challenge and excrete virus. It is important to
note that animals incubating the disease when vaccinated may still develop the disease, sometimes in a milder form, and that
vaccinated, exposed animals may still transmit infection for 7 – 14 days after vaccination and exposure.

B.3 Diagnosis
Antigen detection
The two most commonly used tests are: (1) the complement fixation test (CFT), and (2) the ELISA (an indirect sandwich
test). The ELISA test has largely replaced the CFT. The latter is sensitive and easier to apply but, as with all tests, needs to be
properly standardised to optimise its sensitivity and specificity.

Antibody detection
Serological tests for FMD include:
– The virus neutralisation test (VNT): this is a sensitive serotype-specific test, which requires three days to provide a result.
– The ELISA test (liquid-phase or solid-phase blocking): this is another sensitive serotype-specific test. It is now widely
used because it provides fast results and, unlike the VNT, does not require elaborate tissue culture laboratory facilities.
Positive results can be obtained within five hours of the laboratory receiving the sample.
– ELISA tests to detect antibodies against FMD non-structural proteins (NSP): the preparation of modern FMD vaccines
results in the depletion of NSP. Sera from vaccinated animals contain antibodies against structural proteins, but not
against NSP such as 3ABC or 2C. ELISA tests for NSP antibodies are major FMD diagnostic advances as they allow
antibody titres that result from FMD infection to be distinguished from those resulting from vaccination.

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B. Foot-and-mouth disease A-52

Both the VNT and ELISA are OIE-prescribed tests for international trade. Reverse transcription (RT) polymerase chain
reaction (PCR) tests are available for FMD. PCR is a highly sensitive and specific technique but, because of the possibility of
cross-contamination, as well as expense, its use is almost entirely confined to specialist laboratories.

B.4 Control and eradication

The aim of control measures is to break the transmission between infected and susceptible animals. To be effective, all routes
of transmission must be considered and addressed with controls and biosecurity measures, some examples include:
– Stopping animal movements into and out of an infected village.
– Disinfecting all vehicles before leaving a restricted (infected) area.
– Not allowing animal feed produced in an affected area to be fed to susceptible animals in an unaffected area.
– Ensuring that people follow strict biosecurity and disinfection procedures before leaving an infected area.
– Using vaccination to reduce the number of susceptible animals in an infected area.

B.5 Clinical signs

Cattle
FMD has an incubation period of 2 to 14 days, depending on the infecting dose, strain of virus and susceptibility of the
individual host. The following clinical signs may be seen:

Specific clinical signs. Vesicles on the tongue, hard palate, dental pad, lips, gums, and muzzle. Vesicles on the coronary band and
interdigital space. Vesicles on the teats, particularly in lactating cows. Profuse salivation. Nasal discharge which is mucoid at first then
becoming mucopurulent. A dramatic drop in milk yield.
Less-specific clinical signs. Pyrexia lasting 1 to 2 days (rectal temperatures of 40 ºC). Mortality in young calves. Inappetence and weight
loss. Stamping of feet and lameness. Stock prefer to lie and resist attempts to raise them. Lactating cows with teat lesions, mastitis and
difficulty in milking.
FMD should be suspected if multiple animals in a herd have the clinical signs listed above.

(a) Foot lesions (b) Tongue lesions

Figure 23. Clinical signs of foot-and-mouth disease in cattle.

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Pigs
The incubation period of FMD in pigs varies with the strain of infecting virus, the dose of virus, the route of infection,
individual susceptibility and the environment under which the animals are kept. It is usually two or more days, but can be
as little as 24 hours (particularly when infection is spreading within a herd).

Specific clinical signs. Initially mild lameness and blanching of skin around the coronary bands. Vesicles on the coronary band and heel of
the feet (including the accessory digits), on snout, lower jaw and tongue. Lesions on the coronary band are the most consistent sign of FMD
in pigs. Vesicles on the tongue are usually found far back on the tongue or very small vesicles of erosions are found at the tip. If the pigs are
housed on hard floor surfaces, there may be evidence of vesicles on the elbows, hocks or other areas of prior skin abrasion. Teat lesions in
lactating sows.
Less-specific clinical signs. Pyrexia (rectal temperatures 39 to 40 º C). Lethargy, groups of pigs huddle together. Reduced appetite,
inappetence. Mortality in young piglets. Stock prefer to lie and resist attempts to raise them.
FMD should be suspected if multiple animals in a herd have the clinical signs listed above.

(a) Snout lesions (b) Foot lesions

Figure 24. Clinical signs of foot-and-mouth disease in pigs.

Small ruminants
The incubation for FMD virus in sheep is usually between 3 and 8 days. Vesicular disease may fail to develop in some
infected sheep, while others may show only a single visible lesion. A notable feature of FMD in small ruminants is that the
clinical signs of disease are subtle and often unapparent. Thorough clinical examination of 10 to 20 animals in a flock is often
required to make a diagnosis.

Specific clinical signs. Vesicles develop on the interdigital cleft, bulbs of the heel and coronary band. These lesions can be very difficult
to see. Vesicles form in the mouth, but they rupture more easily and are usually only seen as shallow erosions, most commonly on the dental
pad, but also on the hard palate, lips and gums. Vesicles can appear on the teats or prepuce.
Less-specific clinical signs. Lameness is usually the first sign of FMD in sheep and goats. In a field situation, lameness due to other
causes may already be present and this may conceal the presence of FMD. Reluctance to walk. Mortality in lambs and kids.
FMD should be suspected if multiple animals in a herd have the clinical signs listed above.

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B. Foot-and-mouth disease A-54

(a) Ruptured vesicle on dental pad (b) Lesion on interdigital space and coronary band.
Note the blanching and swelling

Figure 25. Clinical signs of foot-and-mouth disease in sheep.

B.6 Ageing lesions

When investigating an outbreak of FMD, it is possible to make relatively accurate estimates of the age of lesions during a
clinical examination of affected stock. This is important, because it allows you to estimate the date of onset of clinical signs
in the herd (or flock). This, in turn, then allows you to estimate the likely date of exposure to virus.

Information can usually be obtained from the herd/flock manager to indicate when clinical signs first appeared. When there
is some uncertainty in this estimate, or in situations where the animals have not been closely monitored, ageing of the lesions
can be a valuable tool. For example, if you are visiting a village in which there are four farms and all of them are infected
with FMD, you can examine animals on all of the farms and estimate the age of their lesions, and the farm that has animals
with the oldest lesions can be called the index case farm.

Ageing lesions is particularly useful for a disease such as FMD because the clinical progression of lesions in affected animals
follows a relatively predictable course. The table and the graph below can be used as a reference. It is important to bear in
mind that the ageing of lesions is approximate because other factors (such as the presence of secondary infection) can alter
the rate at which the lesions heal.

Table 5: Description of the clinical appearance of FMD lesions according to the number of days post infection.
Day Appearance
1 Blanching of epithelium followed by formation of fluid filled vesicles.
2 Freshly ruptured vesicles characterised by raw epithelium, a clear edge to the lesion and no deposition of fibrin.
3 Lesions start to lose their sharp demarcation and bright red colour. Deposition of fibrin starts to occur.
4 Considerable fibrin deposition has occurred and re-growth of epithelium is evident at the periphery of the lesion.
7 Extensive scar tissue formation and healing has occurred. Some fibrin deposition is usually still

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B. Foot-and-mouth disease A-55

Figure 26: Diagram showing the pattern of appearance of FMD lesions and their relationship with viral excretion as a function of time.
Note: Detailed information on FMD, including information on aetiology, epidemiology, diagnosis, prevention and control, can be found in:
OIE (2017). Terrestrial Animal Health Code. World Organisation for Animal Health. Available at: http://www.oie.int/en/international-standard-setting/terrestrial-code/access-online/
OIE (2017). Manual of Diagnostic Tests and Vaccines for Terrestrial Animals. Available at: http://www.oie.int/en/international-standard-setting/terrestrial-manual/access-online/
OIE Technical disease cards: http://www.oie.int/animal-health-in-the-world/technical-disease-cards/

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 A-56

C. Classical swine fever

C.1 Aetiology
Classical swine fever (CSF) is caused by a Pestivirus. Although there is only one antigenic type, there are a number of different
strains which vary in their virulence. The virus is capable of surviving for long periods of time in frozen, salted or smoked
pork. This is an important characteristic that increases its potential for geographical spread, as virus can easily be transferred
from one place to another in pork products and cause disease outbreaks in pigs fed uncooked garbage.

C.2 Epidemiology
Worldwide distribution
The disease is enzootic in Asia, continental Europe, South America and Central America. Canada, the USA and the Caribbean,
apart from Cuba, are free from the disease. Apart from Madagascar and Mauritius, Africa is also free from the disease. In
Oceania, the disease has only occurred on two occasions (New Zealand in 1930 and 1953), but on both occasions the disease
was quickly eliminated by slaughtering the affected herds.

Virus survival
CSF virus is moderately fragile in the environment. This virus is sensitive to drying and ultraviolet light and is rapidly
inactivated by a pH less than 3. Sodium hypochlorite and phenolic compounds are effective disinfectants. CSF virus can
survive for long periods in meat, but is destroyed by cooking.

Disease transmission
Infection of susceptible pigs is normally by the oral or nasal routes. Even before clinical signs develop, infected pigs shed
virus in all their excretions and secretions. The normal means of spread is by direct contact between infected and susceptible
animals, but airborne infection can occur over short distances. With the chronic form of the disease, virus persistence is
characteristic. Infection of pregnant sows with low-virulence strains often results in congenital infection in their piglets. Such
infected piglets are immunotolerant virus shedders and are often responsible for maintaining the disease in a herd. Feeding
infected pork products to pigs (i.e. garbage feeding) has been an important way of keeping the disease cycling in enzootic
areas or introducing disease into previously free areas. Humans can spread infection by syringes, vaccination paraphernalia
and the like. Flies may transmit infection mechanically to nearby piggeries.

As stated above, CSF can enter a country by means of infected pork products finding their way, un- treated, to pigs fed
garbage. This is what happened in the two outbreaks that have occurred in New Zealand. Many countries have implemented
legislation to ensure that garbage fed to pigs must first be cooked so that the risk of introduction by means of meat infected
with CSF virus (or other exotic infectious agents) is lessened. Legally imported pork may only come from countries that are
free from the important exotic diseases of pigs, so the risk is low, but smuggled pork products represent a much greater risk
of introducing CSF (and FMD and swine vesicular disease) viruses. Quantitatively, the amounts of smuggled pork products
entering the country are small, most are eaten by humans, and any waste is more likely to be disposed of in urban dumps
than in garbage collected for feeding to pigs. Nevertheless, some risk probably exists and, for this reason, piggeries which
feed garbage to their animals continue to be regulated and kept under surveillance.

It is likely that any introduction of CSF would first be evident in garbage-fed pigs. The classical acute disease would quickly
be brought to the attention of a veterinarian, allowing rapid action to be taken. The danger with less-virulent disease is that
it may be allowed to carry on for some time before a diagnosis is sought, and during that time the opportunity for spread
to other herds may be increased by movement of infected pigs. The worst scenario is where the disease establishes itself in
a wild pig population.

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Direct transmission of CSF arises from contact with the following material from infected animals:
– Nasal and/or lacrimal secretions
– Urine
– Faeces
– Uterine fluids

Vertical (trans-placental) transmission

Indirect transmission of CSF arises from:

– Consumption of infected meat
– Artificial insemination
– Contact with contaminated mechanical vectors, including personnel, vehicles, contaminated clothing, other animals and arthropods

Breeding herds are very important in the control of CSF. Animals in an infected breeding herd will often show only subtle signs
of disease, but they are an important source of infection (through production of congenitally infected piglets, for example).
Breeding herds are also important because they will often supply pigs to other farmers or producers, thus facilitating the
spread of disease. Breeding herds should be a main target in a control programme.

Village smallholdings will not usually be the source of an outbreak of CSF. Smallholdings usually tend to become infected
when infected pigs are bought from commercial breeders. But smallholdings can represent a risk if smallholders practise
swill feeding (which increases the risk of pigs becoming infected by the oral route) or if there is the opportunity for pigs to
come into contact with wild pigs.

Incubation period
The incubation period for CSF varies from 2 to 14 days. However, this is complicated by the fact that there are several
different forms of the disease. When you are performing tracing during investigation of an outbreak of acute or peracute CSF,
you should use the incubation period of 2 – 14 days, but be aware of the possibility of sub-clinically infected herds being a
source of CSF virus.

Morbidity and mortality

There are three forms of CSF. Which form an animal or herd develops depends on the time of infection (pre-natal or post-
natal) and the virulence of the viral strain:
– Acute: post-natal infection with highly virulent strains.
– Chronic: post-natal infection with low-virulence strains.
– Congenital infection: pre-natal infection with low-virulence strains.

Highly virulent strains result in a very contagious viral infection and large amounts of virus excretion. Virus is shed in oro-
nasal and lacrimal secretions, urine and faeces. There is rapid spread, mainly through direct pig-to-pig contact. The virus
can also be transmitted indirectly by mechanical vectors such as people, vehicles, other animals and arthropods. Pig density
plays an important role in the transmission of highly virulent strains of CSF.

Infection with low-virulence strains of CSF will often go unnoticed, and disease is transmitted from sows to piglets by in
utero transmission. There may be a short period of virus excretion during the acute phase of infection, but with lower levels
of virus than the highly virulent strains. A large quantity of virus is shed during farrowing, and congenitally infected piglets
represent a continuous source of infection. With the chronic form of the disease there is clinical improvement after the acute

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phase of disease, but a persistent leukopenia remains. A second period of illness then follows, characterised by anorexia
and depression, fever and, often, death. Pigs that survive have growth retardation, skin lesions and arched backs. They may
continue to live for 100 or more days, but will eventually die. These animals will be seropositive if serological testing is
carried out.

The carrier state is a very important component of the epidemiology of CSF and plays a major role in the maintenance
of the virus in a population. The carrier state occurs when a piglet is infected in utero at such a time that the piglet is
immunotolerant to CSF virus. The immunotolerant pig appears healthy at birth. These apparently healthy ‘carrier’ piglets
continuously excrete virus and can live up to 11 months of age. They are not easy to detect and so remain a constant source
of infection for susceptible pigs throughout this time, thus perpetuating CSF in the population. It is therefore important to
ensure that control measures prevent congenital infection of pigs.

C.3 Diagnosis
When virulent virus strains are involved, the clinical picture in an infected herd will be strongly suggestive of the disease.
With less-virulent strains, care must be taken that the disease is not ascribed to other causes, such as salmonellosis, even
though such bacteria may be present. The disease may be difficult to differentiate from African swine fever, which presents
with similar clinical signs.

Virus isolation provides the definitive diagnosis. Virus can be recovered from a number of tissues, though tonsil is the
preferred tissue. Immunostaining (fluorescent antibody or immunoperoxidase) is a valuable method to demonstrate virus in
tonsil tissue. However, care must be exercised to use CSF-specific monoclonal antibodies for such tests, as infection of pigs
with bovine viral diarrhoea virus or border disease virus will cross-react with classical swine fever antisera.

C.4 Control and eradication

During outbreaks, confirmed cases and contact animals may be slaughtered and a quarantine imposed. Destruction of
infected herds and subsequent cleaning and disinfection of premises should be straightforward. Carcasses derived from
infected premises prior to the diagnosis being made, would be traced and destroyed to prevent any spread of infection by
garbage feeding. Providing diagnoses are made promptly, inter-herd spread should be limited and the possibility of wild pigs
becoming infected much reduced.

Vaccination may be used as a tool to assist in controlling an outbreak and eradicating the disease. In countries where the
risk of reintroduction of virus is high, control by vaccination is the control method of choice. Periodic serologic sampling
is necessary to monitor for the potential reintroduction of disease. Modern vaccinations allow a distinction to be made
between infection and vaccination titres.

It is likely, in the initial stages of an eradication response, that a controlled area would be established within which movement
of live pigs and pork products would be restricted and pig herds monitored for any spread of disease. The extent and
duration of these measures would be decided upon following an assessment of the time between infection and detection of
the index case and would be governed by factors such as: the presence/absence of any secondary outbreaks; the destinations
of animals moved from infected herds in the period before diagnosis; and the distribution of pork product from abattoirs
that had processed pigs from the infected herds prior to diagnosis. New stock could be introduced to properties 15 days after
cleaning and disinfection.

C.5 Clinical signs

CSF is a highly contagious viral disease affecting pigs and wild boar. The disease can occur in a number of forms (acute,
chronic and congenital). Many of the signs are relatively non-specific, so it is important to know some of the major differential
diagnoses of this disease. Given the seriousness of CSF and of some of its differentials, the appearance of clinical signs that

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are typical of CSF in a number of animals warrants further investigation and implementation of emergency control measures.
The differential diagnoses for CSF include:
– African swine fever (cannot be clinically distinguished)
– Salmonellosis
– Erysipelas
– Pasteurellosis
– Viral encephalomyeletis
– Thrombocytopaenia purpura
– Warfarin poisoning

Acute CSF
With the peracute form of the disease, death occurs within 24 to 48 hours of infection. Mortality can reach 100%. Often, the
only clinical finding is sudden death.

Clinical signs of the acute form of disease include: inappetence/anorexia; discharge from the eyes and nose; enlarged lymph
nodes; coughing; constipation followed by diarrhoea; fever (usually 40 ◦C); huddling; haemorrhages (redness) on the skin
of the ears, tail, abdomen, and inner surfaces of the limbs; weight loss; staggering gait; cyanosis (blue colour) of the ears and
nose; and convulsions.

Post-mortem findings with the acute form of disease include: petechial (small) haemorrhages on the epiglottis; enlarged and
haemorrhagic lymph nodes; enlarged and necrotic tonsils with pinpoint haemorrhages, petechiae and ecchymoses on the
skin; haemorrhages in the body organs, particularly the kidney, heart, bladder, lung, gall bladder, and spleen; oedema of the
lungs; fluid in the body cavities; and encephalomyelitis with perivascular cuffing.

Sub-acute infections can occur in which the signs are the same as the acute form but generally milder, with a lower rate of
mortality.

Chronic CSF
Pigs with the chronic form of CSF will often appear normal and show good appetite for a longer period of time than those
with the acute or sub-acute form of the disease. Growth retardation and wasting are the most evident signs.

Clinical signs of the chronic form of disease include: fever; failure to thrive; diarrhoea; difficulty breathing; coughing;
dermatitis (which is often generalised); reddening of the skin; and abortions.

Post-mortem findings with the chronic form of disease include: enlarged lymph nodes; atrophy of the thymus; inflammation
around the heart and the lining of the chest cavity; consolidation of the lungs; poor body condition; small (button) ulcers in
the large intestine; secondary pneumonia; and enteritis.

Mild or sub-clinical CSF

This form of the disease is typically seen in sows that have been inadequately vaccinated, or sows which become infected
with a virus of low virulence. These sows may appear normal, but give birth to shaking piglets, many of which die.

Clinical signs of the mild or sub-clinical form of disease include: transient pyrexia; transient inappetence; foetal death; foetal
resorption; mummification; stillbirth; or birth of live, congenitally deformed piglets. Abortion rarely occurs.

Detection of CSF in pig-breeding operations can be particularly difficult, since clinical signs in adult pigs may be mild and
similar to other (more common) diseases. CSF should be suspected in any case of reduced fertility in a herd, especially where

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other risk factors (e.g. the presence of disease in wild boar) are present and/or other diseases of the reproductive tract have
been excluded.

Congenital CSF
Clinical signs of the congenital form of disease include: congenital tremor; weakness; runting; and poor growth.

The congenital form of CSF occurs when a sow is infected during pregnancy. The sow may or may not show any sign of
disease. If the sow is infected before the piglets’ immune system is developed (from 50 to 70 days of gestation), the piglets
will be apparently healthy at birth. These piglets shed virus after they are born and therefore represent a risk to susceptible
pigs or susceptible herds. At several weeks of age these piglets develop typical clinical signs of CSF, but these are likely to be
milder than usual, last longer and there is no associated fever. If a pregnant sow is infected before 50 days of gestation, foetal
death, mummification, abortion and deformity of piglets typically results.

Note: Detailed information on CSF, including information on aetiology, epidemiology, diagnosis, prevention and control, can
be found in:

OIE (2017). Terrestrial Animal Health Code. World Organisation for Animal Health. Available at: http://www.oie.int/en/
international-standard-setting/terrestrial-code/access-online/

OIE (2017). Manual of Diagnostic Tests and Vaccines for Terrestrial Animals. Available at: http://www.oie.int/en/international-
standard-setting/terrestrial-manual/access-online/

OIE Technical disease cards: http://www.oie.int/animal-health-in-the-world/technical-disease-cards/

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D. Equipment checklist
The following equipment should be ready for use at all times and should be taken by the investigation team or individual
investigator when carrying out a field visit.

D.1 Personal protective equipment

– Latex or plastic gloves

– Protective mask

– Protective eye glasses

– Boots

– Protective suit

D.2 Restraint equipment

– Ropes

– Pig restrainers

D.3 Disinfectant and cleaning material

– Brush

– Soap

– Detergent

– Cotton wool

– 70% alcohol solution

– Disinfectant solution, e.g. 4% washing soda (Na2CO2), soap, 1 – 2% sodium hydroxide solution

– Spraying equipment, footbath equipment

D.4 Medical supplies

– Antibiotics and antiseptics, e.g. penicillin, gentian violet, 70% alcohol solution, Negasunt dusting powder

– Vaccine (if available) with appropriate cold chain facilities

– Cotton, gauze, and tape

– Forceps

– Sedative or anaesthetic drugs

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D.5 Sample collection

– Tube with glycerine buffer
– Needles and syringes
– Plastic bags and rubber bands
– Cooler with ice packs
– Cotton swabs
– Sticky labels

D.6 Data collection

– Outbreak investigation forms
– Case recording forms
– Sample submission forms
– Notepad and protective folder
– Pens and pencils
– Recording tape
– Other necessary stationery, e.g. tape and glue, scissors, stapler, batteries

D.7 Communication, transportation, navigation

– Mobile phone or radio communication equipment
– List of all field stakeholders
– Public awareness material
– Digital camera
– GPS device
– Detailed maps of affected area
– Gasoline

This list should be photocopied so that it is available for use by all who work in your office.

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E. Cleaning and disinfection

Decontamination1 is the combination of physical and chemical processes that kill or remove pathogenic microorganisms.
Decontamination of premises where infected animals have been housed reduces the risk of the spread of infectious disease
to new animals. When premises have been identified as infected and measures have been undertaken to remove or eliminate
the source of infection on those premises, disinfection needs to be carried out. The disinfection process should include items
such as:
– Buildings with wooden, metallic or masonry structures
– Machinery of mostly metallic components
– Pipework of various types
– Water tanks
– Animal food storage areas
– Sewage waste

Depending on the infectious agent involved, different decontamination procedures and disinfectants need to be used
for different sites on the premises. In situations where the disease agent does not spread directly from animal to animal
(e.g. bluetongue), comprehensive decontamination of the premises is not warranted. In contrast, some viruses (e.g. swine
vesicular disease and foot-and-mouth disease) are relatively stable on inanimate objects and can be spread to remote animals
via contaminated people, clothes and equipment. Viruses that can be spread by this type of contact require the most
comprehensive decontamination programmes.

Preliminary cleaning work is invariably required before any chemical disinfectants are applied. Simple cleaning of surfaces by
brushing with a detergent solution is effective in removing contaminating viruses and is fundamental for achieving effective
chemical decontamination. Most disinfectants have reduced effectiveness in the presence of fat, grease and organic dirt.
Every effort should be made to remove organic matter from all surfaces that are to be decontaminated. Hot water and steam
are effective in cleaning many cracks and crevices where pathogens are likely to accumulate. The insides of pipework can
often only be cleaned effectively by steam.

A knowledge of the properties of the contaminating virus is a fundamental part of planning a decontamination strategy.
Choosing the most appropriate disinfectant is dependent on the nature of the virus particles. Three general classes of virus
have been described (Klein and DeForest, 1981).
– Category A viruses are of intermediate to large size and contain lipid, which makes them susceptible to detergents, soaps
and most disinfectants. Such viruses are susceptible to dehydration and do not persist, except in cool, moist environments.
The best disinfectants to use for these viruses are detergents, hypochlorites, alkalis, Virkon or glutaraldehyde (see below).
– Category B viruses have no lipid and are smaller and more hydrophilic. These viruses are relatively resistant to lipophilic
disinfectants such as detergents. Although they are sensitive to most disinfectants they are less susceptible than viruses in
Category A. The best disinfectants for these viruses are hypochlorites, alkalis, Virkon or glutaraldehyde (see below).
– Category C viruses have no lipid and are intermediate in size. These viruses fall between Categories A and B in terms
of their sensitivity to disinfectants. The best disinfectants to use for these viruses are detergents, hypochlorites, alkalis,
Virkon or glutaraldehyde (see below).

1 This section of the manual is a summary of information presented in Geering et al. (2001) and in the Handbook of the Philippines National Foot-and-Mouth
Disease Task Force 1995 – 2003

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E.1 Types of disinfectants

Disinfectants can be grouped into five chemical categories:
– Soaps and detergents
– Oxidising agents
– Alkalis
– Acids
– Aldehydes

Soaps and detergents

The application of soaps and detergents is the essential first step for achieving decontamination. In most cases, the primary
aim is the removal of organic material, dirt or grease from the surfaces that are to be decontaminated. Most industrial and
domestic brands of soaps and detergents are satisfactory. Hot water, brushing and scrubbing enhance the cleaning action.
Similarly, steam improves the cleaning and decontamination process by raising the temperature and penetrating crevices.
However, steam by itself can only be used as a decontaminant if the temperature of the surface can be raised to at least 100
◦C and held there long enough to allow inactivation of the agent. Because of uncertainties regarding temperatures and times

of contact, steam is only recommended as an adjunct to decontamination.

The surfactant action of soaps and detergents is an effective decontaminant for all Category A viruses, because of their outer
lipid envelope. For decontamination procedures involving exotic viruses in Category A, soaps and detergents are effective
disinfectants in their own right.

Many commonly used disinfectants in hospitals, surgeries, dairies and food-processing areas involve soapy combinations of
phenolics or quaternary ammonium compounds. These agents are specifically antibacterial and are effective against category
A viruses. They have no activity against category B viruses and limited activity against category C viruses. Although they may
be useful for preparatory cleaning purposes during an outbreak of an exotic viral disease, they are not recommended because
more effective cleaning agents and viral decontaminants are available.

Iodophors are combinations of solubilising agents and a carrier that releases free iodine. It is difficult to define active
concentrations with certainty in all circumstances, so iodophors are not recommended for the inactivation of viruses.

Oxidising agents
Oxidising agents are the disinfectants recommended for most situations. Chlorine is released from hypochlorite solutions
and is a powerful oxidising agent that is effective against all virus groups. The effectiveness of hypochlorite is greatest in the
pH range 6 -– 9. The activity of hypochlorite decreases markedly in the presence of organic material. Hypochlorite solutions
are not chemically stable and decompose rapidly as temperatures rise above 15 ◦C.

Virkon is a disinfectant with outstanding virucidal properties. It has low toxicity and is effective against members of all 17
virus families, but it has not been approved for use on skin. Its activity is based on a buffered synergised acid peroxygen
system containing a high percentage of surfactant. It is relatively safe to use and comes in a powdered form ideal for dilution
at the site of an exotic disease outbreak. It can be sprinkled in powdered form over wet or boggy areas, but the concentration
of disinfectant achieved in this situation cannot be accurately controlled.

Alkalis
Both sodium hydroxide (caustic soda) and sodium carbonate (washing soda) are widely available in large quantities at
low cost and both have a natural saponifying action on fats and other types of organic matter, which assists the cleaning
process. Because they are virucidal under heavy burdens of organic material, they are ideal agents for decontaminating
animal housing, yards, drains, effluent waste pits and sewage collection areas.

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Acids
Acids are generally highly virucidal. They have a wide range of uses, ranging from the treatment of liquid effluent to personal
decontamination. Hydrochloric acid is a strong acid that is widely available from hardware stores and is less toxic than other
strong acids. Citric acid is a milder acid, available in solid form, that is active against acid-sensitive viruses and can be used
safely for personnel and clothing decontamination. It is particularly useful when added to detergents for the inactivation of
foot-and-mouth disease virus.

Aldehydes
Glutaraldehyde is an effective disinfectant that is active against all virus families and other microorganisms in concentrations
of 0.2% w/v. It remains effective in moderate concentrations of organic material, is chemically stable and only mildly corrosive
for metals. For large-scale decontamination, however, the cost of glutaraldehyde is likely to be high.

A 40% aqueous solution of formaldehyde gas is called formalin and is a useful disinfectant. Formalin diluted with 12 parts
water produces 8% w/v formalin which is an active disinfectant against most virus families.

Gaseous formaldehyde can be used to decontaminate air spaces, the insides of motor vehicles, and equipment that must be kept
dry, e.g. electronic devices. The conditions must be carefully controlled, however, in terms of gas concentration, temperature,
humidity, time of contact and even distribution of the gas. Under emergency conditions on a contaminated property, it is unlikely
that all of these conditions can be adequately controlled. In addition, the space to be decontaminated must be completely
sealed to prevent gas escape, because the most effective dwell time for inactivation is anywhere between 15 and 24 hours.
Other problems include the toxicity of gas, the dangerous nature of its generation in non-laboratory conditions (potassium
permanganate reacts violently with formalin), the environmental protection guidelines that prevent the release of formaldehyde
gas to the atmosphere, and the difficulty of completely purging residual formaldehyde gas from confined spaces.

E.2 Disinfectants for specific diseases

In the tables that follow, the numbers cited in the columns labelled ‘Disinfectant’ refer to the disinfectants listed in Table 10.

African swine fever and classical swine fever (Category A viruses)

African swine fever and classical swine fever are caused by Category A viruses (Asfaviridae and Flaviviridae, respectively).
The best disinfectants to use are detergents, hypochlorites, alkalis, Virkon or glutaraldehyde.

Table 6: Recommended disinfectants for African swine fever and classical swine fever.
Item to be disinfected Disinfectant/chemical/procedure
Live animals Euthanasia (ASF) or vaccination (CSF).
Carcasses Bury or burn.
Animal housing/equipment 1, 2a, 2b 2c, 3.
Environment housing/equipment Eradicate ticks or burn wooden structures (ASF).
Humans 1.
Electrical equipment 5c.
Water tanks Drain.
Feed Bury or burn.
Effluent, manure Bury or burn, 3a, 3b, 4a, 4b.
Human housing 1, 2a, 2b, 2c.
Machinery 1, 3a, 3b.
Vehicles 1, 3a, 3b.
Clothing 1, 2a, 2b, 2c, 3a, 3b.
Aircraft 1, 2c.

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Avian influenza and Newcastle disease (Category A viruses)

Avian influenza is caused by a Category A virus. The best disinfectants to use are detergents, hypochlorites, alkalis, Virkon
or glutaraldehyde.

Table 7: Recommended disinfectants for highly pathogenic avian influenza and Newcastle disease.
Item to be disinfected Disinfectant/chemical/procedure
Live birds Euthanasia or vaccination.
Carcasses Bury or burn.
Animal housing/equipment 1, 2a, 2b, 2c, 3a, 3b.
Environment housing/equipment N/A.
Humans 1.
Electrical equipment 5c.
Water tanks Drain to pasture where possible.
Feed Bury or burn.
Effluent, manure Bury or burn, 3a, 3b, 4a, 4b.
Human housing 1, 2a, 2b, 2c.
Machinery 1, 3a, 3b.
Vehicles 1, 3a, 3b.
Clothing 1, 2a, 2b, 2c, 3a, 3b.
Aircraft 1, 2c.

Foot-and-mouth disease (Category B viruses)

Foot-and-mouth disease is caused by a Category B virus (Picornaviridae). The best disinfectants to use are hypochlorites,
alkalis, Virkon, glutaraldehyde, hydrochloric or citric acid.

Table 8: Recommended disinfectants for foot-and-mouth disease.

Item to be disinfected Disinfectant/chemical/procedure
Live animals Euthanasia or vaccination.
Carcasses Bury or burn, 3a, 3b, 4a, 4b.
Animal housing/equipment 2a, 2b, 2c, 3a, 3b.
Environment housing/equipment 3a, 3b.
Humans 1, 4b.
Electrical equipment 5c.
Water tanks 3a, 3b.
Feed Bury or 5b.
Effluent, manure Bury or 4a, 4b.
Human housing 2, 4b.
Machinery 2c, 3a, 3b, 4a, 4b.
Vehicles 2c, 3a, 3b, 4a, 4b.
Clothing 2a, 2b, 2c, 3a, 3b, 4b.
Aircraft 2c.

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Rabies (Category A viruses)

Table 9: Recommended disinfectants for rabies.
Item to be disinfected Disinfectant/chemical/procedure
Live animals Destroy without damaging head; beware of being bitten
Carcasses Submit head to diagnostic laboratory; burn or bury remainder of carcass
Animal housing/equipment 1 (to clean) followed by 2a, 2b
Environment housing/equipment N/A
Humans Bites should be thoroughly washed with 1 then cleaned with a disinfectant suitable for human wounds. Unless
the animal can be shown conclusively to be free from infection, a post-exposure course of human diploid cell
vaccine and human immunoglobulin should be started
Electrical equipment N/A
Water tanks N/A
Feed N/A
Effluent, manure Burn or bury
Human housing N/A
Machinery N/A
Vehicles N/A
Clothing N/A
Aircraft N/A

E.3 Recommended concentrations and contact times

Table 10: Recommended disinfectants and concentrations for inactivation of viruses.
Disinfectant Details Final concentration Contact time
1. Soaps and detergents - - -
2a. Sodium hypochlorite (bleach) 1 part 5.25% sodium hypochlorite to 5 parts water. 3% w/v (30,000 ppm) 10 - 30 min
2b. Calcium hypochlorite 30 g calcium hypochlorite to 1 litre water. 3% w/v -
2c. Virkon 20 g Virkon to 1 litre water. 2% w/v 10 min
3a. Caustic soda 20 g caustic soda to 1 litre water. 2% w/v 10 min
3b. Sodium carbonate anhydrous 40 g sodium carbonate anhydrous to 1 litre water. 4% w/v 10 min
3c. Washing soda 100 g washing soda to 1 litre water. 10% w/v 30 min
4a. Hydrochloric acid 1 part 10 Molar hydrochloric acid to 50 parts water. 2% w/v 10 min
4b. Citric acid 2 g citric acid to 1 litre water. 0.2% w/v 10 min
5a. Glutaraldehyde As appropriate to yield 0.2% w/v. 0.2% w/v 10 - 30 min
5b. Formalin 1 part 408% w/v 10 - 30 min
5c. Formalin gas Only used by experienced personnel. - 15 - 24 hours

Sodium hypochlorite: NaClO

Calcium hypochlorite: Ca(ClO)2
Caustic soda: NaOH
Sodium carbonate anhydrous: Na2CO3
Washing soda: Na2CO3 .10H2O
Hydrochloric acid: HCl

0.2% w/v: 2 grams (weight) per 1,000 mL (volume) water.

One part per million (ppm) is equivalent to one part per 1,000,000 parts. That is, (1 ÷ 1,000,000) × 100 = 0.0001% (or 1% = 10,000 ppm).

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I have a 40% w/v solution of disinfectant concentrate. The final concentration required for disinfection is 8% w/v. How many litres of
concentrate are required to make 50 litres of made-up disinfectant?
A 40% w/v solution is equivalent to 400 g of disinfectant in 1 litre of water. An 8% w/v solution is equivalent to 80 g of disinfectant in 1 litre
of water. How many mL of a 40% w/v solution are required to provide 80 g of disinfectant?
mL of 40% solution required = (80 × 1000) ÷ 400 mL of 40% solution required = 200
So, 200 mL of a 40% w/v solution are required to make 1 litre of an 8% w/v solution. Therefore, 10 litres (50 × 200 mL) of a 40% w/v
solution are required to make up 50 litres of an 8% w/v solution.

E.4 The decontamination and disinfection process

In any large-scale decontamination and disinfection procedure the cost of soaps and/or detergents and disinfectants will be
minor relative to labour and other operational costs. Use disinfectants at their recommended concentrations.

Decontamination
– Transfer animals to another place so you can clean their pens properly.
– Prepare soaps and/or detergents before you start working; wear appropriate work clothes.
– Cover all the electric outlets with plastic and masking tape.
– Remove all dirt and debris sticking to the walls and floors of pens. Remove manure, debris, bedding and other organic
materials.
– Discard items that are no longer used, such as cartons, rotting wood and other materials.
– Make sure there is plenty of opportunity for water to drain away from the area in which you are working.
– Start decontamination from the top (i.e. the ceiling) then work your way downwards (to the floor).

Disinfection
– Make sure that disinfectants are freshly made up at the appropriate concentration (see Table 10 for details).
– Make sure disinfectants make physical contact with the area being disinfected for the appropriate time (again, see Table
10 for details).
– Start disinfecting from the top (i.e. the ceiling) then work your way downwards (to the floor).
– Discard unused disinfectant.

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F. Sample collection and submission

Correct sample collection and submission is important in order to provide samples that generate useful information and
to ensure that they are transported to the laboratory in a safe and secure manner. The following guidelines are taken from
instructions provided by the Regional Reference Laboratory (RRL) for FMD in Pak Chong (Thailand). For individual country
laboratory requirements, the laboratory should be contacted to supply specific instructions for collection and submission of
samples.

F.1 Sample collection

Suitable samples for collection are blood, epithelium or infected tissue and vesicular fluid.
– Always use a fresh needle for every animal. Reusing the same needle can spread disease between animals and can
contaminate the specimen by mixing the blood from two animals.
– Always use a new syringe for every animal. Reusing an old syringe can spread disease and contaminate the sample.
Plastic syringes can be cleaned and sterilised, but they quickly become stiff and difficult to use, so reuse is best avoided.
– Restrain the animal properly before getting blood. If the animal moves, it is much harder to collect blood, and may be
dangerous to the animal or to you.
– Make sure the skin of the animal is clean before taking a sample. If there is dirt or faeces on the skin, it can be scraped
off and then cleaned with some alcohol on cotton wool or a swab. Let the alcohol dry before inserting the needle.
– Blood clots quickly after it has been collected. If the serological test used by the laboratory needs serum then plain blood
collection tubes should be used. If plasma or blood cells are required (e.g. white blood cells for antigen detection tests)
then an anticoagulant should be used to prevent clotting. Check with the laboratory which anticoagulant is preferred.
When using an anticoagulant, the sample should be gently mixed once it is in the tube. Rock the tube from end to end
three or four times to mix. Do not shake the tubes, as this will break the cells and ruin the sample.
– Used needles should be disposed of carefully. Never throw needles on the ground, or leave them lying around. A plastic
bottle with a narrow neck makes a good container for used needles. When full, it should be burnt in a hot fire to destroy
the needles.
– For jugular samples from cattle and buffalo, use a 16 to 18 gauge 1.5 inch needle. When collecting blood from the cranial
vena cava in pigs, use a 20 gauge 2 inch needle (for adults). If collecting from the ear vein, a fine (19 to 23 gauge) needle
should be used. For sheep and goats, collect blood from the jugular vein using a 18 to 20 gauge 1 inch needle.

F.2 Transportation and processing of samples

Blood will be in good condition for testing if three rules are followed: (a) handle blood with care, (b) do not allow blood to
get too hot, and (c) do not allow blood to sit for too long before testing. When blood is collected in the field it should be
placed straight into a cool box or refrigerator. If a cool box is used, sealed ice bricks should be used, otherwise the ice will
melt, the tubes will get wet and the labels will run or fall off. Make sure that the tubes are kept upright at all times.

The samples can be kept in a cool box with sealed ice blocks for a single day. In a car refrigerator, they can be kept for 2 to
3 days at 4 ◦C, but should be processed as soon as possible.

Blood is made up of blood cells and the fluid in which the blood cells are carried, the plasma. The red blood cells contain
haemaglobin, which transports oxygen. If not handled properly after collection, the red blood cells can break, releasing the
haemoglobin into the plasma. The red staining of the plasma makes laboratory analysis impossible. The plasma contains
many different substances, including antibodies and clotting factors. When blood is collected, it can be stored in tubes either
with or without an anticoagulant (such as lithium heparin, or citrate). If no anticoagulant is present the blood will clot. The

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fluid that separates out from the clot is called serum. Serum is plasma without the clotting factors. The best way to make
sure that blood is suitable for testing is to remove the red blood cells as soon as possible after collection. Once this is done,
the serum or plasma can be frozen and stored for a very long time. Use a centrifuge to separate the cells from the serum or
plasma. Place the blood tubes evenly in the centrifuge, so it is balanced, and spin them for 10 minutes at about 2000 rpm (or
slightly longer for specimens with anticoagulant). When the centrifuge is finished, all the blood cells should be at the bottom
of the tube, and the clear serum or plasma at the top. Use a pipette to transfer the serum or plasma from the blood tube to a
serum tube. Label the serum tube, and freeze it at -20 ◦C or colder ready for analysis.

Protocol for sample submission to the OIE RRL, Pak Chong, Thailand
It is recommended that you send samples by air freight to Suvarnabhumi International Airport, Bangkok. The Department
of Livestock Development (DLD) officers will arrange the customs clearance of the samples and these will be collected by
staff from the RRL. Contact staff at Pak Chong before sending samples. Packaging and dispatch of samples and biological
materials should adhere to the following procedures:
1. Collection of samples.
– Epithelium and infected tissue: Vesicular fluid or epithelial tissue from vesicular lesions should be collected for
laboratory diagnosis and type identification using antigen capture sandwich ELISA and virus isolation. A piece of
epithelial tissue no smaller than 2 cm × 2 cm should be collected. The tissue should then be placed in a strong
container, or a bottle with a screw cap, suspended in a mixture of 50% glycerin with 0.04 phosphate buffer pH 7.2 –
7.6 and added antibiotics. There will be considerable loss of infectivity if samples are sent in a buffer outside of this
pH range.
– Vesicular Fluid: At least 1 mL of vesicular fluid must be collected and packed, as it is, in a tightly closed, screw-cap
vial. The vial must be kept at freezing temperature if immediate transport to the FMD laboratory is not possible.
– Blood: Blood samples should be collected under sterile conditions. The serum should be separated by centrifugation
soon after collection and kept in screw-cap vials with O-rings. Serum samples should be kept at -20 ◦C before
dispatch.

2. Packaging
Samples must be packed in primary and secondary IATA-approved watertight containers so that the samples arrive in
good condition and do not present any hazard to persons or animals during shipment. It is essential that the contents
of containers which break or leak during transit do not contaminate the outside layer of the package. The recommended
procedure for packing samples is as follows:
– Samples must be put in a primary container (glass or plastic tubes or bottles) with screw caps and wrapped with paraffin
film or adhesive tape individually in order to prevent leakage of fluid. The wrapping of bottles or primary containers
should be carried out in clean surroundings.
– The primary container must be packed in watertight secondary packaging, which should be a strong, crushproof and
leakproof metal container. The container should contain absorbent cotton wool sufficient to absorb the entire contents of
the primary container.
– The secondary packaging must be placed in an outer container. This should be a polystyrene foam box covered with a
hard box or IATA-approved container.
– Sufficient information and a list of samples or materials should be enclosed in an envelope, enclosed in a plastic bag and
placed between the secondary packaging and outer box.
– It is recommended that the secondary packaging is placed in a freezer box to ensure that all materials are kept cool during
shipment. These packs should be pre-frozen at -20 C before packaging.
– If dry ice is used for packaging, it must be placed around the outside the secondary packaging. Dry ice must not be placed
within the primary packaging as it may cause breakage of the sample tubes.

3. Labelling. The outer surface of the package must be clearly labelled with the following details:

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– The name and address of the institute submitting the samples.

– Contact telephone numbers.
– Infectious substance hazard label.
– light number and estimated arrival time.
– Air waybill number.
– Dry ice label (if necessary).
– The package should be addressed as follows:
PATHOLOGICAL MATERIAL OF NO COMMERCIAL VALUE
Department of Livestock Development
Regional Reference Laboratory for FMD in South-East Asia
Pak Chong, Nakhonratchasima, 30130
THAILAND
Tel: +66 44 279112
Fax:+66 44 314889
PERISHABLE FRAGILE KEEP AT 4 °C

4. Dispatch
All biological materials must be sent by airfreight direct to Suvarnabhumi International Airport. Before dispatching samples,
the sender must notify the Regional Reference Laboratory at Pak Chong by facsimile (+66 44 314889). The institution
submitting the samples should provide details of the air waybill number, flight number and time and date of arrival of the
package in Bangkok. Staff of the Department of Livestock Development (DLD) and Regional Reference Laboratory will
clear the parcel through customs at the airport. The parcel will be collected and taken to Pak Chong by staff of the Regional
Reference Laboratory.

F.3 Samples for classical swine fever

The principles outlined above for FMD sample collection can be applied to other diseases, such as CSF. Specific details for
CSF are as follows:
– For virus identification, the following samples should be collected during post-mortem examination: tonsil, lymph nodes
(mesenteric and pharyngeal), kidney, and distal ileum.
– From live animals, blood should be collected into EDTA.
– For serological testing, serum samples should be taken from recovered animals, from sows with congenitally affected
litters, and from pigs under surveillance.
– All samples should be refrigerated and shipped to the laboratory as soon as possible.

Note: Detailed information on sample collection and submission can be found in:
OIE (2017). Terrestrial Animal Health Code. World Organisation for Animal Health. Available at: http://www.oie.int/en/
international-standard-setting/terrestrial-code/access-online/
OIE (2017). Manual of Diagnostic Tests and Vaccines for Terrestrial Animals. Available at: http://www.oie.int/en/international-
standard-setting/terrestrial-manual/access-online/
OIE Technical disease cards: http://www.oie.int/animal-health-in-the-world/technical-disease-cards/

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G. Participatory epidemiology

G.1 Key principles of participatory appraisal

– Behaviour and attitude
- Listen, learn and respect
- Be prepared to unlearn negative attitudes and stereotypes
- Act as a facilitator, not an expert
– People are knowledgeable
- On subjects important to their livelihoods
- Certain individuals have unique and valuable perspectives
– Co-learning
- Share knowledge, experience and analysis
- Combine local and professional knowledge for effective acceptable action
– People are rational
- There is an insider’s and an outsider’s perception of behaviour
- Based on the information available, most people make rational decisions
- The appearance of irrational behaviour means that a misunderstanding may have occurred

– Optimal knowledge/optimal ignorance
- There is a balance between the need for information and the need for timely decision-making
– Action-orientated

- Be prepared to take action rather than just collect data

G.2 Summary guidelines for semi-structured interviews

1. Prepare yourself: this is possibly the most important stage! Define the topic you want to investigate, work out the key 4
or 5 questions you want to ask and who it is you want to interview. If possible, bring an assistant along as a note-taker.
2. Introduce yourself and the purpose of the meeting: Your informants will want to know why you have come and why
you have an interest in the selected topic.
3. Watch your body language throughout: Be friendly, informal and respectful, and try to sit on the ground! Stay calm:
there is never any need to become emotional!
4. Start with general questions/comments: This will put people at ease. The easiest way to begin is to start with something
visible that everybody can agree with. Use simple language. Ask only one question at a time.
5. Mix questions with general discussion: By introducing variety, you will keep up the interest of your informants. Casual
dialogue will ensure good communication.
6. Use diagrams, symbols, and other drawings: These will help in keeping people interested and ensuring everybody
participates and understands.
7. Use simple language: Avoid ‘scientific’ words. Ask only one question at a time, avoid leading questions, long or
complicated questions, or questions that can be answered with a simple ‘yes’ or ‘no’.

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8. Probe: This is the most difficult stage. If an interesting point comes up, try to discover more. Six small words (why, how,
who, what, when, where?) will help you to probe: keep them in mind throughout!
9. Observe: Watch closely to make sure that everybody participates (especially women) and the conversation is not
dominated by a few individuals. Also make sure that people are not getting restless (a sign that they are getting tired):
normally, 90 minutes is the maximum for group interviews.
10. Thank the participants: When the interview is over, thank your informants and give them an opportunity to ask their
own questions: this is polite and will give you valuable clues!
11. Make full notes after the interview (unless you have a note taker): Wait until the interview is over before you write
full notes. During the interview itself, only write down the main points so that you do not slow down or interrupt the
conversation.

G.3 Summary guidelines for focus group discussions (FGD)

1. Determine the purpose: have clear objectives
2. Analyse the situation: build good knowledge of local conditions or start with interviews with key informants
3. Prepare a discussion guide: it has to be a written guide with open-ended questions. Avoid ‘why’ questions and those
that require only a yes/no answer. List questions in logical order, from general to more specific, from factual to more
sensitive.
4. Choose the right group: you can choose heterogeneous or homogenous groups. Homogenous groups (similar age, sex,
socio-economic background) are often preferred, because it often facilitates free discussions; however, to obtain a wide
range of views quickly, you will often need to interview a heterogenous group with a mix of participants (old/young,
urban/rural, poor/not poor, etc.).
5. Select the right participants: pick participants that are likely to express a range of views. To get the right variety of
participants, the choice should be random from a group. If there is no good way of finding out suitable persons try
avoiding convenience sample (e.g. people easily accessible).
6. Arrange the physical environment: choose a ‘neutral’, easily accessible place and seat everyone in a circle. Avoid
disturbances from other people, have adequate light and sufficient silence, and provide drinks and/or snacks (not noisy).
7. Conduct the session appropriately: one moderator will conduct the session. He/she should not act as an expert, but
stimulate and support discussions. If the moderator is an ‘expert’, questions may be answered after the session. One
note-taker/recorder will record what is happening in the group, e.g. reactions, feelings and comments from participants.
A tape-recorder is generally used.
8. Obtain consent from participants: the moderator and note-taker/recorder should introduce themselves, give the
participants information about the topic of discussion and explain how the session will proceed. They must then obtain
consent from participants before the session begins and ask for permission to use a tape-recorder.
9. Encourage discussion: create an unthreatening environment. Moderate, listen, observe, and analyse. Show interest and
be careful not to make judgements, there are no right or wrong answers. Encourage involvement of the participants.
Use, “Can you tell me more about…”, “What about you?”, “What is your view…? Try to deal with ‘Dominating’ and
‘Reluctant’ persons.
10. Build rapport and empathise: observe non-verbal communication and handle sensitive issues (write down the
participants’ comments anonymously). Control the timing, but in a subtle way (allocated time to various topics), to
maintain interest. At the end, summarise, check for agreement and ask for additional comments.

Considerations to make before running FGD and when analysing responses:

1. People often do not understand why they are doing the things they are doing, and therefore cannot tell you.
2. Sometimes people are in touch with their reasons and their feelings, but they cannot express them.

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G. Participatory epidemiology A-74

3. Even when they do understand why they are doing things, they often do not want to tell you.
4. When they do tell you, they often do not tell you the truth, or the whole truth.
5. Often people are not interested in examining their motivations.
There is rarely a single reason why a given person does something.

G.4 Method for drawing an outbreak risk map

Imagine, for example, you are conducting a study on CSF in pigs, and you are interested in identifying risk factors for the
introduction of CSF to village pig populations and risk factors for CSF spread between different pig populations. You have
travelled to a village that recently experienced an outbreak of CSF in its pigs to study the outbreak and identify these risk
factors.
1. Begin by creating a participatory map with the villagers, making sure that all the geographic and physical features are
included.
2. Discuss with the villagers what animal diseases are important to them. Since they recently had an outbreak of CSF in
their pigs they will likely mention CSF, and then you can focus on your disease of interest from that point forward.
3. Work through the various disease determinants that you are familiar with. You might have them listed, or you might use
a mental checklist. To name a few: first household affected, second household affected, spread of the disease through the
village, types of pigs affected, nearest pig market, homes of pig traders, movement patterns of pig traders on bicycles or
motorcycles, location of commercial pig farmers, movement patterns of suppliers (feed, litter, piglets, etc.) and buyers
(piglets, weaners, finishers, meat, etc.) for commercial operations, location of butchers, location of rivers and gardens,
houses that have pig houses, places where free-range pigs like to gather, etc.
4. Ask probing questions as details develop on the map. For example, once the pig market and the first affected house are
mapped, you can ask: When was the last time people in this house visited the pig market? Did they bring back any new
pigs and put them their pen?
5. Be sure to observe closely. When the path of the pig trader and the path of the outbreak spread are drawn, look to see
if they are similar. If they are, ask questions to probe deeper. For example: When did the outbreak start? When did the
pig trader last pass through the village?
6. Keep your mind open to discovering new risk factors as the map and the discussion develops. Do not simply run
through the risk factors that you are already familiar with.
7. Remember that there may be sensitivities about an outbreak. Be careful not to create an atmosphere of recrimination,
where some people begin blaming others for their disease problems. For example, the informants may want to hold the
person in the first affected household responsible if they begin to feel that the outbreak was their fault. Make sure the
atmosphere of the interview is one of open discovery, so that what is learned can be used by both you and the members
of the villagers to prevent outbreaks in the future, not to exact retribution for outbreaks in the past.
8. When the exercise is complete, discuss with the villagers what they have learned, and how this may help them prevent
outbreaks in the future.

G.5 Proportional piling method

1. Have your ranking criteria clear in your own mind.
2. Use open-ended questions to develop the list of items or categories for scoring. 
For example, ‘what are the health
problems that affected cattle and buffalo in the community in the last year?’
3. Probe the responses. Ask for descriptions and clarifications.
4. Explain that you want to carry out an exercise to better understand what you are learning
about their health problems.

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Draw circles on the ground, one circle for each disease mentioned, and place a drawing or card next to each circle that
illustrates the disease. Circles can also be made from construction paper or drawn on flipchart paper.
5. Make sure that everyone recognises each category by its drawing or card.
6. Place 100 counters in a pile, and ask the respondents to divide them according to a particular characteristic or parameter.
Respondents should not count the counters, but divide them visually. Record the question now if you have not already.
For example, ‘Please divide these beans to represent the impact each disease had on your livelihood in the past year’.
7. Allow time for discussion to enable respondents to reach a consensus about how to divide the piles. When the
group appears to be finished, summarise and crosscheck the result. “Does everyone agree? Does anyone disagree that
tuberculosis has such a big impact?”
8. Count the counters, but leave them in place so that the result can be discussed.
9. Probe the results. Why did they make these choices?

100 stones
representing
a specific herd
age group

Healthy
during the
last year

Sick during
the last year

Herd incidence

FMD Blackleg CBPP ECF Trypanosomiasis Other diseases

Example of proportional piling method to estimate disease incidence. Using a pile of 100 stones, the informant was asked to
divide the stones to show the pattern of ‘sick cattle during the last year’ and ‘healthy cattle during the last year’. The pile of
stones representing sick cattle was then sub-divided by the informant to show the pattern of cattle having each of the main
five diseases previously identified by the informant through semi-structure interviews, plus a category called ‘other diseases’
(a total of six disease categories). Each pile of stones was then further sub-divided to show the pattern of cattle dying and
surviving for each disease category. This resulted in two piles of stones for each of the five diseases and the ‘other diseases’
category (Catley et al., 2004).

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G.6 Matrix scoring disease definition method

Imagine that you would like to conduct a matrix scoring exercise to understand the clinical signs a community associates
with different diseases.
1. Use the diseases mentioned by your respondents. When your respondents tell you the name of a disease in their language,
use that name during the interview rather than an English or scientific name. That way, everybody, respondents and
research team alike, is on the same page.
2. Obtain a list of clinical signs and epidemiological features for each disease.
3. Draw a matrix on the ground or on flipchart paper. Make sure it is big enough for everyone to see it. Include a column
for each of the diseases. Use pictures, objects, or cards to represent the diseases and place these across the top of the
matrix. Be sure to mention which disease each card represents, using the local language name, as you place it on the
ground. This way, those that cannot read or understand the picture can memorise the cards as they appear.
4. Use all the indicators (clinical signs) mentioned by the respondents for the various diseases. Write the first indicator on
a card, or use a picture or object to represent it. Place this to one side of the first row of the matrix. Be sure to repeat it
aloud so that all the participants know what it is.
5. Place a pile of 30 counters next to the indicator and ask the participants to use them to show how strongly the indicator
correlates with each disease. Summarise and crosscheck for agreement between the respondents. Leave the counters
where they are.
6. Repeat the exercise for each indicator one by one, gradually building up the matrix. Leave the matrix in place so that
everyone can view the results and discuss as a group.
7. Carefully probe the informants as to why they are scoring the way they are, both during the exercise and after the matrix
is complete. Finally, summarise the results and give the informants the opportunity to make changes if they wish. Ask
your respondents what new learning or insights they have gained from the exercise.
8. Record the results in a matrix in your notebook.

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Animal Disease Outbreak Investigation
and Management